Testing Hurdles

Lack of Availability of COVID Testing Remains a Challenge

Many, perhaps most, hospitals in the US continue to face problems with not having enough supplies to fully respond to the COVID crisis.  The lack of readily available COVID testing remains a big part of that challenge.  Supply chains for medical supplies, including personal protective equipment, have been disrupted.  These supply chain disruptions are effecting more than just COVID related items, but also medications and equipment that have nothing directly to do with the pandemic.  Our hospital is certainly effected by this and in speaking with some of my colleagues who are working at other rural hospitals it is much the same story elsewhere.  There also seems to be a significant problem in coordination of efforts at state and federal levels that then trickle down to impact us locally.  

To keep things in perspective, there is a bright side. As a society, we are making amazing strides in developing testing given how long it took to develop a test for HIV/AIDS for example, which was about 4 years.  We are into this COVID pandemic by only a few months.  And, of course, it is reasonable that resources be diverted to COVID “hot spots”.  Yet, one cannot help but feel frustrated.

Soon we will begin to start relaxing at least some of the shelter-in-place restrictions following the plan developed by our State leaders.  However, much of that plan calls for testing using either PCR or antibody, to accurately determine the true prevalence of the disease.  This type of testing is simply not readily available.

Last week, MCDH was poised to participate in a wide spread testing program through the Sonoma County Health Department that would have given us access to about 1,200 tests which would have been performed by the newly opened Chan-Zuckerberg Biohub Lab at UCSF.  We excitedly starting making plans to open free, drive through testing.  However, no sooner did the UCSF lab get up and running then it quickly became overwhelmed and we are now told not to expect any tests in the “foreseeable future”.

False starts, conflicting information and guidelines that change on a frequent basis seem to be the hallmark of our response to this health crisis.  Having said that, I remain cautiously optimistic.  We are slowly moving forward in our testing capability here.  

One reason for optimism is that Adventist Health (AH) started managing our hospital this week.  We expect that this will increase testing capability and indeed, they were helping us out even before this recent step.  Due to their sharing of their limited testing capability, we have the ability to do the Abbott test, with its one hour turn around, but we only have enough tests to use them on patients admitted to the hospital.  We do have the ability to send out the test now to our sister hospital in Ukiah which has a larger analyzer.  Also, we still have the ability to send to Quest.  Turnaround times on the Quest test have improved and we have enough test swabs to move forward more aggressively in testing some of our population.

With a relaxation at some larger hospitals on the restrictions to do elective surgery, we are starting to get inquiries about the feasibility of doing pre-op COVID testing.  That is a service that we want to provide and are working to set up.

In the meantime, we remain fortunate in that the prevalence of COVID out here on the Coast is extremely low as judged by the fact that we have no patients getting admitted who are sick with the disease.  It remains our strong desire to be able to open up testing to the general community.  Our lab and xray departments are open for business.

— William Miller, MD, FACP, Chief of Staff, MCDH