The Long Sunsetting of COVID Testing

As is usually the case in the American healthcare system, there are some groups of people in Massachusetts who have had cheap and free on demand PCR testing nearly the entire pandemic, with turnaround times well under 24 hours. How was this possible? 

aerial photography of water beside forest during golden hour

Subsidized and free COVID-19 testing, vaccines, and treatment will soon be gone. Frequently reported is the fact that a PCR test, previously free, but often not easy to get, will cost roughly $120. At this price, the number of people able to access reliable testing will drop significantly. 

And it’s not like that $120 is getting you a better or faster test than you got before. In January of 2022, Quest was reporting 2-3 day turnaround times, and LabCorp 1-2 days. These times do not include the time to get an appointment or the time it takes to ship the sample to the testing facility, resulting in real turnaround times that are highly variable across the country. In rural areas, people typically wait 5-7 days to get results. Getting COVID test results back more than 24-48 hours after giving your sample makes this expensive test useless for both individual and public health objectives.

As is usually the case in the American healthcare system, there are some groups of people in Massachusetts who have had cheap and free on demand PCR testing nearly the entire pandemic, with turnaround times well under 24 hours. How was this possible? 

Several local universities set up some version of surveillance testing either independently or with the help of the Broad Institute. Because these community testing sites were local, high throughput, and paper free, they consistently achieved turnaround times significantly less than 24 hours from sample collection. As a result, we have been able to blunt the impact of virus spread on our campuses and maintain in person teaching for much of the past two years – and we didn’t spend $120 per test. 

In the lab that I helped build, we process 5-8,000 PCR tests a day at peak capacity with an average turnaround time of 14 hours. At 18 months of operation, our cost all in with overhead, is about $5 per test. This is much lower than the even the price of less sensitive over-the-counter rapid diagnostic tests, which retail between $12-$15 each. A better test at a cheaper price.

PCR testing is old technology. It’s such an integral part of scientific research that it was optimized, automated, and commoditized years ago. With technologies like PCR, there are economies of scale. COVID-19 testing is just one small application of this powerful technology. It is underutilized in the context of other infectious disease challenges, most notable for the detection of antibiotic resistance and to augment good antibiotic stewardship. That we are not using this technology at scale to improve diagnostics and healthcare outcomes is inexcusable. 

But ultra-modern testing facilities like the one we built still operate within a fragmented healthcare system where different payers are not connected electronically, and we were unable to easily offer our services outside of our university setting. We were hamstrung by outdated and incompatible software at other institutions, regulations on sharing healthcare data, and a longstanding national neglect of the public health infrastructure.

Beyond renewing the funding for subsidized testing now expiring, we have a real opportunity now to make inexpensive PCR testing available to everyone. The PREVENT Pandemics Act, introduced in January by Senators Patty Murray (D-WA) and Richard Burr (R-NC) of the Senate Health, Education, Labor, and Pensions (HELP) Committee seeks to “tak[e] common sense steps to act on lessons learned from the pandemic response and improve the nation’s preparedness for future public health emergencies.”

At this point, the bill contains no language to incentivize entrepreneurs, academic institutions, and other entities to build modern molecular testing facilities at the state and local levels. Sites like these could protect students in K-12 public schools, police, firefighters, teachers, healthcare workers, and essential workers. We would be able to protect everyone, not just the fortunate few.

Author: Catherine Klapperich

Find me on Twitter @DrKlapperich

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