JUNE 25, 2020 — These blogs usually start with someone’s story. For many years, my job has been listening to Alaskans and then sharing their experiences, most recently through these blogs.
Today is different because it’s my story.
My name is Ann Potempa, and I’ve run the Play Every Day campaign since it launched in 2012. My oldest son and I got tested for COVID-19 this month and waited a longer-than-expected amount of time for our test results — almost a full week. Dr. Anne Zink, Alaska’s Chief Medical Officer, asked me to write about our experience.
“There is a lot of variability in the wait time,” Zink said. “I think the variability in it can be very challenging.”
The challenge comes in having to limit your family’s or household’s activities until your results come back. We received a piece of paper with this guidance after leaving the testing location: “You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis.” Staying away from others while you wait for results prevents the spread of possible infection.
The state’s health department and laboratories are improving how they work together to complete COVID-19 tests, hiring staff and quickening the sharing of results from lab to provider to patient to minimize the wait when possible — ideally closer to three days from test to result. Zink said they’re trying many strategies to make it easier to get tested and to get results quicker. She also said Alaskans can call providers and urgent care centers in some communities to find rapid tests that can turn around results in less than an hour.
For many people like me who got non-rapid tests, however, the results take more time to process and return. I’m sharing our testing experience to show how, and why.
Testing and staying away from others while waiting for results
Typically, Play Every Day is focused on promoting daily activity and healthy drinks for Alaska children. We believe it’s important to pivot right now and talk with families about COVID-19 and other broader issues that affect children’s health: How can they keep active while preventing the spread of illness? If they develop symptoms, should they test, and what can they expect in terms of receiving those results?
This month, my 14-year-old son and I had minor symptoms that in other years would have seemed like nothing special: chills, body aches, slightly higher-than-normal temperatures. At this time in Alaska, the recommendation is to test even minor symptoms. So we did that Tuesday, June 9. Then we waited.
As the days passed without results, I began to wonder why. This led me to work with Alaska’s health leaders to make sure Alaskans were given realistic turnaround times for COVID-19 tests. I find it’s easier to muster the patience to wait if I know how long it could take, and if I know why I am waiting.
Waiting is frustrating, even for people like me who work in public health and focus on this pandemic every day. It’s surprising how much we needed to cancel while we stayed away from others and waited for results. Our family canceled activities for everyone, unsure if the others who weren’t tested could be sick and just not symptomatic. We rescheduled three haircuts, which meant the stylist lost business that week. Our home improvement contractors lost work because we didn’t want to put them at risk of infection by being in our house. My son gave up his appointment to test for a driver’s permit, which felt like a big deal for a teenager. Both my sons lost a week at an outside summer camp that had made significant changes to prevent spreading COVID-19. My youngest son was crushed, because he lost out the most — given he wasn’t even the one who had symptoms.
A week earlier, Pegge Erkeneff of Kasilof had a similar experience. After having mild symptoms, she visited the Kenai Public Health Center on Wednesday, June 3, to get tested.
“You now need to consider yourself positive until you hear from us,” the nurse told her. That meant staying away from other people until she got her result.
On the drive home, she realized what she had to cancel: a Thursday appointment with the dog groomer and a Friday haircut for herself that she’d put off since February due to the pandemic. She even canceled using a pick-up service at the grocery store in the unlikely case that she’d get into an accident while driving to the store and unintentionally expose an emergency responder.
Waiting for results got harder as the days added up, she said. She didn’t get her negative result until five days after she got tested.
“There is the real frustration of waiting and patience, and then just letting go,” Erkeneff said. “This is just what life is like now. And I’m making a choice (to get tested) — for my own peace of mind and for others.”
It’s very important to stay away from others after testing to protect them in case you are infected, said Coleman Cutchins, Alaska’s lead clinical pharmacist who is overseeing the COVID-19 laboratory testing. Cutchins explained the testing process in Alaska, why there’s variability in turning around results, and what the state’s laboratories are doing to quicken that process when possible.
Understanding why turnaround times can vary for results
The time it takes to turn around a COVID-19 test result depends on a number of factors: what kind of test was run, where the laboratory is located, the number of samples that came through that day or week to be processed, even whether or not the test is for someone who really needs to know quickly if they’re sick — such as someone in a nursing home who could face higher chances for serious illness.
Many people getting COVID-19 tests in Alaska are getting what’s called a high extraction PCR test, Cutchins said. Never mind the complicated name. What it means is these tests require a multi-step chemical analysis in a laboratory to determine a positive or negative result. These are the standard tests used to detect viruses like COVID-19.
If you get a COVID-19 PCR test done in Alaska, it could be run in labs inside the state or outside. As of mid June, there were three main laboratories in the state running tests: the two state public health labs in Anchorage and Fairbanks, and the Alaska Native Medical Center lab, Cutchins said. Some people’s samples — like my family’s — are shipped out of state to commercial labs to run. Our samples went to a lab in California. A number of factors, including health insurance, can affect where a sample is taken to analyze and return a result, Cutchins said. Shipping some samples gives the state more options in terms of running tests, but it can add to the turnaround time of getting results if you add the time to fly the sample out of state. That’s not always the case, though. Cutchins said some samples shipped out of state returned results in about two days.
The number of tests done daily in Alaska is a very fluid number, Cutchins said, and can triple from one day to the next. Recently, the number of tests significantly increased as health and travel mandates required them for certain medical procedures and made them available to people arriving into airports. As of this week, almost 100,000 tests have been run for those in Alaska.
Comparing and contrasting rapid and non-rapid tests
A rapid test may be the right choice for an individual, but the wrong choice for other situations, such as a planeload of people. Cutchins uses a simple cup of coffee to explain the difference between running a PCR COVID-19 test at a lab and running a rapid test using a machine. If you only want one cup of coffee, you would use a machine that inserts one pod of grounds and returns a full cup of coffee. That’s like this rapid testing machine. It processes only one test at a time, but can turn around a result in 15 minutes to about an hour.
If you have a large group of people needing coffee all at once, you wouldn’t buy 100 one-cup coffee machines. You’d call your local shop to brew a lot of coffee to serve everyone more quickly than a one-cup machine could do. That’s like the COVID-19 test run at a laboratory. A laboratory can run a large number of tests in a day, which means a longer turnaround time for the whole batch but a quicker turnaround time than you’d see if you ran each sample one at a time through machines. On a given day, that could mean running up to 3,000 tests through Alaska’s public health laboratories, Cutchins said.
A COVID-19 test starts with a health care provider inserting a swab into an individual’s nostril and collecting a sample of respiratory secretions, or instructing the individual to do the swabbing. For a sample that will be processed in a laboratory, the time between when the sample is taken and when it reaches a local lab could be hours. If it’s shipped outside Alaska, that lag could get longer by a day or so. Once at the lab, it can take about 12 hours to unpack the sample, prepare it in a sterile environment that doesn’t infect the laboratory workers, and run the test. At the end, a clinical biologist needs to interpret each result, one by one.
“It’s not like a pregnancy test,” Cutchins said. “It doesn’t give you a plus or a minus.”
He said it’s a lengthy process that you can’t make much faster given the current technology at labs. Other steps can add to that time, though, including entering results and transferring them back to the providers who ordered them, and ultimately to the person who got tested.
Rapid testing machines are available around the state, Cutchins said. For some of these machines, technicians insert the sample into the machine on site that can turn around a result in 15 minutes to an hour or so. These machines are particularly useful when there are small numbers of people who need testing and quick results are needed by health care providers, Cutchins said. Rapid tests do require more virus to be detected in the sample to return a positive result, he said.
A rapid test may be a good option for running a small number of tests, but it’s not the right tool for large flights, Cutchins said. An airplane full of people would quickly overwhelm a rapid testing system. Samples collected following the arrival of larger flights aren’t typically run in rapid machines. Instead, they’re sent in batches to larger laboratories to run using the longer process explained earlier, Cutchins said.
Improving Alaska’s lab capacity to turn around consistently quicker results
Cutchins said our family’s almost one-week turnaround time was longer than many experience. In the past week, though, he’s see turnaround times fluctuate overall — getting longer, shorter and then longer again. Many Alaskans, he said, can expect results in three to five days. His goal is to get most tests returned closer to three days for people in larger locations like Anchorage, the Mat-Su Borough and Fairbanks, and four to five days for samples that are shipped to a lab in another community to complete testing. Quicker turnarounds for results are important to reduce waiting time, to improve the chances that people stay away from others while waiting for results, and to quicken public health nurses’ ability to reach out to people who’ve been exposed to someone who tests positive.
Cutchins said the health department is using several strategies to reduce turnaround times. He’s updating a plan that doesn’t rely too heavily on one laboratory. If one lab faces higher demands, another can step in. If shipping out of state becomes problematic, more testing can shift back to the state public health laboratories.
His plan prioritizes shorter turnaround times for those most in need. State health officials will make the fastest testing strategies available for people who need results as quickly as possible, such as someone facing higher chances of serious illness or living in a higher-risk setting like a nursing home. Other hospitals in Alaska are also working to purchase more laboratory equipment to run tests locally, he said.
Cutchins shared other good news, including new technology recently approved by the U.S. Food and Drug Administration that could triple testing capacity. He said this could be available in Alaska within the coming months. Alaska’s public health labs are also hiring more staff to process and run tests. They just got new software that makes it easier to enter a test result, share it with providers and ultimately the patient. All of these can help return a faster result, Cutchins said.
Making things better while you wait
Our family has stayed with the same pediatric clinic in Anchorage since both of our sons were born. One of the first people to meet my oldest son within hours of his birth was his pediatrician.
She had been closely watching for our lab results day after day. The clinic’s nurses regularly checked in with the lab. They would talk to me multiple times daily to give updates, even when there was none. On Sunday morning, five days after my nasal swab, I learned my results were negative. My son’s results, however, weren’t back yet. On the sixth day following our tests, our pediatrician called me to talk through the waiting period, saying she would continually check until she got an answer for my son.
And she did.
At 10:51 p.m. that night, she texted his results:
Our pediatrician’s kindness during off hours was my reminder of how much people care for each other right now. It’s a reminder that while you worry and wait and focus on your frustrations, there are people trying to make things better. That is the case here. Rapid tests are available in some communities so Alaskans can get same-day results. Multiple laboratories are increasing staff, making it easier to enter and share test results, and working together to run more tests as quickly as possible and return those results to the health care providers who ordered them.
Then, your doctor can give you the answer you’ve been waiting for, even when it’s in the middle of the night.