COVID-19 testing capacity can't keep up with demand in Larimer County

High community demand for COVID-19 testing is lengthening wait times for test results and taking a toll on Larimer County’s ability to trace and isolate the contacts of people who test positive.

Larimer County officials are encouraging residents to seek a test only if they have COVID-19 symptoms or contact tracers have identified them as a close contact of a person with COVID-19.

The strain on community testing capacity was especially noticeable the week of Thanksgiving, when the county’s free testing appointments were fully booked a week out. County health director Tom Gonzales attributed the spike in demand in part to a rush of people trying to use COVID-19 testing to clear themselves for Thanksgiving travel or get-togethers.

“That's really what hit us before Thanksgiving,” Gonzales said. “Everybody wanted to go get tested before they went traveling to see family and friends. … We were struggling to actually test people that had symptoms or were close contacts of (confirmed cases) because of the demand on testing.”

Testing capacity has come a long way in Larimer County, from about 30 tests a day in March to well over 3,000 a day now. The county has worked with a private lab in Boulder and Colorado State University’s veterinary diagnostics lab to increase capacity. Providers like UCHealth and Banner Health have also substantially increased their testing capacity, and representatives told the Coloradoan they're not currently facing testing capacity issues.

Larimer County has also increased its health department staffing by 50% to cover increased need for contact tracing and other pandemic-related work.

But demand for Larimer County's free COVID-19 testing continues to outpace supply as community transmission rises and the chance of encountering someone with COVID-19 remains almost as high as ever before. The county’s 14-day average case rate is 772 in 100,000, up from about 300 in early November. It neared 1,000 per 100,000 people during the last week of November.

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The county’s climbing case rate has leveled off somewhat over the last week, which has Gonzales feeling relieved, but it’s too soon to tell if we’re on our way to flattening the curve. If Thanksgiving gatherings triggered a wave of COVID-19 cases similar to what we saw after Memorial Day and Halloween, we should see that effect in case numbers this week, Gonzales said.

The testing capacity issue has less to do with a shortage of tests and is more related to equipment and staffing limitations, Gonzales said. Machines and staff can only process so many samples during a given period. Labs could also face shortages of basic supplies like gloves and beakers if the community sees another period of testing demand similar to the week of Thanksgiving.

The county is working with the state to introduce a new rapid response test for select groups, including people in congregate living situations and possibly schools. Rapid response tests can yield results in as little as 15 minutes. The tests would be reserved for people with COVID-19 symptoms, and they have an “imperfect” rate of false negatives, county health department spokesperson Katie O’Donnell said.

Still, “rapid response is great, because you can find out you're positive, get an isolation order and know exactly what you need to do all in one fell swoop,” she said. “That's what we'd like to be able to do. There's just some logistics and background we need to verify before we can get there.”

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Continued heavy demand for testing means it's taking longer for people to get test results back. As of Thanksgiving, over 60% of test results had a turnaround time of four days or more. That metric has improved since then, dropping to about 24% as of Dec. 1 (the most recent date available from county data). The county’s goal is to get test results back in two days or less, a benchmark it was hitting in August and September.

“If we get results back in two days, we can immediately get with the person that's positive, isolate them and find their close contacts,” Gonzales said. "But if you get the test result seven or eight days later, it goes from maybe four or five close contacts to 20 or 25. All of that increases testing demand and decreases our ability to isolate and quarantine.”

Getting a COVID-19 test before traveling or seeing people outside your household uses up limited testing capacity, and it’s actually not an effective strategy for preventing transmission, Gonzales said. The coronavirus has an incubation period of two to 14 days after infection. During that incubation period, the virus is rapidly replicating inside your body, and you are likely to become contagious — but you could still test negative, because your viral load hasn’t hit the trigger point for a positive test result. In the days that follow, you could still spread COVID-19 to your friends and family even though you got a negative test result before traveling.

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If you contract COVID-19 while you’re traveling and take a PCR test when you reach your destination, there's a good chance it will come back negative because of the virus’ long incubation period.

In other words, getting tested before or after holiday travel can give people a false sense of security with the added consequence of tying up testing capacity. The county is discouraging people from using that approach for Christmas and advising people to stay home this year.

“We can't mix different households — and I know, that is so hard,” Gonzales said, adding that he and his wife and two kids are celebrating the holidays with just their household this year. They recently learned that one person they normally would’ve celebrated Thanksgiving with tested positive for COVID-19, “so if we hadn’t stopped mixing, we might now have the virus, or we would be in quarantine. I think it's important for individuals to know that we need to keep it to ourselves for now so that later we can all get together again.”

Gonzales and O'Donnell asked community members to keep the continued sacrifices of health care workers in mind and strive for patience as Larimer County gets closer to widespread availability of a COVID-19 vaccine.

"Everybody's tired; everybody's waiting for this vaccine to come," O'Donnell said. "But we just need to hold out a little bit longer. I think we're starting to see some of that COVID-19 fatigue feeding into our community."

UCHealth, Banner say they're meeting testing demand

UCHealth, which is operating a drive-through COVID-19 sample collection center at The Ranch in Loveland, isn't currently experiencing any major capacity challenges, UCHealth spokesperson Kelly Tracer said. The site offers testing six days with a week for people with a provider's order or COVID-19-like symptoms. UCHealth is testing an average of 475 people at the drive-through center each day it's open. 

UCHealth is typically able to process tests within 1-3 days, down from an average of 3-4 days in October, Tracer said. The hospital system saw a "dramatic increase in demand" for testing at Northern Colorado drive-through locations in October and early November, she said. The volume of tests conducted at Fort Collins and Loveland sites rose 62% between September and November, from 10,800 tests in September to 17,500 in November.

"The sheer numbers alone led to some longer lines on some days and longer wait times for results," Tracer wrote in an email.

But recently installed equipment has helped the UCHealth system reduce the turnaround time for test results, Tracer said.

Banner Health has also seen increased demand for COVID-19 testing at its Larimer County sites, said Matt Hailey, executive director of Banner Western Division Laboratories. Demand for PCR tests doubled between September and November, and tripled between September and the days before Thanksgiving, he said.

Banner has been working with testing vendors to get more of the reagent needed to process tests, and it has increased flights transporting samples from Colorado to its primary testing lab in Arizona. 

Jacy Marmaduke covers government accountability for the Coloradoan. Follow her on Twitter @jacymarmaduke. Support her work and that of other Coloradoan journalists by purchasing a digital subscription today.