Covid-19 cases have hit record levels amid omicron's surge, causing a significant increase in demand for tests. But, due to limited resources, some laboratories are triaging access to tests to ensure timely results—and while at-home tests could help fill this void, many of those are also in short supply.

Laboratories, health systems limit access to testing

As cases numbers continue to rise, some laboratories and health systems have been forced to ration access to tests to limit the amount of needed processing, giving priority to individuals who have symptoms or other health concerns, the Wall Street Journal reports.

"There are a finite number of people who do laboratory testing. It's not an endless resource," said Emily Volk, president of the College of American Pathologists. For example, the Carle Foundation Hospital Laboratory in Illinois ran about 13,000 PCR tests within the week ending Jan. 1, but claimed it could run around 18,000 tests per week if it had enough staff and supplies.

Now, many institutions are triaging who is eligible for Covid-19 tests to ensure that the patients who need a test the most are able to get quick results so they can isolate or receive treatment.

For example, the University of North Carolina is restricting tests to individuals who have Covid-19 symptoms, employees, and patients who are required to take a test before surgeries. According to Melissa Miller, director of the UNC microbiology lab, UNC is performing around 1,200 tests every day, sending results to patients within 24 hours—and roughly 33% of the tests have come back positive.

Similarly, the University of Washington (UW) last week temporarily closed some of its testing sites and is prioritizing appointments for individuals who have Covid-19 symptoms or a known exposure. On Dec. 30, Geoffrey Baird, UW Medicine's acting chair of laboratory medicine and pathology, said their turnaround time for test results had stretched beyond two days.

"A Covid test that is not back for several days, it just isn't terribly meaningful because someone could go on and spread the virus," Baird said.

Separately, Bruce Wellman, a pathologist at Carle Foundation Hospital Laboratory, said, "We've got the choice of delayed results, which have no value, versus timely, immediate results, which do have value."

Health experts have cautioned that limiting access to tests has the potential to increase the virus' spread if people are turned away from testing altogether. "What we don't want is for people to not be able to get tested in the community and then show up at the ER to get testing," said Miller. "But there is a maximum amount that you can collect in a day."

Suppliers are struggling to keep up with the demand for Covid-19 tests

Over-the-counter, at-home tests have helped ease pressure on laboratories, but they have been in short supply. 

Following previously improving coronavirus conditions last year—such as fewer cases, a rise in vaccination rates, and guidance from health officials that vaccinated people did not require testing after exposure—test suppliers grappled with a shrinking demand for Covid-19 tests.  

Amid this lack of demand, some suppliers either scaled back or stopped producing Covid-19 tests.

For instance, leading test manufacturer Abbott Laboratories closed one of its factories, scaled back test production at another, and destroyed test card components after the company decided the products would likely expire before they would be needed.

Then, test manufacturers and policymakers were caught off guard by the emergence of omicron.

"Everyone thought the vaccines were going to solve everything, which meant the administration took its eye off the ball when it came to testing," said Zeke Emanuel, a professor of health care management at the University of Pennsylvania and a former Covid-19 adviser to President Joe Biden.

According to Mara Aspinall, a professor of biomedical diagnostics at Arizona State University, the United States currently has a capacity of 260 million at-home tests per month—a number that will likely double by March. But according to Aspinall, "Testing has not been front and center."

Many of the tests currently available are being used by large institutions with testing requirements, like schools and workplaces, making it difficult for individuals to find test kits at pharmacies or other retailers, the Financial Times reports.

In addition, Jason Feldman, Vault Health's CEO, said, "[E]ven if there were enough tests available, everyone is hoarding rapid tests."

Currently, the White House is working to finalize contracts for 500 million at-home tests, which will be made available to Americans for free, but it has not yet disclosed when those tests would be delivered. (Smyth et al., Financial Times, 1/8; Abbott, Wall Street Journal, 1/10; Brown, Bloomberg News, 1/8)