COLUMBIA — State public health officials say they're working to dramatically increase COVID-19 testing statewide, even as they acknowledge it's regularly taking more than a week for South Carolinians who waited in line to get a swab up their nostril to actually learn the results, making them essentially useless.
Those delays amid a surge in testing are consequently deterring people from lining up to get checked, helping to explain why there's been a weeks-long backslide in testing, said Dr. Joan Duwve, public health director at the state Department of Health and Environmental Control.
Other challenges include South Carolina's sweltering summer — reducing the time test-takers can stand outside in protective gear at drive-thru sites — staffing the sites without impacting local hospitals' capacity, and national shortages in testing supplies, she told legislators and DHEC board members this week.
The falling tests come with cases dropping as well, helped by dozens of S.C. cities requiring masks.
Frustrated legislators say they're willing to spend whatever it takes to get the job done — with quicker results — but they need solutions, not excuses. They'll return next month to allocate $668 million remaining from $1.9 billion the federal CARES Act sent South Carolina for COVID-19 reimbursements to state agencies and local governments.
While recognizing that South Carolina's testing per capita has improved from 46th to 33rd nationwide, as the 264,100 residents tested during July more than doubled May's total, it's still not nearly good enough in a state with one of the nation's highest COVID-19 infection rates, legislators said.
If there are national shortages, clearly other states facing the same problems have found workarounds South Carolina needs to copy, Sen. Vincent Sheheen said Wednesday, repeating what he's said in a series of meetings on COVID-19 testing.
"I'm very tired of hearing there's not enough (testing) re-agents," said the Camden Democrat, noting the Legislature has funded all of the agency's requests so far this pandemic. "Your agency can't be successful and we can't help you if you can't tell us how to be more successful. I've asked this question for months now."
Asked what successful states are doing, Marshall Taylor, DHEC's acting director, replied, "I don't have an answer for you."
More than 5 percent of South Carolina's population was tested in July, more than doubling the 2 percent goal DHEC set in May.
But over the last three weeks, the average number of daily tests has fallen by nearly one-third, from about 8,750 to roughly 6,000, according to an analysis of DHEC data, looking at rolling seven-day averages.
And the testing goal should be 10 percent monthly to actually identify enough of the people who are infected, including those without symptoms, to stem the spread, said Sen. Tom Davis, who led the Senate panel on testing and contact tracing.
When DHEC officials indicated that's doable by year's end, Davis made clear that's unacceptable.
"We want this achieved now. We’re taxing our health care resources now. People are getting infected and dying now," said the Beaufort Republican. "We can’t wait to ramp this up. It’s not a function of money. It’s a question of leadership and coordinating all the resources and getting it done."
Part of the problem, he said, has been DHEC's changes at the top.
Taylor, the agency's chief attorney, was forced to step into the director's role for the second time this pandemic in late May, just before South Carolina's numbers of cases and deaths shot up.
And Duwve joined the team in mid-April from Indiana, filling a role held by an interim placement for more than a year.
A list of recommendations from Davis' panel, adopted by a Senate committee Wednesday, includes setting that 10 percent monthly testing goal and providing DHEC however much it costs in staff, supplies and equipment to reach it.
"We're on the fast track," Duwve told board members Thursday, calling the testing ramp-up "Operation Warp Speed."
Steps DHEC's taken so far include contracting with four labs to increase the public agency's testing capacity to 8,800 tests daily — up from 2,000 it managed to reach by early June by operating two shifts seven days a week.
DHEC is also requiring those labs, by contract, to match the public lab's turnaround of test results within 48 hours, Duwve said.
"Results that take six to eight days to get to a patient do us no good," Taylor told senators. "It's just a number that doesn't help us."
The agency also pledged there will be at least one testing event weekly in all 46 counties starting in September — an initiative DHEC officials initially said would start in August.
More than 140 temporary, drive-thru testing events are scheduled through the end of September, in addition to the 222 health care facilities and pharmacies offering tests, according to DHEC.
People who waited in line for hours at those events have reported not knowing for a month or more whether they tested positive or negative on that day. In the meantime, they're out and about. And for those who were positive, DHEC was unable to take the next step and make calls to figure out who else they may have infected before it's way past too late.
Those mobile testing sites across the state temporarily raised the time it took for people to get results, said Heather Woolwine, spokeswoman for the Medical University of South Carolina, DHEC's main partner in testing.
Its lab was taking up to 10 days to provide residents a diagnosis, but that's down to between five and seven, she said.
The machines themselves were part of MUSC's problem, as nonstop processing caused breakdowns that few technicians nationwide could fix, Woolwine said.
A 10-day wait on results has been common across a lot of states due to backlogs in private labs, said Josh Michaud, associate director of global health policy at Kaiser Family Foundation.
But there is no average for turnaround nationwide, as there's nothing requiring any lab to report that data. Adding to the problem is a lack of incentive for testing suppliers and labs to be speedy, as they're going to get paid regardless, he said.
"In places where you have lots of cases and a surge in testing because of that, there's a limitation in supplies. All of that works to gum up the system and slow things down," Michaud said. "It's almost useless to get test results more than a week old. It helps nobody. But the lab will get paid."
Quest Diagnostics, a private lab conducting COVID-19 tests, explained it had to prioritize processing last month amid a testing surge, including from the South, to people hospitalized, those at high risk of getting seriously ill or dying, and health care workers.
Amid that surge, any test not for a priority patient could take more than a week to be analyzed.
But there's no longer a backlog, and the average turnaround has shrunk to two to three days, thanks to a combination of decreased demand and increased capacity, said Kim Gorode, spokeswoman for the New Jersey-based lab.
For hospitals like Roper St. Francis Healthcare, a shortage of testing reagent was the main hold-up.
The Charleston hospital receives a new shipment weekly, and if that supply ran out in a couple of days, it's stuck without until the next shipment, said Dr. Chris McLain, its chief physician officer.
“It’s simply a supply issue," he said. "There’s not enough.”
He does think fewer people are lining up to get tested in the state. But he also thinks the spread of the disease has started to slow, thanks partly to mask mandates that cover roughly 40 percent of South Carolina's population. He pointed to fewer hospital admissions in the state over the last week.
“If it were just a delay in getting the results back, we would be seeing more people coming in,” he said.
