The University of Virginia hopes to run 2,000 COVID-19 tests a day by mid-May — a target that, if met, would account for about 20% of the tests the state says it needs to run in order to reopen.
UVa started using an in-house test March 18 and has since been able to run 500 tests a day using a mix of its own machinery and commercial testing platforms and by creating its own supplies. This month, the university is set to acquire two more machines that will boost capacity to 2,000 a day.
The university is looking to run 3,000 tests a day by early June.
“It’s not soon enough,” said Dr. Amy Mathers, an infectious disease physician and associate director of clinical microbiology.
Mathers said a shortage of testing platforms, kits and other supplies have hampered efforts to increase the availability of tests.
“The commercial testing companies are not manufacturing enough kits or platforms,” she said. “Even if we wanted to design our own platform and kit, we would still have to get all the plasticware, all the chemicals, we would have to have an instrument on which to run it. The United States generally has gotten out of a lot of manufacturing. I think we are seeing the effects of that right now.”
Ramping up testing is a crucial step in the state’s plans to reopen; Gov. Ralph Northam has said he wants to test 10,000 people a day before easing restrictions. Since the pandemic took hold in March, Virginia’s testing rate has lagged behind almost every other state, according to an analysis by the Virginian Pilot.
The state has averaged about 4,000 tests a day, according to the Pilot. As of Friday, about 105,000 tests have been conducted for COVID-19, with about 10% of results for people who had been tested multiple times, according to the Virginia Mercury.
Mathers works daily to coordinate and keep track of the testing to ensure that the university doesn’t overpromise capacity.
“It’s like air traffic control every day,” said Mathers, who helped to develop the university’s test.
Right now, UVa could double its capacity right now if it had enough testing kits. In order to run a test on a machine, doctors need a set of chemical reagents that come in kits supplied by the company that manufactured the platform.
“The companies have to give you, not just the platform or the machine, but they have to give you all the chemical components so that you can run the test,” Mathers said.
UVa has a Cepheid Infinity that could theoretically run 1,000 tests a day, but Mathers said they’ve only been allocated 150-200 kits a day.
Still, those numbers are helpful for a state still working to coordinate a patchwork of public and private labs; according to the Virginia Mercury, the state lab in Richmond can only run 450 tests a day, a rate lower than other states, and most tests have been done at large commercial labs.
To combat supply chain issues, Mathers and others at UVa also are working to make necessary materials themselves, such as 6-inch-long nasopharyngeal swabs used to collect samples from individuals and viral transport media, a fluid that helps keep the virus alive so it can be tested.
The swabs have been particularly hard to find because only three companies are making them, Mathers said.
Mathers is working with UVa engineers to make swabs, and she’s recently started a trial with the Food and Drug Administration to show that their version works as well as those currently on the market.
“It’s a really necessary thing,” Mathers said. “We’re going to have tests, and we can’t run the tests because we don’t have swabs.”
Once registered with the FDA, Mathers said researchers will distribute swabs to people across the state.
Right now, UVa has been testing its own patients, as well as those in congregated settings such as nursing homes or correctional facilities, in addition to running tests for other hospitals, Mathers said, though the Virginia Department of Health has moved to expand the criteria of who can be tested.
“There’s 8.5 million people in the state and we cannot test all of them on any given day,” Mathers said. “We’re going to have to continue to make sure that we test smartly and unfortunately, that means we can’t test everyone all the time.”
The lack of widespread testing has limited public health officials’ ability to figure out where the virus is spreading in a community and contain it.
“As we expand testing, one of the things that’s really important is that we make sure we’re testing the right people,” Mather said. “Because to control transmission, we have to test the people in the places where transmission is ongoing, so that we can stop it.”
Even if diagnostic testing ramps up, experts say that developing antibody testing, which can detect if someone has been infected and recovered from COVID-19 — even if they never displayed symptoms — is a crucial next step to getting people safely back to work and school.
However, antibody tests can vary widely, and not all currently available are reliable, according to recent research.
UVa is evaluating an antibody test currently in development, Mathers said, but hasn’t started it using it widely. Rather, researchers are testing individuals known to have been infected to see how the antibody test performs.
“We want to make sure how it works in a [specific] population before we open it up for everybody to start running it,” she said.