COVID-19 testing: 24-hour turnaround is essential to ending the pandemic

Victorians have the right to be angry about testing delays and to demand 24-hour results. In fact, it should be an urgent priority.

Under the state of disaster declared on Monday, the Victorian government says anyone in self-isolation must stay home all day every day.

Each day about 20,000 coronavirus tests are done. This means tens of thousands of Victorians could be compelled to stay home 24 hours a day for three days. That’s a lot to ask of anyone, let alone essential workers who’ll miss out on pay, people whose mental health is fraying, people with kids.

The government says lab turnaround times are averaging about two to three days. Bill Gates has said tests that take longer than two days to come back are “a complete waste” and pathology companies should not be paid for them.

Faster testing won’t just mean you’ll get your result sooner — it will encourage people to get tested.

Expected delays in receiving results means people will seek a test only when they feel truly ill. Delays create uncertainty for the chief medical officer about who is sick, where, and what policies are working.

Ending the pandemic sooner

If the government wants to manage the pandemic it needs timely and complete information. A paper published in the Lancet in July found the most important thing government can do to improve contact tracing is substantially faster testing.

“Reducing the testing delay — i.e. shortening the time between symptom onset and a positive test result, assuming immediate isolation — is the most important factor for improving contact tracing effectiveness,” the authors from European universities concluded.

“Once testing delay becomes three days or longer, even perfect contact tracing (i.e. 100% testing and tracing coverage with no tracing delay) cannot bring [the reproduction value] values below one.”

And as we know, with a reproductive value over one, the virus keeps growing.

It’s not impossible. But it’s expensive

Since I began advocating for a 24-hour results guarantee, most of the pusbback is about being polite and undemanding of the government at this difficult time.

Nobody has a public health argument in favour of long testing delays, and nobody rejects the idea they discourage people from getting tested.

In this era of $70 billion for JobKeeper, being polite is a preposterous argument. We will support an economy devastated by coronavirus. We must therefore be willing to throw more money at fighting it on the front line.

The reason we’re not spending more to speed up results is we have low expectations. People are used to waiting for lab results. That’s what psychologists call “anchoring” — waiting a week for lab results seems normal. But that’s not longer a relevant anchor. We’re in a health emergency. A better anchor might be the waiting times that doctors expect when they order a test for a hospital inpatient — generally results are back within an hour or two. Looked at that way, 24 hours is generous.

Once we open the floodgates to spending more on the problem, there are many ways to solve it.

We must expand laboratory capacity urgently. We should locate testing sites near laboratories and vice versa. We should run labs 24 hours a day. And if our labs are truly backed up, we should run hourly charter planes full of swabs to laboratories in Perth and Adelaide, Sydney and Brisbane, Wellington and Auckland — perhaps even Bangkok, Singapore and KL. Use ADF planes if need be.

If we are only willing to do testing on the cheap, it will be slow. As soon as we make an ironclad commitment to speed, we will find the resources.

Note this also. Labs might not be the choke point. Look at this quote provided to me by a Department of Health and Human Services spokesperson:

Lab turnaround times are currently averaging around two to three days but there may be cases where this is longer. Positive results are prioritised and generally communicated to the patient within 24 hours.

If they can send a positive result within 24 hours, why not a negative one? It suggests some delays are actually about communicating the result. Bureaucratic and process delays rather than physical delays. Eliminating those must be an urgent priority.

The government is understood to be paying $100 a test. At 20,000 tests a day, that’s just $2 million a day. Given the cost to the economy is in the hundreds of millions every day — not only during the pandemic but for months and years afterwards — I can’t see why that’s the limit of our testing budget.

If I were in charge I’d design a testing contract with a sliding scale where companies get incentives for being fast. Something like this:

$500 if tests are returned within four hours
$300 for within 12 hours
$100 for within 24 hours
$50 for within 48 hours
$0 for within 72 hours
-$50 for within four days
-$100 for within five days
-$200 for after five days.

The government has placed a huge burden on its citizens: stay home, wear masks, close your business, in many cases lose your livelihood. We bear these burdens stoically. But duty runs two ways. It’s fair to ask more of our government. It is fair to demand a 24-hour results guarantee.

Should the government enforce faster testing in Victoria? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication in Crikey’s Your Say column.