A quick virus test? Sure, if you can afford it

J. David Goodman, The New York Times

Posted at Aug 31 2020 11:54 AM

A quick virus test? Sure, if you can afford it 1
FA lab technician prepares COVID-19 specimens for testing at a Quest Diagnostics facility in Chantilly, Va., April 8, 2020. Erin Schaff, The New York Times

NEW YORK — As major laboratories struggle to meet surging demand for coronavirus tests, wealthier people and others in privileged professions are avoiding long waits for results — anywhere from four days to more than two weeks in New York City — by skipping the lines.

Some are signing up for concierge medical practices that charge several thousand dollars a year for membership and provide quick turnaround testing. Others have turned to smaller laboratories or doctors’ offices that have their own equipment and can give results in a few hours or less.

“So far, we have tested 12 billionaires,” said Dr. Andrew Brooks, chief executive of Infinity BiologiX, a New Jersey-based company that developed a saliva test used by professional athletes, universities and financial institutions. “This concern is universal.”

Executives at smaller labs in the New York region described a sharp increase in calls from those looking for faster results — not just doctors with wealthy patients but also businesses that need swift, reliable testing. Movie production companies, banks and even trucking companies have turned to small labs.

Horace Mann, a Bronx private school where tuition runs more than $50,000 a year, hired a screening company, Sterling, to offer on-demand saliva tests for staff, students and parents.

Some physicians’ offices are offering results in less than 24 hours for people who can pay $150 or $200 out of pocket for a test.

From the start, the pandemic has exacerbated existing inequalities, including access to quality health care. In the early weeks of the outbreak, those with money and connections found ways to get tests when few were available. Now, they get faster results.

As reliably fast results become available for those who can afford them, frustration mounts in the New York region over delays for standard tests that come at no cost to people but often do not yield results for several days. Public health experts say such a lag can render test results far less useful, given that people who have the virus can infect others in the meantime.

The FDA Food and Drug Administration has also recently approved several affordable rapid tests, which can deliver results in hours, but they are not yet widely available.

Officials in New York see robust diagnostic testing and swift contact tracing as key to maintaining the state’s low levels of infection. Gov. Andrew M. Cuomo and Mayor Bill de Blasio have blamed large national laboratories for a backlog in processing test results. While smaller labs can often produce results faster, there are not enough of them to handle tests on a citywide scale.

Since last month, the median wait time for coronavirus test results had gone up in New York City, from two days to three, a change that the city’s Health Department has attributed primarily to slow processing by Quest Diagnostics laboratories. The city this month opened several “express” testing sites, promising results in 24 hours.

Some of the fastest turnaround times have been seen in hospital-based testing, especially samples from patients who are having surgery. For patients in the emergency room or admitted to the hospital, most results come back within a day, city officials said.

But for many others, the timeline is much less predictable.

During one week in early August, one-quarter of all test results in New York City came back in more than 13 days, according to the Health Department. About one-third of the tests were handled by Quest, the department said.

Quest, which can process some 150,000 coronavirus tests a day, has said recently that its turnaround times have improved. The company said in a statement on Tuesday that its average testing turnaround had been reduced to two days.

For those with an exacting clientele, there has been competition to establish relationships with smaller labs.

“When we started, we had a regular lab, Quest, and we were getting results back in seven days, which is worthless,” said Dr. Matthew Priddy, who runs a concierge medical practice in Indianapolis.

Priddy said he found a small local lab to work with and now his patients — who pay between $150 and $600 a month in membership fees — get coronavirus test results in around two days. He declined to name the lab, so that others did not flock there.

“I’m just being selfish for my patients,” he said.

Under the elevated train tracks of the D train in Bensonhurst, Brooklyn, Lenco Diagnostic Laboratories processes results for hospitals and doctors’ offices, as well as for boutique medical practices like one called Sollis.

At Sollis, for an annual individual membership fee of up to $5,000, patients can be seen in the equivalent of a private emergency room, or get chest X-rays at home.

Demand for testing at Sollis has been driven in part by members traveling back from at-risk places or to countries that require testing, particularly in the Caribbean, said Andrew Olanow, a co-founder of Sollis. The company has about 4,000 members in the New York area and in recent weeks opened an office on the West Coast.

“Twenty-four to 48 hours, that’s our turnaround time,” he said.

Samira Shamoon said she received quick results through Sollis, which she joined at the height of the outbreak in New York in March as she rushed to move from her Upper East Side co-op to a family home in Bridgehampton.

“I needed the results by 2 p.m. the next day,” said Shamoon, who runs a health and beauty communications firm, recalling her panic one evening when her temperature hit 99.5 the day before an important client dinner. She got her negative result at 11:55 a.m.

She said other people she knew in the Hamptons had done the same, including a woman who told her she had been tested for coronavirus eight times.

Shamoon paid $12,000 for a membership for herself, her husband and her two aging parents. Each home visit cost $1,000.

“That fee is for the immediate turnaround care,” she said, adding that the cost of the test itself, performed by Lenco, would be put through her health insurance, as it is for everyone with insurance who gets a coronavirus test.

“We are fortunate,” Shamoon said. “At the end of the day, I have to remember that.”

Lenco, which in a recent week handled about 5% of laboratory tests in New York City, has managed to provide fast results by limiting the number of tests it runs, said Dr. Robert Boorstein, the medical director.

“A lot of others commit to stuff that they’re not able to do,” Boorstein said. “We’re doing about 2,000 tests a day. We get calls to do another 1,000 tests, or another 2,000 tests. We won’t take that business until we can get commitments from suppliers.”

Some doctors guarantee fast results because they have diagnostic machines to process tests inside of their offices, said Scott Pope of Roamd, a company that works with concierge doctors around the country charging as much as $40,000 a year in membership fees.

Others have been trying to get rapid point-of-care testing machines, the types of devices used in the White House. The devices, which are increasingly appearing outside of exclusive parties and social gatherings, deliver results in 30 minutes.

Pope said he knew of several doctors who had ordered such machines, only to have them redirected to the federal government.

The machines remain in short supply. They use a different method — an antigen test — that has been considered less accurate than the more standard testing procedure used by most laboratories. And for travel to a place where a negative test is required, antigen tests are often not accepted.

For now, wealthy people and many businesses are relying on the same sorts of tests used by everyone else in the country — they’re just finding ways of getting the results back faster.

John Catsimatidis, the billionaire New York grocery magnate, said he had hired a concierge service, Studio Med, to test himself and the approximately 100 people at his offices. The turnaround time for each test was 24 hours.

How did he ensure that the results came back in a day? “You pay them a lot of money,” he said.

“We made it conditional: we’d give them the business if they’d get it done,” Catsimatidis added. “I think a lot of companies are doing the same thing.”

For fast results, and tests that do not require an uncomfortable nasal swab, some companies, sports leagues and universities have looked to saliva testing.

Infinity BiologiX, a company affiliated with Rutgers University, developed the first such approved test, which yields results in one or two days and has been used on the university’s athletes as well as the PGA Tour and Major League Soccer.

Increasingly, companies are looking for tailor-made testing regimens, hoping to bypass the uncertainty in the larger marketplace, Brooks said. The chief executives of those companies often take the tests themselves too.

“One, they want to make sure it works,” he said. “Two, they want to be able to say, if it’s good enough for me, it’s good enough for everyone. And three, they absolutely want to know for themselves.”