Back to the basics in diagnostic testing

June 23, 2021

As vaccination rates climb — albeit more slowly now than earlier in the year — labs in many parts of the country are handling fewer SARS-CoV-2 diagnostic tests. At the same time, newly vaccinated people are emerging from their homes and re-engaging in their pre-pandemic routines. They may be determined to catch up with healthcare services they put off earlier in the COVID-19 pandemic.

At least, that is the scenario labs should be prepared to address.

I expect labs will see testing levels for wellness exams, chronic disease management, and surgeries return to (and possibly exceed) pre-pandemic levels.

There is evidence of pent-up testing demand. For example, a February 2021 report from the Urban Institute found that 36% of adults 18-64 years old either put off or went without necessary medical care during the pandemic. This happened for two reasons: (1.) They were concerned about exposure to COVID-19; (2.) Their healthcare providers reduced services, making it difficult to obtain appointments.

But now, both the volume of SARS-CoV-2 testing and the positivity rates on those tests have dropped nationally.

Data from the Coronavirus Resource Center at Johns Hopkins University chronicles the course of the pandemic in the United States, including the post-vaccination decline in infections and testing. On April 12, 2020 — back when testing supplies were limited and only symptomatic people were tested — the United States conducted 129,358 tests, or 39 per 100,000, with a positivity rate (based on a seven-day rolling average) of 21.2%.

Then came the 2020 holiday season. Despite pleas from public health officials to stay home, lots of Americans traveled, and the result was predictable. On November 28, 2020, the United States conducted 1,659,731 tests, or 506 per 100,000, with a positivity rate of 9.3%. On January 10, 2021, the United States conducted 2,044,361 tests, or 623 per 100,000, with a positivity rate of 13.1%.

The situation was quite different by June 10, 2021, when the United States conducted 778,470 tests, or 237 per 100,000, with a positivity rate of 1.9%.

Labcorp executives have been watching testing trends and commented on them in the company’s first quarter 2021 earnings report and 2021 guidance, which it released in April 2021. The reference lab said it expects its 2021 revenue from COVID-19 testing to plummet by 35%-50%, and its revenue from its base testing business to grow by 13.5%-16%.

There are many basic diagnostic assays involved in the routine of care of patients, and labs could see demand increase for all of these during the remainder of 2021.

For example, wellness exams and pre-surgery consultations could include tests to assess cholesterol, potassium, and glucose levels as well as kidney and liver function. Complete blood count (CBC) and coagulation studies (PT/PTT) also are common tests.

Labs also are likely to see more demand for tests to manage chronic diseases. Unlike annual wellness exams and pre-surgery assessments, chronic-disease testing involves repetition of the same tests over time, such as to monitor HbA1c levels in patients with diabetes or blood-clotting rates in patients on anticoagulation therapy.

That means it is back to the basics for many labs in the United States.

I welcome your comments, questions, and opinions – please send them to me at [email protected].