[dabigv13]

I wonder if some of this is supply chain.  Just because the manufacturing capacity exceeds demand, doesn't mean that there isn't a lag time between increased demand and when the supplies reach where they need to be in time to match the spike in supply.

Especially with travel impacted, and a lot of these supplies being manufactured on the other side of the world.

BC

I think this is potentially an issue, but six months in to the outbreak, you would expect the testing supply chain pipeline to be full by now. The purchasing people also should know what the lead times are, and I would expect the lead times should be going down, not up. Independent of the cause, if I am a lab who can't test because I don't have a reagent (for whatever reason), I would be screaming to the press and the public about it. We aren't seeing that.

I think it more probable that there are administrative delays that make the process take more time than it should. There are lots of "steps" in getting a sample from the test subject to the remote lab and back, and each one of those steps probably isn't optimized for speed. Nobody has analyzed the system from the point of view of minimizing the delay. Each step may not take real long, but is death by 1000 cuts. Several different organizations are involved in each step. Tests are probably marshaled several different times in the process. Each time one waits for "enough" tests to accumulate, there is a delay. Obviously, I don't know this for a fact. However, given it is a system that has been created basically from nothing in the last 5 or 6 months, it is unlikely it is well optimized.

This is incorrect. There are real delays in reagent supply chain. Our hospital recently had to add a new type of testing machine, not cheap. We could have bought more of the other testing machines we already have that functions very well, but by diversifying we can ensure more backup capability, and use different types of reagents because we couldn't get enough from what we had to return labs quick enough. We needed 48 hour turnaround but were starting to come up to 72 hrs. This is pretty unusual- normally there is one type of lab you can order for any particular lab. Now there's three, two in house and one send out (Quest, which takes the longest, and only used for low priority tests now).

This is not including rapid tests, only PCR.

Now, different orgs have different throughput and needs. My wife's practice uses a more smaller, perhaps more boutique, lab without big numbers and bought a lot of reagents when able. They can turn around a test in 6 hours.

The main issue again is our prevalence. If this thing wasn't raging everywhere we'd surely have results uniformly in less than 24 hrs.

Here's NYT on this-
https://www.nytimes.com/2020/07/23/healt...rtage.html

[dabigv13]

I wonder if some of this is supply chain.  Just because the manufacturing capacity exceeds demand, doesn't mean that there isn't a lag time between increased demand and when the supplies reach where they need to be in time to match the spike in supply.

Especially with travel impacted, and a lot of these supplies being manufactured on the other side of the world.

BC

I think this is potentially an issue, but six months in to the outbreak, you would expect the testing supply chain pipeline to be full by now. The purchasing people also should know what the lead times are, and I would expect the lead times should be going down, not up. Independent of the cause, if I am a lab who can't test because I don't have a reagent (for whatever reason), I would be screaming to the press and the public about it. We aren't seeing that.

I think it more probable that there are administrative delays that make the process take more time than it should. There are lots of "steps" in getting a sample from the test subject to the remote lab and back, and each one of those steps probably isn't optimized for speed. Nobody has analyzed the system from the point of view of minimizing the delay. Each step may not take real long, but is death by 1000 cuts. Several different organizations are involved in each step. Tests are probably marshaled several different times in the process. Each time one waits for "enough" tests to accumulate, there is a delay. Obviously, I don't know this for a fact. However, given it is a system that has been created basically from nothing in the last 5 or 6 months, it is unlikely it is well optimized.

This is incorrect. There are real delays in reagent supply chain. Our hospital recently had to add a new type of testing machine, not cheap. We could have bought more of the other testing machines we already have that functions very well, but by diversifying we can ensure more backup capability, and use different types of reagents because we couldn't get enough from what we had to return labs quick enough. We needed 48 hour turnaround but were starting to come up to 72 hrs. This is pretty unusual- normally there is one type of lab you can order for any particular lab. Now there's three, two in house and one send out (Quest, which takes the longest, and only used for low priority tests now).

This is not including rapid tests, only PCR.

Now, different orgs have different throughput and needs. My wife's practice uses a more smaller, perhaps more boutique, lab without big numbers and bought a lot of reagents when able. They can turn around a test in 6 hours.

The main issue again is our prevalence. If this thing wasn't raging everywhere we'd surely have results uniformly in less than 24 hrs.

Here's NYT on this-
https://www.nytimes.com/2020/07/23/healt...rtage.html