What Limits Testing

Spurred by comments, I decided to dig into the reasons that COVID-19 tests aren’t as plentiful as we might like. The reasons are actually pretty simple: the reagents are niche products, supplied by a handful of small to medium-sized companies. According to Thomas the suppliers are:

  • Integrated DNA Technologies
  • Qiagen
  • Biosearch Technologies
  • BEI Resources

The largest of these is a medium-sized company. The rest are small. Just to remind you of how I use the terms a small company has revenues up to about $200 million annually; a medium-sized company has annual revenues from $200 million to $1 billion; above that is a big company.

Contrary to the impression you might have received in economics classes the difference between a small company and a big company isn’t just revenue. Said another way small companies can’t expand their production rapidly even if you give them more money. The small company that can do that is rare, indeed. They just don’t have the management time.

Given enough time and persistent demand major players will get into the business but they’ll wait and see—they won’t gamble on it. The most likely major player is Baxter due to its present relationship with one of the top suppliers (disclaimer: although Baxter is an old client of mine I haven’t had anything to do with them for years). Intellectual property is probably a barrier to entry as well.

14 comments… add one
  • Drew Link

    As the resident small company manager I will tell you that your observation is flat damned correct, and flat damned wrong. That’s where we come in.

    You are correct that the vast majority of small companies have trouble expanding. Capital needs; talent; family squabbles etc. But what the hell do you think we do? We have been there and done that. We can outmaneuver a medium sized company 24/7/365 if we have the resources; and we are good at assembling those. Convene a study – two weeks later convene the board – make a decision on the spot.

    It has served us well.

  • bob sykes Link

    The US is doing well over 2 million tests per day. People in high risk jobs and athletes get tested every day. That’s five to six times the number of daily tests that were done back during the pandemic peak.

  • Andy Link

    It’s probably related, but I’m more concerned/annoyed at the lack of test timeliness. It’s still taking 4-7 days here usually.

    My sister with dementia who lives in a memory care facility got tested on Tuesday and the positive results came late yesterday. There’s currently an outbreak there and 4 people have already died. Sadly, it’s not isolated, elder care places all along the front range here in the state are having outbreaks. Once it gets inside it’s very difficult to control, especially when it takes many days to confirm who is and isn’t infected.

  • Grey Shambler Link

    I can’t see what good calling for more testing is, the election is essentially over. I suppose the Dems could figure out an angle to leverage Republican heartlessness in the Ga contests.

  • PD Shaw Link

    I agree with Andy, 4-7 day turnaround for tests is a pretty useless test in terms of preventing the person tested from spreading the infection — they are very likely done infecting people. At that point your simply using the test to try to get contacts to self-quarantine. Good luck with that.

    Also rapid tests use fewer, less scarce reagents.

  • Grey Shambler Link

    As regards that situation, it seems you need to isolate everyone, delayed test results and delayed symptoms make anything less only a delaying tactic. But then you run into cost.
    I pray that your sister will be safe.
    If Tom Brady tests positive, he can quarantine, that’s just not feasible for the working class, paycheck to paycheck, small apartment dwelling people, you can mandate it, but it won’t happen. Cost again.

  • steve Link

    We still cant test everyone we would like to test in our hospitals. With the constant shortage of reagents we are often left guessing. Since people can be infectious while asymptomatic we are having unnecessary exposures. We were seeing 10 day turnarounds but now they are 4-7 days too. I guess people keep wanting to make this about politics but in the hospital we actually use the tests to determine care. We also need them to monitor our staff. For people who have the option of working at home they are useful. For families that can isolate they are useful.

    Capital seems to often be the limiting factor for these small companies. That should not happen now. We have known this is a problem since March, at least. Should have been fixed.


  • PD Shaw Link

    There is one county in Illinois that is not under warning. Its Champaign County, home of the University of Illinois, which was responsible 12% of tests in the state each day, 2% in the country. I don’t think their saliva test requires reagents. And the FDA was not helpful in approving this and they were not helpful with advancing testing methods for the first six months or so of the pandemic.

  • The U of I’s saliva test has a 11% rate of false negatives.

  • Andy Link


    Thanks for the kind words.

    One problem with memory care facilities, and assisted living generally, is they are not really designed for quarantining – quite the opposed, they’re designed to promote social and personal interaction. The place where my sister is at was not full, so they were able to setup one wing as a covid wing, but there simply isn’t enough room to isolate everyone. The staff tried to keep people in their individual rooms, but that is difficult with dementia.

  • PD Shaw Link

    @Dave: I don’t think that’s accurate way to evaluate the test. What is the test’s purpose?

    “Accuracy is entirely dependent on what your target is. And so, sure, if your target is PCR detection of RNA, then an antigen test just won’t work, because it literally doesn’t pick up RNA after the virus has gone. But if the target is infectious people — which is really the most important public-health target — then these tests become extremely accurate. And that’s the issue — we shouldn’t be using a medical target, we should be using a public-health target. If they are being used for medical diagnostic purposes, they might not be as accurate as you would like, but as a public-health tool, they’re very accurate.”


    Illinois uses a PCR test from saliva w/o RNA extraction, so that’s not quite apples to apples, but a timely test that can be used frequently is better than one that will not, but will detect the virus for longer periods. (Article mentions how FDA bought all of those Abbot lab strips and then effectively crated them next to the Arc of the Covenant)

  • Andy Link

    This is something Im just now hearing about. Even with 20/20 hindsight this is both remarkable and vexing:


  • It’s completely unsurprising to me as it would be to anyone who’s ever tried to get something approved by the FDA.

  • PD Shaw Link

    @Andy: That’s a good piece. I would add that much of the time delay could have been avoided with human trials — Once past Phase II, vaccinate and expose paid volunteers to the virus instead of waiting for a test group to be infected naturally. I don’t take a hardline on this because I see the ethical issues, though this seems to be an ethic of degrees.

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