niman Posted September 13, 2016 Report Posted September 13, 2016 Pregnant Women Anxious as Florida’s Zika Test Results Take Weeks MIAMI — So many pregnant women have taken advantage of Florida’s offer of free Zika testing that state laboratories have been unable to keep pace, doctors and patients say, leading to long delays for women anxious to know whether the virus has passed to their fetuses. The delays began with a well-intentioned and much-applauded offer. On Aug. 3, Gov. Rick Scott announced that the state would provide the costly Zika tests to all pregnant women, a move intended to quell fears and allow low-income or uninsured women to be tested. Babies infected with Zika can be born with microcephaly, a devastating brain malformation, or with eye and ear defects. “We’re ramping that up across the entire state,” Mr. Scott said at the time. But hundreds of women in Miami-Dade County, where Zika is spreading, have been waiting weeks for state results on the same kinds of tests that private laboratories are turning around in three to seven days, doctors said. For some women, the delays could complicate already distressing decisions about whether to terminate their pregnancies if they test positive. Florida forbids abortions after 24 weeks. State health officials declined to say how many tests had been done, provide a reason for the delay or explain how they planned to remedy it. But doctors and researchers attributed some of the delay to a lack of resources, with not enough staff members to analyze the test results. Acknowledging the delays, Dr. Lillian Rivera, the Florida Health Department administrator for Miami-Dade County, told a panel of Zika experts from the University of Miami last week that the reasons were complicated. Sometimes, she said, “tests are done and have been delivered, and sometimes there are bureaucratic reasons; they are in someone’s computer or fax machine.” The state has contracts for some of the work with two major private laboratories, LabCorp and Quest Diagnostics, she said. In a small number of Florida cases, the long wait can be traced to a final cumbersome test that must be analyzed by the Centers for Disease Control and Prevention or an approved laboratory to confirm the presence of the virus. For many women, the delays have added to the stress of pregnancy. “It worries me because I just want to know and I want to make sure the baby is healthy and everything is O.K.,” said Aileen Perez, 31, a nurse practitioner who is 20 weeks pregnant and has been waiting nearly five weeks for her results. Ms. Perez, though, said she was confident that her results would come back negative because she had been very careful — wearing long sleeves, applying repellent and staying indoors as much as possible. The Health Department said in a statement that more than 6,649 people had been tested for Zika statewide as of Monday. So far, 86 pregnant women in the state have tested positive. In all, 771 Florida residents have tested positive for the virus; most were infected while traveling abroad. The long waits for pregnant women in Florida come as Congress continues to argue over a bill that would inject $1.1 billion into efforts to prevent Zika, test for the virus and develop a vaccine. Congress left for its August recess after the bill stalled in the House as Republicans and Democrats clashed over a measure that would exclude Planned Parenthood from the list of providers designated to combat the virus. Some doctors worry that the backlog could get worse. Doctors recommend that pregnant women receive a Zika test every trimester, and obstetricians in Miami-Dade County say that many of their patients will soon need to be retested without knowing the initial results. Dr. Christine Curry, an obstetrician at the University of Miami Health System, which is a partner with Miami’s only public hospital, and a director of the university’s Zika response team, said she had 400 pregnant patients who were waiting for results, some for as long as six weeks. Doctors and pathologists are urging that Florida increase the number of tests they are sending to private labs to be processed, which would take some of the pressure off the state. “Anyone waiting four weeks, who is pregnant, that is a really long time,” Dr. Curry said. “It’s really stressful for them. The first ones we tested were in August, and they came back for the next appointment saying, ‘Where is my test result?’” Dr. Curry said the governor’s offer was significant because it gave low-income pregnant women or uninsured women a chance to be tested, but she said the state had not been able to cope with the numbers rushing to be tested. Private tests range from $120 to $750. Mr. Scott’s offer was “awesome,” Dr. Curry said, “but a mandate without resources is hollow.” In her office at Jackson Memorial Hospital, Miami’s largest public hospital, the number of women seeking the test rose from one or two a day to 10 or 20 a day, or more, she said. Dr. Ellen Schwartzbard, an obstetrician at South Miami Hospital, said she had encountered similar problems. While most of her patients choose to go to private labs, 20 of the women who relied on free public testing are waiting for results four weeks later. “There is definitely a level of frustration,” she said. “This lag time of four to five weeks can impact the patients’ decisions to terminate the pregnancy because now they are further along in their pregnancies. Unfortunately, there is no control over the situation.” Pathologists said the backlog had grown tremendously, raising fears that if locally acquired Zika cases spread to other counties in Florida, the wait would grow considerably. Dr. David M. Anderson, the medical director of Pathology Laboratories at Jackson Memorial Hospital, said the hospital was waiting for the results of 800 to 900 specimens tested for Zika. Part of the backlog stems from the cumbersome testing process. Most people must undergo a series of tests to either rule out or confirm they have the virus. There is no one simple diagnostic test that does this, a complaint of doctors and researchers who are pushing for funding to develop a simpler, less costly kind of antibody test. The first blood or urine test, the PCR, is relatively straightforward but is effective only if a person currently has the infection, which stays in the body for about two weeks. A negative result requires a patient to move on to an antibody test called IgM, which can show if someone has had the virus in the last 12 weeks. Both of those tests take only hours to process, and private labs have a turnaround time of a week or less. Quest plans to offer the IgM test, which LabCorp already offers, in the next few weeks. But if someone tests positive on the antibody test — and many do not — a more complicated antibody test typically follows, one that is conducted only by the C.D.C. or a C.D.C.-approved lab. This test pinpoints whether the antibody is related to Zika, and not dengue or Chikungunya. If the test is sent from an outside lab, it can take as long as five weeks to confirm results and deliver them because the test is complicated, said a C.D.C. spokesman, Benjamin Haynes. Mr. Haynes said there was no backlog for this kind of testing at the C.D.C. The C.D.C. has performed the antibody test this year on 3,500 samples, all but a few from the United States mainland. Some are from Puerto Rico. “Faster and better diagnostics is high on the list” of priorities, said Dr. Rivera, the Health Department administrator.
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