Frustrating Patchwork of California Coronavirus Tests Have and Do Not Have

Extensive diagnostic tests are not yet available during the months of new coronavirus epidemics in the United States. California offers a calm view of roadblocks nationwide.

It is difficult to overestimate how unequal access to critical test kits is in the largest US states. Some counties in Southern California have set up drive-through sites to make the test available to those who need it, while northern rural counties have tested untreated sewage and confirmed that coronavirus We are looking to see if it has penetrated the community.

Testing capabilities from county to county, from city to city, and even from hospital to hospital within a city vary, as well as the definition of who is eligible for testing.

Desert testing, due to overwhelming supply chains and disjointed public health systems, hit the hardest hits in northern California’s rural and low-income cities long before the pandemic.

Without a coordinated federal response, state-wide local health departments, hospitals, and commercial laboratories have competed for the same rare substances. Whether or not they “have” or do not have depends largely on their pocket depth, connectivity to suppliers, and how the state allocates emergency supplies.

Complicating these issues is the lack of state or federal public health infrastructure that is empowered to acquire and allocate resources on a large and equitable scale. Hospitals and healthcare systems, which many people go to for care, are designed to focus resources on their patients and workers. Their bureaucracy cannot readily adapt to community engagement and education that could bring testing to the masses. Also, it is not set up for contact tracking to ensure inspection and monitoring of people exposed to COVID-19 patients.

These roles usually belong to county health departments and operate on a bone-free budget in much of California, making it difficult to prevent a lethal pandemic as well as a multi-year outbreak of STDs. .

Over the past two months, the state has been isolating test disasters one after another, but some of them are more widely used by reducing their own supply trades and expanding test sites in underserved areas. We are taking steps to make it possible. Dr. Bob Kotcher, One of three test task forces called by Governor Gavin Newtham, California.

But conversations with dozens of local health authorities, hospital systems, scientists, and elected officials reveal how complex that job can be.

Visit Lake County, a recreational mecca just over two hours north of San Francisco. With 65,000 inhabitants and very little testing equipment, they relied on buying swabs on Amazon and stealing chlamydia test kits for swabs and the liquids used to transport specimens to the lab. . Through what the county cobbled together, it identified six cases of COVID-19, and all were found through nurses or volunteers who went out to seek patients.

“Basically, you have to make tea leaves to understand what’s going on,” he said. Dr. Gary Pace, County Health Officer.

Pace knows the county has infected the community. This is because they started running tests on the cases they identified and on raw sewage to check for the COVID-19 virus. Samples from four processing plants are back positive. “It’s a way to get more information, because you can’t test it,” he said. Unlike diagnostic kits, which rely on competing supplies for all health departments in the country, sewage sampling is done free of charge by technology startups.

Newsam highlighted rural and urban disparities while announcing an ambitious program to increase testing last week. “One of the big struggles we had in the last few weeks of this pandemic was to reach the rural and remote areas of the state to get a test site up and running,” he said. Said.

NewSom is committed to dramatically increase the level of coronavirus testing by focusing on rural towns and communities of color. California is currently testing about 25,000 people per day, but there is a strategy to increase that to 60,000-80,000 people per day.

The state has opened the first of 86 pop-up test sites for troubled areas. It has launched a program that trains 10,000 workers to serve as investigators for temporary illnesses that can perform contact tracing, which is believed to be essential in stopping the spread of the virus.

Pace said he wrote to the governor to demand one of the pop-up sites. “There are under-tested situations across the state, and if you’re trying to demonstrate progress, the number of ways to do that is numerical,” he said. “But we are interested in equity. In my view, we need horizontal coverage, not a large number.”

Mendocino County, located along California’s rugged North Coast, also expressed similar frustration. In late April, Abbott Laboratories created a rapid inspection machine at the Health Center in the Round Valley Indian Reservation, which was distributed through Indian Health Services. That day, members of the tribe felt sick. The person was positive for COVID-19, as was the family of five. The county previously identified only five cases, all related to travel.

Dr. Noemi Duhan Mendocino County public health officials fear a more widespread outbreak among the six tribes living in the settlement. The state has since provided 2,000 test kits to people who live or work around their bookings. Doohan’s office needs to hire a courier to drive the test for two and a half hours to a public lab in nearby Sonoma County where supply is limited.

It is all laboratories and counties per se.

Testing in California is due to a mix of commercial and public labs, and everything is plagued by supply chain restrictions. But those with deeper pockets and stronger commercial relationships were counties and public laboratories competing for limited resources.

Over 500,000 people live in rural Tulare County, which straddles the peaks and hills of Sierra Nevada. In addition, California has one of the highest per capita death rates for COVID-19. Until recently, local public laboratories were the only place in the county to test for this disease. After borrowing staff from another county, purchasing additional machinery, and suspending testing for most other illnesses, we are now able to process 85 tests per day. Authorities can also send samples to commercial laboratories in other parts of the state, but say the days of turnaround will be a bottleneck in tracking patients and finding contacts.

In the heart of the state’s Salad Bowl coastal agricultural area, Monterey County relies on donations and horse racing to meet demand. The local hospital found the expensive materials needed to make the missing reagents and mixed the batch Public labSaid Donna Ferguson, lab director. The hospital also provided the county with 1,000 swabs that Ferguson used to barter with Riverside County for an extraction kit.

And through the kindness of strangers, she discovered another important resource, a temporary gap due to restrictions on laboratory workers.

Ferguson said that during an interview with a local public radio station in March, if one of the three microbiologists working in the lab became ill, it could negatively impact the county’s laboratory throughput. I thought there was. The next day she was called by a graduate student at Hopkins Marine Station near Stanford. He was listening to the interview. Can he and his colleagues help? Since then, six graduate student crews from three universities have volunteered in the lab, trebling the ability to perform 120 exams per day.

The supply chain is a concern for labs of all sizes, but manufacturers seem to prioritize orders from commercial labs and large healthcare systems over public health labs. Public Health Institute Association, It represents most laboratories run by the national public health department.

Headquartered in New Jersey, Quest Diagnostics, a medical testing giant, performs 350,000 coronavirus tests weekly at facilities across the country. But it’s flooded with samples from across the country, and even if it worked to facilitate backlogging, counties and private hospitals are awaiting results.

Kaiser Permanente says it can test 2,000-2,500 people weekly across the state. Northern California’s leading provider, Sutter Health, tests approximately 650 people daily throughout the hospital. Common Spirit Health, including the Dignity Health hospital, says it can process 50,000 samples per week, if needed. As of last week, Stanford University has conducted more than 20,000 tests for residents of the Bay Area.

But even giants can’t afford an unlimited supply. “It’s really a manufacturing line. They’re the limiting factor right now,” said Karen Smith, Vice President of Systems for Laboratory Services at Common Spirit Health.

In addition, there are no hospitals set up to solve the wider problem of access disparities across the state. They can generally treat ill patients with enough to look for their ER. But coordinating supply and testing across the community has historically not been their role.

“If I’m asymptomatic, I’m not going to the emergency room. That’s where I want to be the last in the world right now,” said Dr. Omid Bakhtar, Medical Director of Outreach Lab Services at Sharp HealthCare in San. Diego. “I’m frustrated. I have the ability to do more. [specimens], But how can I get it? “

No test takers

Around the state, some counties were able to stabilize supply flows due to more financial resources and relationships with major hospital systems and research institutions.

Both the Los Angeles and Riverside counties say they are more confident in their supply chains and ready to provide testing to their population. Several other counties, including most of the Bay Area, are calling for more people to be tested, including those considered essential without COVID symptoms.

However, some counties that succeeded in strengthening the test are tackling yet another issue. Not enough people to test. There are two reasons. A few weeks after being told that you shouldn’t go to the test because of a shortage, the public seems to still stick to the message that more tests are available. And the public health workforce devoted to finding people in need of inspection is exhausted.

San Francisco can test 4,300 people daily in a publicly supported lab, but as of late April, it received only 500 samples per day. Los Angeles tests approximately 10,000 people each day, but says it needs to be doubled to raise shelter-in-place orders. The focus in the coming weeks will be to increase testing between uninsured people and those in risky living environments such as homeless camps and skilled nursing homes.

Health officials say that part of the challenge is that the same group has been hit hard by the virus in many cities but is not keeping informed the poor and colored communities. I am. In San Francisco, for example, Latinos make up 16% of the population, but make up 25% of COVID-19 cases. In Los Angeles, blacks represent 9% of the county’s population, but represent 15% of COVID-19 deaths for which racial and ethnic data are available.

Kocher of the State Test Task Force has acknowledged that the state has more to do. However, he also has a sufficient amount of testing capacity available today, especially through large volume commercial laboratories that the state states that large volume specimens should be processed.

“I’m concerned at this point that not enough samples have been collected,” he said.

When staff begin to allow them to slowly return to work or school, experts agree that the case will turn upward, further increasing the need to contact labs, tests, and tracers. We need more resources to prepare for that future.

“We need money,” said Dr. Henning Ensor, a health officer in Santa Barbara County. “A lot of money. A lot and a lot.”

Kaiser Health News Kaiser Family Foundation is an editorial independent non-profit program. KHN is not affiliated with Kaiser Permanente.

Copyright NPR 2020.