As coronavirus cases surge, California is once again facing testing shortages and delays reminiscent of the first weeks of the pandemic in March. Those issues, healthcare providers say, are hurting the state’s most vulnerable first.
This week, California marked record numbers of Covid-19 cases and deaths, with more than 12,800 new cases on Tuesday and 159 deaths on Thursday. With medical centers and testing sites overwhelmed, supply shortages have left Californians in some counties waiting more than a week for an appointment to get tested, and and even longer while labs process their results.
“It breaks my heart when we have to say no, we can’t test you,” said Dr Grace Neuman, an internist who runs the testing program at the South Central Family Health Center, in Los Angeles.
The center, which serves about 25,000 patients, is now only able to administer 25 test kits a day. A few weeks ago, Neuman said she was able to test four times as many patients, but commercial labs, facing a shortage of supplies, have been pinched and unable to process more than a couple of dozen tests from the center each day.
The uncertainty can be harrowing for her patients, Neuman said, many of whom are Latino workers at warehouses, factories, restaurants and grocery stores – where the risk of catching coronavirus is especially high.
Shortages in minority and low-income areas
As the first US state to issue a shelter-in-place order in March, California initially seemed to have avoided catastrophe. As bars, beaches, restaurants and movie theaters began to reopen in June, the governor, Gavin Newsom, and health officials set ambitious goals to test at least 60,000 Californians a day and train 10,000 contact tracers to investigate and monitor outbreaks. But an explosion of infections over the past month has derailed the state’s best-laid plans.
Although the state is now conducting more than 100,000 tests each day, most counties don’t have the resources to diagnose everyone who may be sick and follow up with everyone who might have been exposed. Last week, state officials released new rules prioritizing tests for essential workers and people with severe symptoms and health complications. And this week, officials announced guidelines for “pooled testing”, which allows labs to bundle and process several tests at once.
The demand for diagnostics has continued to outpace supplies, however, and tests are especially scarce in minority and low-income communities. Last week, the California Medical Association, Primary Care Association and Pharmacists Association urged Newsom in a joint statement to redirect resources to health centers, especially those in underserved communities.
Most smaller community clinics and hospitals rely on commercial labs, which processes thousands of tests a day from around the county. Quest, one of the biggest companies that processes coronavirus tests in the US, said in a statement this week that the demand for testing had “outpaced” its capacity.
Large-scale drive-though testing sites, scattered throughout the state and run by Google’s sister company Verily, are inaccessible to those without cars, said Andie Martinez Patterson of the California Primary Care Association. Those who lack documentation or have undocumented family members may also be wary of typing all their personal information into a private company’s website, she said. “It’s community health clinics that really service low-income, minority communities,” Patterson said. “And these centers often have the least access to testing resources.”
This issue isn’t unique to California. ABC News and FiveThirtyEight found that across the country, neighborhoods with higher numbers of Black and Latinx residents had fewer testing sites. Unequal access to testing is one of many unfair facets of a pandemic that has taken a disproportionate toll on Black, Latino and Native American people, Patterson said.
“I feel like Covid-19 is like the Grim Reaper. It goes out and picks on people who are the most vulnerable,” said Neuman. “And I want to be able to give them all answers about whether or not they have it.”
It was frustrating that many Californians continued to flout mandates to wear face masks in public, she added. “It’s not asking that much,” she said – and it could stop the domino-effect of outbreaks leading to test shortages, leading to more, bigger outbreaks.
“The more and more people get sick, the more we need to test,” said Omai Garner, the director of clinical microbiology for the University of California, Los Angeles, health system, whose lab processes about 1,000 coronavirus tests a day. “And we just have this mountain of infections that’s building and building.”
Garner’s lab, staffed with about 100 trained technicians, runs five types of coronavirus tests at once because they were not able to acquire enough of any one kind to meet the demand, requiring technicians to keep multiple methods and protocols straight. “My staff is going above and beyond, volunteering to work overtime,” he said. “I guess during a pandemic is our time to work hard. This is what we signed up for.”
The UCLA lab processes tests not only from patients in the university’s health system, but also from nearby hospitals and nursing facilities. “I wish we could quadruple the number of tests we’re running,” he said, to help out smaller health centers and rural medical facilities.
‘Testing and tracing alone can’t suppress it any more’
The torrent of cases and long turnaround times for test results have inundated contact tracers in some counties, making it impossible for them to track the spread of infections. “There are not adequate resources to make contact with all cases,” said Marc Meulman, the acting director of public health services for Orange County, which employs 185 trained contact tracers but has recorded more than 32,600 cases.
In Riverside county, tracers don’t tend to prioritize calling patients who have had to wait a week or more for test results, according to spokesperson John Arballo. “It’s just not useful at that point because the infection may already have run its course,” he said.
“Mathematically, testing and contact tracing alone can’t suppress the pandemic any more,” said Thomas Tsai, of the Harvard’s Global Health Institute. Regions where infections are surging should consider localized shutdowns, he said, to get the outbreak back under control. The Global Health Institute’s risk map ranks California at an orange threat-level – just under the most severe – with some regions colored red for critical.
Whereas the virus during the first months of the pandemic hovered around major cities, it has now infiltrated all communities, big and small, that may or may not have the infrastructure and resources to test and treat patients. “I worry about rural hospitals and small health clinics,” Tsai said. In California, US military medical teams were deployed to five hospitals in rural areas, to help triage and treat Covid-19 patients.
It doesn’t help that American’s tolerance for risk appears to have shifted since the crisis first struck, Tsai added. In March and April, it seemed – anecdotally – that people who suspected they were sick were more likely to quarantine themselves, he said. “They were behaving as if they had the infection, until proven innocent. Now it seems like it’s the opposite. People tend to be going about their business, until they find out they’re infected.”
