As coronavirus cases increase, California again faces a paucity of tests and delays reminiscent of the first weeks of the pandemic in March. Those problems, health care providers say, are hitting the state’s most vulnerable first.
This week, California marked a record number 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 for the test, and even longer while labs process their results.
“It breaks my heart when we have to say no, we can’t evaluate it,” 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, can now only administer 25 test kits per day. A few weeks ago, Neuman said he was able to test four times as many patients, but commercial labs, facing a shortage of supplies, were caught up and unable to process more than a couple of dozen tests from the center each day.
The uncertainty can be heartbreaking for his patients, said Neuman, many of whom are Latino workers in warehouses, factories, restaurants and supermarkets, where the risk of contracting coronavirus is especially high.
Shortage in minority and low-income areas.
As the first state in the United States to issue a shelter-in-place order in March, California initially appeared to have averted the catastrophe. As bars, beaches, restaurants, and movie theaters began reopening in June, Governor Gavin Newsom and health officials set ambitious goals to screen at least 60,000 Californians per day and train 10,000 trackers. of contacts to investigate and monitor outbreaks. But an explosion of infections in the past month has derailed the state’s best plans.
Although the state now conducts more than 100,000 tests each day, most counties do not have the resources to diagnose everyone who may be ill and track everyone who may have been exposed. Last week, state officials released new rules that prioritize testing for essential workers and people with severe symptoms and health complications. And this week, officials announced guidelines for “pooled tests,” which allow labs to group and process multiple tests at once.
However, the demand for diagnostics has continued to outstrip supplies, and testing is especially rare in minority and low-income communities. Last week, the California Medical Association, the Primary Care Association and the Pharmacists Association urged Newsom in a joint statement to redirect resources to health centers, especially those in underserved communities.
Most of the smaller community clinics and hospitals rely on commercial laboratories, which process thousands of tests per day throughout the county. Quest, one of the largest companies processing coronavirus tests in the United States, said in a statement this week that the demand for tests had “exceeded” its capacity.
The large-scale test drive sites, scattered across the state and run by Google’s sister company Verily, are inaccessible to those who don’t own cars, said Andie Martinez Patterson of the California Primary Care Association. Those who lack documentation or have undocumented family members can also be cautious about writing all their personal information on a private company website, she said. “It is the community health clinics that really serve low-income minority communities,” said Patterson. “And these centers often have the least access to testing resources.”
This problem is not unique to California. ABC News and FiveThirtyEight found that across the country, neighborhoods with more black and Latino residents had fewer test sites. Uneven access to testing is one of the many unfair facets of a pandemic that has come at a disproportionate cost to blacks, Latinos and Native Americans, Patterson said.
“I feel like Covid-19 is like the Grim Reaper. She goes out and messes with the people who are most vulnerable, “Neuman said. “And I want to be able to give them all the answers on whether they have it or not.”
He added that it was frustrating that many Californians continued to violate mandates to wear face masks in public. “It’s not asking for much,” he said, and it could stop the ripple effect of outbreaks causing evidence shortages, leading to more larger outbreaks.
“The more and more people get sick, the more we need to be tested,” said Omai Garner, director of clinical microbiology at the University of California, Los Angeles health system, whose laboratory processes about 1,000 coronavirus tests a day. “And we just have this mountain of infections that is building and building.”
Garner’s lab, which has nearly 100 trained technicians, runs five types of coronavirus tests at once because they were unable to acquire enough of any type to meet demand, requiring technicians to maintain multiple methods and protocols. “My staff goes above and beyond to volunteer to work overtime,” he said. “I think during a pandemic it is our time to work hard. This is what we signed up for. “
The UCLA laboratory processes tests not only from patients in the university’s health system, but also from nearby hospitals and nursing facilities. “I wish I could quadruple the amount of testing we’re doing,” she said, to help smaller health centers and rural medical facilities.
‘Testing and tracing alone can no longer suppress it’
The torrent of cases and long response times for test results have flooded contact trackers in some counties, making it impossible to track the spread of infection. “There are not adequate resources to contact all cases,” said Marc Meulman, acting director of public health services for Orange County, who employs 185 trained contact trackers but has recorded more than 32,600 cases.
In Riverside County, trackers don’t tend to prioritize calling patients who have had to wait a week or more to get test results, according to spokesman John Arballo. “It just isn’t useful at the time because the infection may have already run its course,” he said.
“Mathematically, testing and contact tracing alone can no longer suppress the pandemic,” said Thomas Tsai of the Harvard Institute of Global Health. Regions where infections are increasing should consider localized closures, he said, to get the outbreak back under control. The Institute of Global Health risk map ranks California at an orange threat level, just below the most severe, with some regions colored red as critical.
While the virus during the first months of the pandemic spread through major cities, it has now infiltrated every community, large and small, that may or may not have the infrastructure and resources to assess and treat patients. “I am concerned about rural hospitals and small health clinics,” said Tsai. In California, US military medical teams were deployed to five hospitals in rural areas to help classify and treat Covid-19 patients.
It doesn’t help that Americans’ tolerance for risk has changed since the crisis first hit, Tsai added. In March and April, it seemed, anecdotally, that people who suspected they were sick were more likely to be quarantined, she said. “They behaved as if they had the infection, until their innocence was proven. Now it seems the opposite is true. People tend to take care of their affairs, until they discover that they are infected. “
.
