Health care providers will be busy Friday setting up signs, traffic cones and a big tent, turning another Memphis-area parking lot into another bulwark against the coronavirus.
A new COVID-19 drive-thru testing station is opening at Christ Community Health Services in Hickory Hill. The faith-based health care provider will open another at its clinic in Frayser on Saturday.
Efforts to expand COVID-19 testing here have been hindered by miscalculations and miscommunication, staffing, supply and safety concerns, lack of access and restrictions on access.
But as the number of positive cases and deaths slowly but steadily rise, local officials are facing a new and surprising concern: the declining demand for COVID-19 testing.
So far, local providers are testing about 750 people a day at 10 community sites in the Memphis area.
That number doesn’t come close to matching the increasing capacity for testing in Shelby County, or the growing need for it in the weeks and months ahead.
Members of the local COVID-19 Task force members say the community has more than enough test kits and lab space to test 5,000 people a day.
Many physicians believe that sort of widespread testing is essential to reducing deaths, controlling the spread of the virus, and returning the city and larger society to some sort of pre-pandemic normalcy until a vaccine is available.
As opens in a new windowPresident Trump and Tennessee opens in a new windowGov. Bill Lee talk about reopening the economy, local officials are working to expand testing, in part to prepare for a surge in coronavirus cases they believe is several weeks away.
But even if testing is expanded, local residents need to know tests are available, who can be tested and where they can go get tested.
Christ Community Health Services, for example, which has seven locations across the county, has enough test kits and lab space to test 200 people a day.
So far, they’re running 50-100 tests a day at their South Third clinic.
It’s the same situation at the Tiger Lane drive-thru site run by the University of Tennessee Health Science Center.
That site can perform 200 tests a day, but this week it’s averaged about 100.
“There are dozens of tests going without usage,” Mayor Jim Strickland said Wednesday. “But on top of that, we do need more tests. No matter when we reopen businesses … what we have to do is contain the virus. To contain the virus, we need heavy testing – not only those who are symptomatic but those who are asymptomatic.”
The new testing sites opening this week are part of the local COVID-19 Task Force’s broad new strategy to reverse the decline in local demand for testing.
“We are working to provide access to testing to everyone who needs it, wherever they live,” said Shayla Williamson, chief of nursing and quality control at Christ Community. “We don’t want to miss anyone.”
In fact, health officials are pushing local, state and national leaders to establish regular testing for infection and antibodies on a massive scale unparalleled in U.S. history.
Senate Democrats this week presented a $30 billion plan to build “fast, free testing in every community.”
And opens in a new windowbusiness leaders on Trump’s new advisory council on restarting the economy said this week reopening the economy would require more testing.
“Regular widespread testing is the only way we’re going to be able to reopen the city without reigniting the spread of the virus,” said. Dr. Manoj Jain, an infectious disease expert who is advising the city on its response to the pandemic.
“It’s basic epidemiology,” Jain said. “The more people we test, the more we can identify and isolate those who are infected, especially those who are asymptomatic, and contain the spread of the disease. But a lot of people don’t know they should be tested, or just don’t want to be tested.”
“People trust firefighters”
City firefighters were knocking on the doors of a Memphis Housing Authority senior living facility Thursday, looking for people who need help.
They’re not worried about smoke or fire. They’re worried about the smoldering and still spreading coronavirus pandemic.
Firefighters will be checking on low-income residents to see if any have flu-like symptoms and need or want to be tested for COVID-19.
Friday, the task force will set up a mobile test site at the building and test as many residents as they can.
They will do the same at other MHA locations in the coming weeks.
“We’re looking for new ways to reach citizens who are most vulnerable to the virus, and people trust firefighters,” said Jenny Bartlett-Prescott, chief operating officer of Church Health who is leading the task force’s testing initiatives.
“We have the capacity to do more testing, but we need to be more proactive about finding people who need to be tested.”
The changing guidelines on who should get tested – and then the struggles to get results in a timely fashion – has hindered getting more people tested.
A month ago, local COVID-19 testing was limited to a handful of people who showed symptoms — a fever, dry cough, shortness of breath — and whose tests were approved by a doctor.
Three weeks ago, local health leaders, tired of waiting for government agencies to ramp up testing, set up drive-thru testing sites at Tiger Lane and Christ Community’s clinic on South Third.
Two weeks ago, local COVID-19 Task Force leaders were concerned about having enough test kits, swabs, and lab processing space to meet the rising demand for testing.
Last week, as the task force announced plans to opens in a new windowexpand testing to 1,000 people a day, mechanical breakdowns at local labs caused major delays in test results.
By last weekend, there was a backlog of 1,300 tests.
The longer it takes to get test results, the longer people wait in hospital rooms and homes to find out if they are infected.
Delays of more than 24 hours also opens in a new windowhamper the health department’s efforts to identify and trace the potentially infected contacts of those who test positive.
Memphis-area Baptist Hospitals have performed more than 8,000 COVID-19 tests, more than half of all local tests.
A week ago, 20 percent of its tests were pending results. By Monday, that figure was down to 2 percent. This week, local labs were processing tests in less than 24 hours.
Task force members say testing and processing expanded too slowly at first, and that forced local health providers to ramp up too quickly.
China, where the pandemic began, released the coronavirus genetic code to the world in January.
But while other countries were developing their own tests, the U.S. waited and fell behind. The CDC tried to develop its own test, but its opens in a new windowfirst kits were flawed.
By the time the federal government allowed private companies to make and process tests to fill the void, it was late February. Hard-hit states like Washington and New York took priority.
The first COVID-19 case in Shelby County was confirmed in early March by a test that was taken here, then driven to a state lab in Nashville.
When Christ Community opened its testing site in late March, it was using a national lab that was getting more than 20,000 tests a day from all over the country. Some opens in a new windowtest results were taking up to two weeks. They switched to local Poplar Healthcare.
“There’s been a learning curve for all of us, but we’ve made adjustments. Now we’re getting all results back in less than 24 hours,” said Lance Luttrell, chief operating officer at Christ Community.
Task force members say that American Esoteric Laboratories (AEL), which has been processing most local testing by hospitals, has the capacity to process 5,000 COVID-19 RT-PCR tests a day.
AEL has told local hospital leaders that the lab will also be able to process 5,000 antibody tests a day starting April 27.
Those simple blood tests could detect people who have been exposed to the virus and developed an immune response. Task force members say that’s another critical step for reopening the economy.
“We have solved the testing supply problem and the test processing problem,” said Bartlett-Prescott. “Now we have to address the testing demand problem.”
“Not taking it seriously”
If Frayser was a city, it would be the fourth largest in Shelby County.
But until this week, the neighborhood’s more than 40,000 residents had to go to other parts of the city for COVID-19 testing.
“Lack of access has been a big problem for us,” said Charlie Caswell, executive director of Legacy of Legends community development corporation in Frayser, “but the bigger problem has been getting people here to take this virus seriously.”
Caswell said he’s been battling misinformation and misconceptions about the virus for weeks. Some people he talked to thought the pandemic was a government conspiracy, others thought African-Americans were immune.
“Until the past week or so, preachers here were still arguing about whether it was OK to have services,” Caswell said. “But now the churches are closed, grandma is staying home, and the kids are taking this more seriously.”
By next week, COVID-19 testing will be available at several locations in Frayser, including opens in a new windowCherokee Health Systems and Christ Community Health Services, both on Frayser Blvd.
Task force members say misinformation and mixed messaging have been factors in tamping down demand for testing. But other factors have done more damage.
- Testing requirements have been too stringent.
In February, the CDC recommended testing only those with unmistakable symptoms who had traveled to areas of known exposure.
On March 4, the CDC said anyone who presented with symptoms — a fever, cough and trouble breathing — could be tested as long as a doctor approved.
Now, testing will be available to those who are showing any mild flu-like symptoms as well as those who say they think they have the virus.
”A lot of people have assumed that this testing is not for me,” said Bartlett-Prescott. “It’s for people in another part of town, or people who are a lot sicker, or people with insurance or the means to pay. We’ve got to send the message that this testing is vital and free and available for everyone.”
The task force will be pushing that message with mobile testing sites and events, as well as through churches, grocery stores, community development corporations, and other neighborhood centers.
- Testing was more complicated than many realized.
Testing for a new and highly infectious virus is a sensitive and precarious process, especially in the middle of a parking lot.
Testing sites must be guarded by law enforcement, managed by a slew of volunteers, and run by a clinically trained staff fully protected by gowns, masks, shields and gloves and sanitized after every test.
Testing swabs must be properly and carefully administered, stored and transported to prevent health workers from being infected and testing samples from being contaminated.
Test samples must be properly and painstakingly loaded into machines that require high heat and several chemical reagents, some that were in short supply.
UTHSC developed its own test and set up its own lab. Its plan was to process as many as a thousand tests a day. So far, its robots are able to process about 100 tests a day.
“We’ve learned that you can’t ramp up too fast,” said Dr. Scott Strome, executive dean of the UTHSC College of Medicine. “This is a highly infectious disease. Safety is our first priority — the safety of the people in the lab as well as the safety of the samples we receive.”
- Testing sites haven’t been accessible enough.
As the virus began to spread here in early March, local health care providers realized they couldn’t wait for the state or federal government to begin large-scale testing.
By March 15, the state health department only had 500 kits available for the entire state. Five days later, Gov. Bill Lee signed an order allowing any health care facility in the state to perform testing.
He also said the state would use all of the $10 million of the federal emergency funding on “testing and on supplies for testing and capacity for testing.”
The next day, Christ Community opened the city’s first drive-thru testing site. Two days later, UTHSC started drive-thru testing at Tiger Lane, using tests assembled and performed by medical students. Church Health also started testing its own staff and patients.
It was a good start and eased the burden on local hospital emergency rooms and clinics, but it wasn’t enough to cover the entire community.
opens in a new windowHealth department maps show that more tests have been administered in three areas — around the South Third clinic, around Tiger Lane and Church Health, and around the large hospitals out east.
But maps also show that higher rates of COVID-19 positive tests have been found in three more economically distressed parts of the community — North and South Memphis, Parkway Village and Hickory Hill.
”We’re not reaching the people who most need the testing,” said Keith Norman, senior pastor of First Baptist on Broad. He also serves as vice president for government affairs for Baptist Memorial Healthcare. “Those are the areas where poverty and health care inequities have made people more vulnerable to the virus.”
Starting this week, the task force is using health department data to determine where to set up new drive-thru or mobile testing sites — decisions that will be made week to week.
Christ Community will open temporary sites Friday in Hickory Hill and Saturday in Frayser, and possibly at some of its other clinics in Orange Mound of Binghampton later.
New testing sites have opened at other “safety net” clinics such as Memphis Health Center, Case Management, Inc., Tri-State Community Health, and Cherokee Health Systems.
UTHSC won’t be opening a second Tiger Lane-style site. Instead, UT’s test processing lab will support other temporary community sites.
“We probably don’t need to have any particular site, like South Third or Tiger Lane, open five or six days a week,” Bartlett-Prescott said.
“Clinically staffing each site is difficult, so we’ll move the staffs where they are needed most, depending on the data.”
“Good but not enough”
Austin O’Connor started medical school three years ago to develop the knowledge and skills to start a private practice, not stop a pandemic.
But when government agencies were slow to deliver COVID-19 test kits and sites, O’Connor and his fellow students at UTHSC stepped up to build them.
”The reason I got into medicine in the first place was to help people,” said O’Connor, a third year student from Knoxville. “There’s a lot of anxiety about this virus, a lot of uncertainty about it. That scares people. I’m in a position to help.”
Supervised by physicians on the faculty, four dozen UTHSC medical students have assembled, performed and processed about 2,000 tests over the past month.
Only Baptist and Methodist hospitals have tested more people here.
“No other medical school in the country is doing this,” said Dr. David Schwartz, the medical director at the Tiger Lane site.
“It’s a tribute to our students and to the spirit of Memphis. We didn’t have the federal or state support we needed, but we showed that we have tremendous resources and expertise in this community. We had everything we needed right here. Now we’ve got to get it to people who need it.”
Since local testing began in early March, local health care providers have been waiting for symptomatic patients to come to them.
Testing results have lagged at times, and false negatives continue to be a concern.
But local hospitals and “safety-net” clinics have had enough capacity to perform nearly 15,000 tests in Shelby County, and a few thousand more in bordering counties.
That includes more than 8,000 at Baptist’s six local hospitals, more than 6,000 at Methodist’s six local hospitals, and nearly 1,000 at Regional One Health, St. Francis and St Jude.
That also includes about 2,000 at Tiger Lane, and about 700 more at the Christ Community’s Third Street site.
“That’s good but it’s not enough. We as a community have the capacity to test all of those who are symptomatic,” said Dr. Martin Croce, chief medical officer for Regional One Health.
“And we need to gear up to start testing those who are asymptomatic, especially all of our first responders and health care workers on the front lines, as well as our more vulnerable populations.”
Hospitals are working on plans to test all of their own health care workers as well as those who work for nursing homes and other senior care facilities.
More than one in four confirmed COVID-19-related deaths in Shelby County were “health care associated.”
The health department was unable to provide figures on what percentage of those who have tested positive are health care workers, but task force members say it’s about 15 percent.
Baptist Hospital was the first local hospital to perform COVID-19 tests.
It was the first hospital to set up a separate testing facility outside its emergency room.
It has performed more than 14,000 COVID-19 tests at its hospitals and clinics in Tennessee, Arkansas and Mississippi.
It plans to test and track all of its employees, even those who are asymptomatic, said Dr. Paul DePriest, executive vice president and chief operating officer for Baptist Memorial Healthcare.
“We’ve met the challenge of social distancing and slowing and preparing for the surge, if and when it happens,” DePriest said.
“The bigger challenge for all of us is how we face the future, how we get back to some sort of normalcy.
“Until we have a vaccine, we’re going to have to develop a new respect for testing to determine who is immune, who is infected and needs to be isolated, and who remains vulnerable. That’s going to require all of us to continue to work together.”
This story first appeared at dailymemphian.com under an exclusive use agreement with The Institute. Photos reprinted with permission of The Daily Memphian.