March 14, 2020 -- Shortly after 8 a.m. Friday, cars began to creep up the bridge to Glen Island, a rolling 105-acre shoreline park in New Rochelle, NY, that has been closed to the public and repurposed as a drive-thru testing center for COVID-19.
Three large white party tents, like the kind used for wedding receptions, are set up in a large parking lot. Cars pull out of the safe "cold zone" into a tent, which becomes a "hot zone" as soon as the passengers roll down their windows. There, health care workers, who are covered head to toe in personal protective gear, approach the car to swab the noses and throats of people who might have the highly contagious infection.
The Glen Island testing center is the first facility of its kind on the East Coast. Another drive-thru testing center was set up in Denver, but that one had to close temporarily after the line of people waiting in their cars to be tested stretched on for 4 hours.
South Korea was the first country to try this. The appeal of a drive-thru test is that it keeps a potentially contagious person in their car and away from others.
"It’s not only faster and easier, it’s also smarter and safer because you’re not exposing other people to a person who may be positive," New York Gov. Andrew Cuomo said at a news conference to open the testing center. It can handle as many as 200 carloads of people in a day.
The opening of the drive-thru, with much New York can-do and media attention, came after weeks of frustration and anxiety from residents here and around the country. Many people who’ve fallen ill with symptoms of the new coronavirus have found it nearly impossible to be tested for it, even with their doctor’s recommendation. Some patients have taken to social media to vent their frustrations about the lack of tests or delays in getting results. Meanwhile, 58 people from the NBA’s Utah Jazz, or with connections to the team, immediately got tests after one of the team’s players tested positive.
Early problems with a test developed by the CDC stalled the rollout of kits to public health labs across the country. For weeks, the CDC had the only lab that could run the test, severely limiting the number of people who could get checked. Those early missteps have been worsened by rigid rules at the FDA, which have prevented public and private labs from developing their own tests or testing large batches of samples at the same time.
Earlier in the week, Anthony Fauci, MD, the immunologist who directs the National Institute of Allergy and Infectious Diseases, acknowledged the problem.
"The system does not, is not really geared to what we need right now, to what you are asking for," he told the House Committee on Oversight and Reform. "That is a failing."
The system should work, he said, so that you put a test out to the public "and a physician asks for it, and you get it. The idea of anybody getting it easily the way people in other countries are doing it, we are not set up for that. Do I think we should be? Yes. But we are not."
On Friday, President Donald Trump announced changes to boost state testing efforts. He issued a memo directing the secretary of Health and Human Services to allow states to authorize their own lab testing -- something New York had been granted earlier in the day.
Trump also announced that the federal government was working with private companies to open more drive-thru testing sites in areas hit hard by the new coronavirus.
He said his administration was working with Google to set up a website where Americans can go to find out whether a test is needed, and if so, where to get one.
Health officials have said the lack of testing blinded everyone from seeing the scope of the new coronavirus in the U.S. It has also made public health officials less able to detect and isolate infected people and thus slow its spread. In Sacramento, CA, public health officials acknowledged this week that they’ve given up on contact tracing and quarantines, two tried and true measures used to rein in contagious diseases.
“The reason we have to move on is because testing did not occur. We’re still able to do about 20 tests a day,” Peter Beilenson, MD, director of Sacramento County’s Department of Health Services, told reporters for CaliforniaHealthLine.org. “If you really wanted to quarantine and contain the situation, you would have wanted to know who was positive and quarantine them. Because we never had the tests, it’s kind of a moot point, and the horse is out of the barn.”
In Washington, another hard-hit state, Helen Teixeira, age 50, an artist in Redmond, has been sick for more than a week with pain in her lower lungs and a cough that leaves her breathless. She says just walking a few steps from her home to her studio leaves her sounding like she's run a marathon.
She tried for hours on Friday night to get help at a local ER. A nurse heard her worsening symptoms over the phone and told her to head to the emergency room. She and her husband went, but the ER administrator wouldn't let her in the x-ray room to get the full scans ordered by a doctor, and they wouldn't swab her nose and throat to test.for COVID-19. She left feeling frustrated and stuck. She's also scared. She was told by a doctor that COVID-19 gets worse in the second week.
"I didn't get the care I needed for me. I didn't get the care I needed for the other people around me. The message coming out from our government is anybody who wants to be tested can be tested, everything is fine. Everything is not fine," she said.
She was told by a helpful nurse in the ER that they're only testing people who need to be hospitalized and on a ventilator.
"Once you're already so sick that you need to be in the hospital, that's when they want to burn a test, which sort of defeats the purpose of helping the public at large," her husband added.
Until the day that New Rochelle’s drive-thru opened, New York state, which is among the states with the most COVID-19 cases in the nation, had only been able to run about 3,000 tests -- total.
Critics of the U.S. testing system often point to South Korea, which can test 15,000 people a day. As of March 12, the number of specimens tested for coronavirus totals 3,903 by CDC labs and 9,721 by U.S. public health labs, the CDC reports. In contrast, in hard-hit South Korea, officials there had done more than 188,000 tests as of March 8.
As of March 11, 81 public health labs in 50 states were using verified diagnostic tests, according to the CDC.
Some universities, private companies, and foundations have already been working to fill testing gaps.
At the University of Washington virology lab, which opened a drive-thru testing center for staff, more than 250 people had been tested by March 11, with 3 positive tests, said Susan Hanson, a spokesperson.
Earlier in March, the Bill & Melinda Gates Foundation announced $5 million to help public health agencies in Seattle enhance their testing.
A task force including representatives from the Chan Zuckerberg Initiative and Stanford University will greatly boost how much the University of California, San Francisco, can test for and diagnose COVID-19 by paying for two diagnostic machines, a spokesperson says. Without the machines, the testing capacity is 40 a day. With them, it is expected to increase to about 160.
On its first day of in-house testing, Cleveland Clinic found five positive cases of COVID-19. The results are faster than at other facilities because the results are analyzed in-house, Cleveland Clinic CEO Tomislav Mihaljevic told CNBC in a Friday interview. The capacity is currently 500 tests a day, he said. "We will ramp up that capacity to 1,000 tests next week."
Containing a Cluster
New Rochelle has one of the biggest clusters of COVID-19 cases in the U.S. As of Friday, Westchester County had 158 people who had tested positive, most of them connected with the Young Israel synagogue in New Rochelle. The cluster was so concerning that the state has closed schools and public spaces in a 1-mile radius of the synagogue in an attempt to stop the rapid spread.
Priority at the drive-thru center is currently for New Rochelle residents. Testing is by appointment only.
"We are also prioritizing vulnerable populations," Cuomo said.
Right now, vulnerable people include seniors, people with compromised immune systems, and people with other illnesses -- especially respiratory illnesses, he said.
At the drive-thru, each person in the car gets a swab of their nose and throat. They fill out paperwork so they can be contacted with their test results. The process takes about 30 minutes. Results take about a day.
As the first cars approached, state troopers and county police officers stopped each car and barked orders through a megaphone.
"Stop. Hold up your ID or permit in the widow. Don't roll down the window. Do you work here, sir? Do you have any ID?”
Then, after a long silence, the officer seemed to strain to hear the person inside the car: “You have to go on the website."
Demand for COVID-19 testing has far outstripped the capacity of the labs in the state to perform it, so people are still being tightly screened.
It is a problem that's vastly frustrating to people who may meet some, but not all, of the high-risk criteria.
There are two top testing issues in New York, according to the governor's office: The FDA hasn’t approved enough labs in the state to process the tests, and the labs that do have permission have to do it by hand. They can't load up samples into a machine that could process them automatically.
For the time being, that means many people who want a COVID-19 test won’t find it easy to get one.
"This country is behind on testing, everybody knows that,” Cuomo said.
He said that after weeks of negotiation, his demands to decentralize testing and allow states to manage labs were met by the Trump administration Friday, just ahead of the president’s announcement. The FDA turned over control of testing to New York state. Cuomo quickly authorized 28 public and private labs to test, including using fully automated processing of samples.
New York, which has been able to run 3,000 tests to date, will be able to run 6,000 tests a day by next week, Cuomo said.
“So, we are down in the boiler room now turning all the valves,” the governor said in his second news briefing of the day. “Testing is probably the single most important thing we can be doing now.”
Other measures the Trump administration announced Friday include appointing a czar from the Health and Human Services Department to oversee testing, funding companies developing tests with fast results, and setting up a hotline for laboratories to call for such issues as lack of testing supplies.
There’s also a new pot of money to fund tests that will have rapid readouts, returning results within hours. The money -- $1.3 million -- goes to DiaSorin Molecular, LLC, of Cypress, CA, and to Qiagen LLC of Germantown, MD, to develop two different tests with rapid results. DiaSorin expects the test to be ready within 6 weeks and Qiagen within 12 weeks for the FDA to consider allowing emergency use.
Infectious disease expert Aaron Glatt, MD, calls the new administration action "an excellent move, extremely important, and demonstrates a recognition of the seriousness of this problem. More will be needed and hopefully will be forthcoming," said Glatt, who is chief of infectious diseases and a hospital epidemiologist at Mount Sinai South Nassau in New York City.
Not All Labs Can Process Samples
Eric Blank, DrPH, is chief program officer for the Association of Public Health Laboratories. "Right now there are test kits available for the public health side. Commercial labs and private labs are building their capacity as we speak," he says.
"It's not as easy as pulling kits and testing. You have to get the kit to the labs doing the testing. If a lab has not been doing this test, they have to go through a verification procedure outlined in the emergency use authorization to be sure it will work."
After a health care provider orders a test, the specimen is collected and sent to the lab. The test is processed and a report given back to the health care provider. "The health care provider is then responsible for reporting to the appropriate jurisdiction," he says.
Currently, all positive results from state public health labs have to be confirmed by the CDC.
"We are working on a requirement that we don't have to send to the CDC for confirmation because we are using the same test. That hasn't come through yet," says Blank, and that was still true Friday.
Will we catch up with demand? "Maybe, eventually, if the virus abates," Blank says. "We might be able to keep up with the more necessary demand." By that, he means those with symptoms and those most at risk. "The person who just wants to know, 'Do I have coronavirus or not,’” but doesn’t have symptoms or known contact with someone who is infected, “I would say to them, we need to use the test for people who really need the test."
Where Are the Tests?
There are many stories of people exposed who cannot get tested, even when the typical symptoms of cough and fever are present. Ryan Eiler, 16, after getting home from a model United Nations conference in New York on Saturday, March 7, complained to his mom that he had a headache, which isn't typical for him. The headache lingered over the weekend, but he went to school anyway Monday.
When Ryan came home from school a little early, sent home by the nurse after he developed a fever and a cough, Sarah Eiler's anxiety grew that he may have the new coronavirus. "I called his doctor's office Monday," says Eiler, 48, a reflexology and meditation instructor in Atlanta. She was hoping, of course, to have him tested for COVID-19, as fever and cough are typical symptoms. And she couldn't believe what she heard from the pediatrician's office staff. "They said, unfortunately they didn't have access to any tests at all," Eiler says.
Then Eiler remembered a story she had read about an online lab. "I called them, and they said, yes, they had a test." She ordered it online Tuesday morning, paying $245, and expecting delivery Wednesday.
She ended up not using it. Her pediatrician suggested instead doing a test for influenza first and tried to contact the county health department about testing. Thankfully, it turned out to be flu. "The doctor had to come in with a full hazmat suit," Eiler says. The result: Ryan had influenza B. "I've never been so happy to hear my kid had the flu," Eiler says.