March 17, 2020 Advisory Board's take: Why drive-thrus are only the first step to improving access to COVID-19 tests

Cases of COVID-19, the disease caused by the new coronavirus, are rapidly increasing in the United States, and to help detect cases, several states and health care providers are launching drive-thru testing.

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About the global pandemic

Reports of COVID-19 first surfaced in early December 2019 in Wuhan, China. While the number of new cases of COVID-19 reported in China has been dropping, newly reported cases of the disease have spiked in other countries, with COVID-19 reaching global pandemic status.

As of Tuesday morning, officials reported more than 182,100 cases of COVID-19 globally, including about 81,000 cases in China and about 100,000 cases elsewhere. Officials said as of Tuesday morning there had been at least 7,305 deaths linked to the new coronavirus, including about 3,200 that occurred in China and about 3,800 that occurred elsewhere.

The United States saw its first COVID-19 case in late January, and cases have spiked since then. As of Tuesday morning, state and federal officials had reported 4,482 cases of COVID-19 and 86 deaths linked to the new coronavirus in the United States.

How drive-thru testing helped South Korea's efforts to contain the virus

In recent weeks, the federal government has come under scrutiny for its response to the virus, particularly when it comes to testing efforts. The main points of criticism have centered on faulty tests from CDC; the rules about which labs can perform tests; and the criteria under which patients can be tested, which CDC updated last week. According to the Washington Post, these issues, taken together, "gave the virus a head start to spread undetected."

Some observers have contrasted the United States' response against South Korea's.

In South Korea, drive-thru COVID-19 testing has helped the country increase daily testing capacity. Currently, South Korea has a daily testing capacity of 15,000, which has allowed about 250,000 South Koreans to be tested since the COVID-19 outbreak began on Jan. 20, NPR's "Goats and Soda" reports. The drive-thru tests last about 10 to 15 minutes.

According to the Los Angeles Times, South Korea's aggressive testing has allowed public health officials to detect outbreaks and focus their resources more carefully, and isolate people who could potentially spread the new coronavirus.

With the hopes of increasing testing in the United States, President Trump on Friday announced plans to ramp up drive-thru testing across the United States.

How states and providers are using drive-thru testing  

Across the United States, states and providers have launched drive-thru testing sites to mitigate the spread of the virus and speed up testing. For example, sites have opened in California, Colorado, Connecticut, Minnesota, New York, Texas, and Washington.

Colorado's Department of Public Health & Environment on Wednesday launched the first drive-thru testing center in the state. To be tested, patients must have a doctor's note and photo ID. At the site, patients will drive to a secured area and be tested in their cars at no cost.

Meanwhile, UW Medicine, in Washington state, has been investigating whether its staff can successfully conduct COVID-19 testing through a drive-thru site in a parking garage at University of Washington Medical Center-Northwest. Nurses who are stationed in tents across the parking lot are conducting the tests on employees who remain in their cars. As of Wednesday, they had tested 231 patients. UW Medicine spokesperson Leila Gray in an email told Modern Healthcare the hospital plans to open another drive-thru clinic for patients.

Similarly, M Health Fairview, based in Minneapolis, has set up drive-thru testing at four of its clinic locations. Before patients can receive a test, providers must screen them to determine whether a test is needed. Patients must either call ahead or visit the health system's online care portal for a screening. Patients who show up to the drive-thru without being screened will be directed to the health system's online portal. The health system also is waiving out-of-pocket charges for patients visiting the hospital for treatment for COVID-19 and upper respiratory infections.

In Ohio, University Hospitals (UH) and Cleveland Clinic have partnered to offer drive-thru COVID-19 testing for patients with testing orders from the doctors. The drive-thru testing became available for Cleveland Clinic patients on Saturday at 11 a.m. and for UH patients on Monday at 11 a.m. The drive-thru testing sites will be open seven days a week from 11 a.m. to 7 p.m.

On Sunday, Verily, one of Google's sister companies, launched a pilot website to screen patients for COVID-19. Google said the site is designed to allow "individuals to do a risk assessment and be scheduled for testing at sites in the Bay Area." The website prompts visitors to answer a yes-or-no question: "Are you currently experiencing severe cough, shortness of breath, fever, or other concerning symptoms?" If patients answer yes, the website will stop the screening and recommend the patient seek immediate medical attention because Verily's mobile testing sites are not equipped to handle acute cases of COVID-19.

How effective is drive-thru testing?

According to experts, efforts to expand drive-thru testing might help contain the new coronavirus in areas of the country where the intensity of infection is low, but in much of the United States, it's probably coming too late to make a difference, particularly in hot zones, like Seattle, where there are hundreds of cases.

In response to Trump's calls for more drive-thru clinics, Dena Grayson, a physician and an expert on pandemics who worked on the 2014 Ebola outbreak in the private sector said, "I'm unsure why this step wasn't taken weeks or months ago. The virus has been circulating in the country this whole time, and we have had very limited capacity to detect it. The problem is we're in a situation where the cat is already out of the bag." However, Grayson noted, "This will be very effective in places where there’s not a high intensity of infection and we can catch people early."

Grayson said tests will need to be free in order for patients who are uninsured or undocumented to access them and for public health officials to quickly detect and isolate cases (Ward, Vox, 3/14; Bannow, Modern Healthcare, 3/11; Rall, FOX 8, 3/14; Bercovici, Los Angeles Times, 3/16; Kim, Los Angeles Times, 3/14; Engelberg et al., ProPublica, 3/15; Burton et al., Wall Street Journal, 3/12; Roland/Loftus, Wall Street Journal, 3/13; Secon, Business Insider, 3/13; Johnson/McGinley, Washington Post, 3/7; Kuhn ,"Goats and Soda," NPR, 3/13).

Advisory Board's take

Why drive-thrus are only the first step to improving access to COVID-19 tests

Brandi Greenberg, Managing Director

Health care is not typically thought of as an on-the-go, drive-thru industry—but these are not normal times. During the COVID-19 pandemic, drive-thru test sites—first, in South Korea and now, in the United States—have emerged as an efficient way to expand testing access while also protecting patients and providers from unnecessary exposure. While the United States' actual capacity to test for COVID-19 remains unclear, the proliferation of drive-thru test sites is good news, but it's by no means a panacea for our testing woes.

Drive-thru tests are most useful for people with readily available access to a car. However, the intersection of vulnerable populations and individuals without access to private transportation is significant. For the elderly, children, and people who are reliant on others for transportation, drive-thru tests don't help much. In fact, they could exacerbate disparities in access to care. Pandemic experts have cited walk-through clinics for individuals who can't (or shouldn't) drive as a valuable, supplemental strategy.

For the new drive-thru test sites to have maximum impact, other parts of our nation's comprehensive approach to COVID-19 testing must also work in tandem. Consumers must understand when they should get tested. And they should not be hindered by fear of excess fees or threats to immigration status. Newly-approved private and hospital-based labs need to ramp up their testing capacity as fast as they are able, and more AMC-based labs should strive to come online.

Suppliers of critical reagents and lab materials must accelerate production and distribution so we have enough testing kits to process the influx of samples our expanded drive-through sites will generate. And even when the new tests from Roche and Thermo Fisher come online—both of which promise far faster turnaround times—lab technicians will still need time to get trained on those new technologies. Finally, providers need flexible, coordinated ways of communicating test results to drive-thru patients since many may not have access to online results portals.

CDC, FDA, and other parts of the federal government have done much in the past week to reduce the regulatory red tape and confusion inhibiting broader testing. But it remains imperative that all parts of the health care industry—providers, suppliers, labs, and retail testing sites—work together to ensure broad access to testing and effective ways of communicating results, especially for patients in underserved communities.

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