There was a time in March that health officials had a clear message for the public: Unless you are very sick with symptoms of Covid-19, don’t even bother trying to get tested. Limited supplies were reserved only for patients who checked the boxes on all the symptoms.
By May, the message from county and state health officials had changed: It was, please come and get tested, whether or not you have symptoms. The state of California, using contractor OptumServe, set up two free testing sites, in Salinas and Greenfield, and the pressure was on in Monterey County to max out their usage, otherwise the state might close them. And Monterey County, like other counties, was under pressure to boost testing to get the California Department of Public Health’s blessing to reopen certain sectors of the economy.
Now, with a system that cannot keep up with testing demand, the message has changed again as state officials try to strike a balance.
The county’s OptumServe sites have remained busy in the two months since. Each can test 132 patients per day; usage at the Salinas testing facility is at 97 percent, and in Greenfield, 88 percent of capacity.
Planned Parenthood set up a drive-thru testing site at Monterey Peninsula College, which can serve up to 100 patients per day two days a week. It’s first-come-first-serve, no appointments; but it’s not uncommon for 100 vehicles to be waiting before they open at 9am.
Getting testing facilities up and running – and getting people to use them – proved to by only part of the challenge, though. OptumServe and Planned Parenthood both process samples at Quest, and as other states have ramped up testing, the lab has a backlog. On July 1 at the Salinas testing site, patients received a printout with information on how to retrieve their results; where the handout said, “Your test results will be processed and ready for you in 48-72 hours,” the number was crossed out and someone had written above it in pen, “3-5 days.”
Faced with mounting complaints of slow test results, Quest issued a statement July 6 on the bottleneck: “Demand has continued to rise nationwide, particularly in the South, Southwest and West regions of the country, outpacing our capacity. As a result, the average turnaround time for reporting test results is now one day for Priority 1 patients and 4-6 days for all other populations.”
California Health and Human Services Secretary Mark Ghaly issued a statement on July 4 praising California’s increase in volume – and acknowledging the slowdown. “Together, we increased testing from 2,000 tests per day to 100,000 tests per day in just a few months,” Ghaly said. “We did this by: (1) building laboratory capacity within public and commercial laboratories; (2) establishing new specimen collection sites outside the healthcare delivery system; and (3) disrupting the testing supply chain to ensure adequate supplies of viral media and swabs. As more states begin to scale their testing capabilities, new constraints are materializing within the supply chain.”
Julia Thomae manages the Watsonville Planned Parenthood clinic and the MPC testing site, which is equipped to do 200 tests per week, balancing staff availability and supply availability. “There is no one factor that is the most limiting,” she says.
On July 14, the California Department of Public Health issued new testing guidelines – hospitalized patients with Covid-19 symptoms, close contacts of confirmed cases and patients located in contact tracing are designated as highest priority. On July 15, Ghaly announced the creation of a new testing task force in concert with the new guidelines.
In Monterey County, a total of 34,722 tests have been processed as of press time, with 2,835 positive results. The positivity rate over the past two weeks is 13.4 percent – higher than the 8-percent target for reopening goals. The average turnaround time is three days, but it can take up to 14. The county reports its data based on when test results are received, meaning a lag behind the dates people became infected; with priority on people with symptoms, negative test results may be slower to appear in the data.
The cost per test is roughly $100, but pop-up sites that require infrastructure set-up and take-down can be more expensive. Still, with funding from the Natividad Foundation, the county hospital Natividad has offered five pop-ups, with a sixth planned for July 16 in Monterey; they generally serve the first 100 people to show up. “More requests are coming for testing than we can ever possibly fill,” Natividad CEO Gary Gray told the board on July 10. “We need to take a step back and look at a broader strategy.”
County Supervisor Chris Lopez, who serves on the Natividad board, spoke to patients at a pop-up in King City on July 9. One man from Carmel Valley had tried to get tested at MPC, then drove to King City where he was seen. “He was just thankful it was made available,” Lopez says. “Our community is extremely appreciative.”
Pop-ups, Lopez adds, are likely here to stay as a way to reach more people: “The demand we see is real. It’s low-barrier testing. For someone who’s tech-averse, or perhaps doesn’t have status in this country, putting a lot of information into [the OptumServe] website is daunting.”
The state contract with OptumServe runs through Aug. 31; uncertain of whether testing in Salinas and Greenfield will be extended, county officials are negotiating for one or two county-run sites that would operate beyond that date. And Planned Parenthood is considering how they might add capacity at MPC.
“We’re transitioning from a sprint to a marathon,” Thomae says. “When we started it was, let’s put this together really quickly and meet this immediate community need for a short period of time. Now the reality is, as long as we have a pandemic, there’s going to be a need.”