Western Massachusetts health care providers say they have much better access to COVID-19 testing than a month ago, but ideally, they would like even more.
In mid-March, Estevan Garcia, chief medical officer for Cooley Dickinson in Northampton, was frustrated and concerned.
The hospital could not get enough testing supplies for COVID19. They were low on swabs to reach up the nose, on the liquid to transport samples, and they had to send most specimens to the state lab.
So the hospital mostly limited their rare tests to health care workers with symptoms and very sick patients.
“Things were taking a week to 10 days even to get results back [from the lab],” Garcia said. “It was so difficult.”
Garcia said there's now been a dramatic improvement. He said the hospital has plenty of swabs and transport liquid. They have a test they can run up to 80 times a day at the hospital itself. And the overflow goes by courier to its parent hospital, Massachusetts General Hospital in Boston, which turns around results the same day.
“And we can make determinations about the need for isolation, the need for protection, personal protective equipment,” he said.
Garcia said doctors can now test anyone at the hospital who has potential COVID-19 symptoms — and some who don't, including women about to give birth. The hospital also set up a drive-through testing site for people with a doctor's order.
Garcia said health care workers who've been in contact with COVID-19 patients can be tested, as well as people from nursing homes and rehab facilities, even if they don't feel sick, “because …the risk is higher being in those kind of communal living situations.”
The largest hospital system in the region, Baystate Health, said it's testing about 400 people a day at its main lab, and more at drive-through centers.
Primary care doctors say they can now get a test for patients they suspect of having COVID-19 by sending them to a hospital site.
“We're seeing signs that the tests are getting more available, which is nice,” said Joel Feinman, president of Valley Medical Center, which has offices in Hampshire and Franklin counties. “But it needs to go a lot further.”
That's because the expanded testing still leaves out a lot of people.
“We are able to test our patients at this time,” said Tania Barber, who runs Caring Health in Springfield, a community health center that serves many low-income people. But she’d like to test other people in the community who have little access to doctors or health care in general.
Springfield's health commissioner Helen Caulton-Harris announced the city would start testing homeless people at shelters. Like Caulton-Harris, Barber wants more testing of vulnerable populations, with or without symptoms.
“In particular, communities of color where the rates are higher,” she said, “and that population, we want to be able to reach out to. Find out where the hot spots are and be able to test those areas.”
“We’re not testing folks who come off the street who say, 'I'd like to be tested. I don't have any symptoms,'” said Garcia of Cooley Dickinson Hospital. “That's surveillance testing.”
Garcia considers surveillance testing the next frontier in controlling COVID-19. That's how you know who might be contagious without symptoms. But he said widespread testing across the population is more than hospitals alone can handle.
“Potentially, it's set up by a local department of public health, or the state Department of Public Health or even the National Guard, who knows?” Garcia said. “So that people can actually walk in and you can do thousands of these a day.”
Feinman would also like to see surveillance testing. But until the criteria loosen significantly, he's not directing his doctors to go beyond people who have a strong chance of being positive, either through symptoms or their job or contact with sick people.
“I think if we get into the realm of — anybody who just thinks they might have been in touch with somebody remotely [who has COVID-19], we'd be doing a lot more testing, and I think it would challenge the system,” Feinman said.
Feinman added that eventually, he’d like to test for COVID-19 in the clinic the way they test for the flu or strep throat.
“That it becomes available and that common, and the test is that reliable,” he said. “But we're many months away from that.”
Another way to gauge the spread of the coronavirus is through antibody testing, a blood test that can show who already had the virus and may be immune.
In a Facebook Q&A session, Baystate Health CEO Mark Keroack said that test is just coming onto the health care market.
“We’re anxious to get that kind of testing going here in western Mass. as well, so we'll be able to do better epidemic control,” Keroack said.
That would be a step on the way to allowing not only hospitals to resume more normal activity, but also society at large.
