We've all heard an endless stream of news about COVID-19, especially when it comes to testing. One of the things I've come to understand is that with a high enough level of testing, countries have been able to successfully mitigate or stamp out COVID surges as they arise. Widespread testing = less accidental transmission. For that reason, I'm a big believer in getting tests done early and often to limit the spread of the virus. The two closest calls I've had with COVID were a few months ago in Cleveland, Ohio and a few days ago at a friend's wedding in Lafayette, Louisiana. The interesting part in this story comes in my testing experience following the two events, and how drastically different it was state to state.
First, the Buckeye State
A few months ago, a group of my friends got together in downtown Cleveland for an outdoor meetup. One friend's coworker had unknowingly spread the virus to them a few days prior, and we all found out after they received a positive test. After the result, everyone who was at that hang out, and anyone who had been in contact with that group (IE me) scrambled for a test. Within 48 hours, our entire clique had been successful, most from a nearby CVS with drive-thru testing. My experience with this CVS lasted about 15 minutes from pulling into the parking lot to pulling out of the parking lot.
We needed to provide only an ID, a signature, some mucus, and a phone number to return our results. It was free. We didn't even have to leave our cars. Within hours, phone calls from the testing team went out to our group to notify us of our results (everyone was negative for anyone keeping score) and we all breathed a collective sigh of relief.
From a user's perspective, I took the ease of this process completely for granted. Worse, in November, I assumed that this late in the pandemic that testing would be this accessible everywhere. Boy was I wrong.
Then, the Swamp
Fast forward to November, a good friend of mine gets married. People are social distancing (somewhat) it's a large venue, but it's also a large group. I decide I want to get COVID tested for peace of mind going into Thanksgiving, and quickly realize that this was not going to be as easy as it was in Cleveland.
First, I tried CVS hoping to recreate my success there earlier this year. A quick google search and some phone calls made it clear that while there was drive-thru testing, there were no rapid tests available through CVS in all of Lafayette. I went anyway, figuring getting a lab test done (national average for results is in 3-4 days) is better than no test. However I heard from friends in Lafayette that they had previously waited 3-4 weeks for a COVID test result, which is insane given that every day counts with this virus. So I continued my search for a rapid test.
There were two options for rapid tests that I found via google; one was a MinuteMed clinic in the city, and the other a local hospital urgent care facility called Lourdes. Both involved extensive paperwork, multi-hour wait times, and in the case of MinuteMed, no ability to check-in online, which means waiting in a facility potentially riddled with COVID. I was also informed that the test would cost $100+, even with insurance!
Luckily, I had an in. My aunt let me know that there was another urgent care facility in Lafayette doing rapid tests called Lafayette General Urgent Care, but after scouring their website, I couldn't find any obvious signs that this was the case. I called anyway, and sure enough was able to book an appointment for COVID testing after answering a few questions, which brings me to my next point (I was negative, for anyone still keeping score).
Every place I went to in Lafayette, even CVS, requires a patient to have symptoms before becoming eligible for a test. The requirement seems to fly in the face of logic when you consider the colossal number of cases tied to asymptomatic carriers. The virus can take up to 14 days to show symptoms, a window of time wide enough for an unknowing carrier to infect a massive number of people. Clearly if you've had potential exposure, it would make sense to have access to a test as soon as possible, symptoms or not.
Each of these barriers:
-Long wait times for getting test and test result
Lead to lower rates of testing, and it's not hard to imagine why. Not everyone can afford to spend several hours of their week waiting for a test that's going to cost them over $100 dollars for a virus they might not even have, and might even catch as they're waiting in person to get tested. A person's ability to get a test when they need it should come down to more than luck and lying about symptoms, it should be a given.
I want to emphasize that none of this is the fault of the workers or even the individual companies in Lafayette, but rather of a fractured COVID response nationwide.
State vs. State
You may remember that at the beginning of this disaster that states were actually having to bid against each other for access to PPE and tests, and this acts as a perfect metaphor for how the rest of the response has gone. More well funded states, like Ohio, have done okay with virus response, while poorer states, like Louisiana, have suffered.
Cleveland (despite reports to the contrary), is a major city. It's the 53rd largest city in the US, and has managed to effectively provide tests to its residents. While COVID is surging nationwide and no state is doing well, to date Ohio only has 330,000 cases with a population of 11.69 million, or about a 2.8% positivity rate. Louisiana has about 220,000 cases with a population of 4.65 million, which is a 4.7% positivity rate, or almost twice that of Ohio's. The amount of pop up testing and drive-thru testing in Ohio has all but assured that anyone who wants a test, gets a test at no cost. Ease of access to testing is a large part of the continued difference between Ohio and Louisiana, and a sign of larger disparities between the states and their ability to help their citizens prevent the spread of COVID.
As I mentioned in a previous post about the concentration of wealth generation in the US, the outcomes in this country are becoming more and more divergent, between states with access to large cities (and subsequently, more taxes to fill their coffers) and those without; the pandemic has only made this more obvious.
We've tried the decentralized approach to pandemic prevention for the last 9 months, it didn't work. COVID is surging nationwide for the third time and it promises to be the largest spike yet. It's time for the states to coalesce their response and work together to subdue the virus, and this starts with helping each other out. Even with travel advisories in place, there are plenty of people crossing state lines for any number of reasons making any state-based approach nonsense. Your state's amazing access to healthcare and COVID testing means very little to the pandemic when a neighboring state doesn't have those same resources. COVID-19 has attacked our health with a single-mindedness that only a virus can muster. If we hope to contain it, we need to be just as unified in our response.