Doctors Bring Coronavirus Testing To Underserved Communities

Apr 17, 2020
Originally published on April 23, 2020 9:27 pm

Cars line up in a parking lot outside what is usually a co-working space for women of color in Culver City, Calif. But on this day, it's a makeshift lab for free, rapid antibody testing. These tests are supposed to detect an infection with or past exposure to the novel coronavirus.

Marilyn Arrington is inside her car, speaking to a doctor in Chicago via video chat. A volunteer wearing a mask holds up a tablet computer making this interaction possible.

"Coughing?"

"No."

"Fever?"

"No."

But Arrington is 73, has diabetes, high blood pressure and recently had open heart surgery.

The doctor tells her she's at moderate risk with her underlying conditions and age, and approves a test.

Her great-grandson, Josiah, is sitting in the back seat. It's the furthest he can be from Arrington. The eight-year-old doesn't have symptoms and so the doctor said no test for him.

Another volunteer pricks Arrington's finger, draws blood and drops the sample in a cup. Arrington hopes the results tell her she doesn't have coronavirus or has already had it so she can be with her loved ones.

"I haven't been in the room with my family in three weeks," she says.

Her two daughters won't visit. Her granddaughter and Josiah live with her but stay away from her for fear of making her sick. So she sits alone in her bedroom. The whole family is trying to get tested so they can be together again.

"It's killing me because I need to talk to people, see people," Arrington says.

This car ride is the closest Arrington has been to her great-grandson in weeks. "I want to hug him and do things with him, help him with his homework and right now I just can't."

Arrington's family is trying to protect her, especially as data from states around the country and the federal government indicate that African-Americans have been particularly hard hit by the coronavirus. So far data out of Los Angeles County show that African-Americans account for 16 percent of the COVID-19 deaths but are only about nine percent of the population. And that's based just on the limited testing that's been done so far.

For Arrington, getting a test means "I can get out of my room finally," she says, then puts her hands to her heart. She'd never tried to get a test before because she didn't know how.

She got this one for free through myCovidMD. It's a task force of the Shared Harvest Fund, a non-profit formed originally to tackle student debt. The new task force was founded by three black women, all doctors, who want to get health services and testing to the people who need it: those who don't have access to health care, the uninsured and under-insured. So this is one of several pop up testing sites the group has planned around Los Angeles. And it's helping other cities, like Houston, do the same through crowd funding and private donations. People who want the test and have the means are asked for a donation to pay for a test for someone else in need.

Volunteers test blood samples at a pop-up testing site in Los Angeles County
Leila Fadel / NPR

Among the founders is NanaEfua Afoh-Manin, an ER doctor. She walks around the parking lot in a mask and face shield consulting with patients.

This infection, she says, is spreading in people's communities. And so the solution is to take testing and health services to those communities, especially marginalized groups who are particularly vulnerable right now.

"It's a very well-known saying that when America catches a cold, black America catches the flu," says Afoh-Manin. "We know this because unfortunately a lot of black Americans and other minorities are uninsured or underinsured or the working class."

She says marginilized communities often don't have access to a lot of medical resources even when there isn't a crisis. "The number one luxury right now is telemedicine."

When this pandemic began, Afoh-Manin says she knew many people would fall through the cracks, because typically the place where the most vulnerable go first with health problems is the emergency room. But public officials have asked everyone to stay away unless it's a true emergency.

"You can't go to emergency departments, so you go see your doctor right? Or call your doctor on a computer screen. So what happens if you don't have Wi-Fi at home? What happens if you don't even have a doctor to call? That was the emergency department. But we're telling you not to go there," she says. "So where are we telling these people to go?"

For many people, Afoh-Manin says, the answer is they have nowhere to go and no one to call.

"I had to create someone for them to call. And that's what we did. We created a network of people who care," she says. "I wanted to make sure those who fell out of the safety net were caught."

Right now, Los Angeles County is offering free diagnostic testing and is working to expand testing capacity in neighborhoods that have less access to health care. But like the nation, testing is still severely limited. So, without severe symptoms, people are typically told they can't get a test even if they have underlying conditions that put them at risk. As of Monday, just over 0.5 percent of the state had been tested, according to data released by the state of California. Across the country, about one percent of people had been tested, according to a Johns Hopkins tracker.

At the pop-up testing site, the test for the coronavirus is just the start. People also get video visits with healthcare workers and are paired with a crisis buddy.

"They get their first visit on site here and they follow up with two visits afterwards," Afoh-Manin says. "It's important for us to do the first visit here so people get comfortable with what that looks like. It also helps us identify who can't get tele-medicine, because then we have what we call a home wellness check."

A wellness check means a case manager visits someone at home or gives them a call to check in to see how they're doing. That's how Afoh-Manin hopes to mitigate the spread of the virus and stop other chronic diseases from killing people who are isolated, especially now when so many social services and support systems are suspended.

The tests myCovidMD is conducting are blood tests, not swab tests. It's unclear how accurate the testing is, a concern with much of the new testing that's been rushed out in the midst of the pandemic. The FDA has warned about false negatives with the blood tests for people who are early in the infection and haven't built up antibodies. So far the FDA has explicitly authorized three of these tests for emergency use but dozens of others are also on the market. The test is used mostly to identify people who've had the coronavirus and built up some antibodies to fight the infection. It's still unknown though how much immunity a person has as a result of those antibodies.

Meanwhile Los Angeles County is working with USC to conduct a study to try to understand the spread of the virus by testing the blood of a random sampling of 1,000 residents across the region's different demographics.

The pandemic has shone a light on longstanding disparities in healthcare.

"This COVID-19 crisis has exposed many of the gaps in our healthcare system and in our public health system, and frankly, in our society that were always there," says Christina Ghaly, LA County's Director of Health Services. She says it illustrates "the raw ugliness" of unequal access to services for "communities of color," based often on where people live and what resources are available.

At the four county hospitals Ghaly oversees, testing has been the biggest challenge. So far, only one hospital has onsite testing for the coronavirus.

The county is working to expand testing in the hospitals and under-served communities. But county hospitals have fewer resources then many private hospitals have.

"It's very different if you have a payer mix that is nearly 100 percent uninsured or Medi-Cal, like the public hospital systems in Los Angeles County that are run by my department, versus if you're a hospital system that relies on patients who are all privately insured or even that have Medicare" says Ghaly.

Private hospitals typically structure services in a way that attracts those patients and insurers. So, she says, they make a lot more money then public hospitals, which are the public's safety net. The vast majority of patients at county hospitals live below the poverty line.

Ghaly says she hopes that this pandemic pushes everyone to take a vested interest in making sure that the healthcare system is equitable for all individuals. "That's, I think, our moral responsibility as a people," she says. "I hope that people see also that it's a public health imperative."

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AILSA CHANG, HOST:

And now the story of three doctors, black women from three hard-hit cities - New York, Chicago and Los Angeles. Each is trying to bring free antibody testing and telehealth services to marginalized communities, communities without broad access to health care. NPR's Leila Fadel reports from a mobile rapid testing site just outside Los Angeles.

UNIDENTIFIED PERSON: One, two, three.

MARILYN ARRINGTON: See, Scooty (ph)? Wasn't that bad.

LEILA FADEL, BYLINE: Marilyn Arrington holds her ring finger up to a medical volunteer in a parking lot. He draws blood and drops the sample into a plastic cup with her contact information. The test is supposed to detect antibodies that show an infection or past exposure to the coronavirus, although the tests are new, have mixed results and many warn can't diagnose an early infection.

ARRINGTON: I haven't been in the room with my family for three weeks.

FADEL: Arrington is diabetic, 73, and had open heart surgery, so she's been in her bedroom alone. Her daughters won't visit. Her granddaughter and her great grandson Josiah live with her but stay away for fear of making her sick. They're all trying to get tested. Josiah's in the back seat. The doctor said he doesn't need a test.

ARRINGTON: It's killing me 'cause, you know, I need to talk to people, see people. I want to hug him and do things with him, helping with his homework and stuff. And right now, I can't.

FADEL: Getting test results...

ARRINGTON: That means that I can get out of my room - finally.

FADEL: And the family can be together. Arrington and her family didn't try to get tested before because they didn't know how. While diagnostic testing for the infection has expanded in LA County, like most places, it's limited. And there's a backlog of needed swabs. And while Los Angeles County is offering free testing, because Arrington hasn't had symptoms, she'd be screened out despite her underlying conditions. It's why NanaEfua Afoh-Manin and two other ER doctors started myCovidMD, organized through the nonprofit she founded, Shared Harvest Fund, to get tests and telehealth services to the communities that typically don't have access. That lack of access, Afoh-Manin says, is why she thinks COVID-19 seems to disproportionately impact black Americans.

NANAEFUA AFOH-MANIN: When America catches the cold, black America catches the flu. Unfortunately a lot of black Americans and all the minorities are uninsured and underinsured. They're the working class. Because of that, they don't have access to a lot of resources. And the No. 1 luxury right now is telemedicine.

FADEL: Her voice is muffled because she's wearing a mask and a face shield. Other doctors in other cities are consulting via video chat on tablets held up by volunteers. Afoh-Manin says, pre-COVID-19, the ER was the place people went when they didn't have a doctor or resources. Now they're being told to stay away.

AFOH-MANIN: So I had to create somebody for them to call - wanted to make sure those who fell out of the safety net were caught.

FADEL: Right now, the tests are paid for with private donations and crowd funding. And if people test positive, they're paired with a crisis buddy to help them navigate treatment and services. LA County is also working to expand testing in underserved neighborhoods. At county hospitals, access to diagnostic testing has been the biggest challenge. Christina Ghaly is LA County's director of health services. She says the vast majority of patients at the hospitals she oversees live below the poverty line.

CHRISTINA GHALY: This COVID-19 crisis has exposed many of the gaps in our health care system and in our public health system and, frankly, in our society that were always there. They have just exposed them and exposed them for the raw ugliness that they are in terms of unequal access to services.

FADEL: And she says how communities of color often don't have access to treatment based on just where they live and what resources are available. She says, post-pandemic, she hopes the public takes a vested interest in making the system more equitable for all.

Leila Fadel, NPR News, Los Angeles. Transcript provided by NPR, Copyright NPR.