Dr. Jonathan Fuchs, center, at the Latino Task Force hub on Alabama Street. Photo by Lydia Chávez

The head of Covid-19 testing strategy for San Francisco said in an interview with Mission Local that people making appointments at the city’s two fixed testing sites will only be able to schedule tests “about three days” in advance, rather than the current lead time of two weeks. 

The decision to tighten the appointment window will make it less convenient for low-risk testers curious about their status to go to the Embarcadero or the Alemany site. Doctors refer to these testers as “the worried wealthy,” who should be going to their private providers. 

Dr. Jonathan Fuchs, who leads San Francisco County’s testing strategy at the Department of Public Health, said  “That restriction (a three-day window) would help us further make sure that the resources are available for testing for those who need it.” 

The city, he added, is “really trying to focus these resources for people who are symptomatic and who are close to known positives, and for essential workers.” The change, he said, will happen soon.   

The city has come under increasing pressure to use more of its testing resources for the communities — specifically the Latinx community — hardest hit by the pandemic. Latinx residents account for 15 percent of the city’s population, but 45 percent of the city’s Covid-19 cases. Only 18 percent of the 160,000 people tested at DPH sites in October and November were Latinx.

Critics blame the low numbers on a failure to successfully target high-risk communities. 

“The response has definitely favored the privileged,” said Monica Gandhi, the medical director of the HIV Clinic, Ward 86, at the University of California, San Francisco.

Dr. Kirsten Bibbins-Domingo, the vice dean of population health and health equity at UCSF, added, “If you have one goal of the pandemic throughout, it is to try to make sure that you’re always matching the amount of testing to where there is transmission.”

“Why hasn’t that happened?” Bibbins-Domingo said. “I don’t know that I really have a good answer for that. … It is the responsibility of our elected leaders to ensure that we are testing where it’s needed most.” 

Up until mid-November, more than 70 percent of the city’s testing resources went to the city’s two fixed sites at the Embarcadero and SoMa, where positivity rates have consistently been low. 

In recognition of the need to reach more at-risk communities who live in the southeastern part of the city, DPH closed the SoMa site in mid-November and moved it to the Alemany Farmers Market. 

Still, in the recent surge, the vast majority of the city’s tests — 68 percent in October and November — went to the Embarcadero, where the overall positivity rate was 1.18 percent, and 2.9 percent for Latinx residents.  

Testing distribution and positivity in October and November. Source: DPH

In sharp contrast, the alternative clinic sites, where DPH has successfully reached Latinx and vulnerable populations, received only 9.6 percent of all tests in the same two months. That’s despite high rates of positivity at those sites: 6.3 percent overall and 10 percent for Latinx people being tested.

In the last two weeks of November, the Alemany Farmers Market overall positivity was 3.6 percent and 6.4 percent among Latinx residents – an indication that moving the fixed site there has successfully reached more residents at a higher risk of getting covid. 

Nevertheless, Alemany’s test allotment remains low — 500 a day, only four and a half days a week — compared to some 1,700 a day at Embarcadero, where most people appear fine, but can test seven days a week.

In other news, Fuchs also said the city would begin using the BinaxNow rapid test, which UCSF and the Latino Task Force has used in two recent testing campaigns. He said they were talking to their partners and it could be used “as early as this week” at some of the DPH community clinics.

It will take at least a month to know whether these moves — opening Alemany and adjusting the scheduling process — will succeed in reaching sufficient numbers of at-risk residents.  

Santiago Lerma, a legislative aide to District 9 Supervisor Hillary Ronen said: “There is an acute awareness of where the issue is. If we know where all the people with Covid are, there should be testing sites all over the place … it’s common sense.”

When this is all over, Gandhi said, the city’s response will be examined closely.  “You really could use this as an opportunity to think fundamentally about our common response and take this as the moment of reckoning.”

Lydia Chávez

I’ve been a Mission resident since 1998 and a professor at Berkeley’s J-school until 2019. I got my start in newspapers at the Albuquerque Tribune in the city where I was born and raised. The Tribune...

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10 Comments

  1. Embarcadero tested 5 times as many people as Alemany & ATC sites combined. If we were testing the high-risk population at the same rate we are testing low-risk populations at Embarcadero, we would potentially have found THOUSANDS more cases of COVID during that time.

  2. And the reason why the City has not commandeered the 1979 Mission parking lot behind the BART station where the remaining transit lines still come together to set up testing on demand near where the most at-risk people live is what again?

  3. So instead of making it easier for people to get tests they restrict appointments and make it harder to schedule? What?

  4. The city’s entire approach to testing has been miserable, routinely trying to discourage testing, making it as difficult as possible to access, and passing off responsibility to others instead of treating it the fundamental public health measure that it is. Nobody’s going to make a dozen phone calls to try to find a test if they feel a little under the weather; every single person in the city should just have clear easy directions on where to go anytime if they want a test. The Alemany test site isn’t even open on weekends or after 3:30pm. We know that asymptomatic transmission is a huge part of how the virus spreads, yet the city has never had a real strategy for asymptomatic testing.

    The “pilot programs” run by the Latino Task Force and UCSF have demonstrated, over and over again, that these low-barrier testing efforts work extremely well and catch asymptomatic cases early. Why are they still pilot programs? Why do we do them for a couple days and then stop?

    By way of comparison, UC Berkeley’s on-campus testing effort would be the equivalent of if San Francisco did 130,000 tests/day, scaled for population.

    We’re 10 months in. We should have walk-up testing, strategically located, on demand for everyone who wants it without question or judgement, 7 days a week with extended hours, with support for you if you test positive.

  5. Thank you for the great journalism and the continuation of these articles highlighting … dunno what to call it at this point … “issues” I guess.

    There is one paragraph – quite disheartening to read.
    This is what it should have said:

    Santiago Lerma, a legislative aide to District 9 Supervisor Hillary Ronen said: “There is an acute awareness of where the issue is. We know where all the people with Covid are, Supervisor Ronen and the entire staff are fighting hard to demand testing sites all over the place within the next couple of weeks…it’s common sense.”

    Instead we got a legislative aide stating the obvious with a “somebody should do something about that” vibe. The problem in a nutshell.

  6. DO NOT SEND PEOPLE TO THEIR PRIMARY CARE!!!!!!
    WE DO NOT HAVE PROPER PPE TOTEST PEOPLE!!!!!!
    PATIENTS HAVE TO BE ALLOWED TO USE PUBLIC TEST NO MATTER WHAT INSURANCE OR NOT

  7. 1st less then 3% of the SF population lacks health insurance so we are talking about a small % of the population needing a city run site. The Embarcadero is a great location for drive through tests and represents a wide cross section of neighborhoods.
    The writer is just plain Stupid because the stats do not include testing being done on a daily basis at SF General where many on MediCal are being served.

  8. The factors that make the Embarcadero a testing site not serving at risk population cannot be pinned on the “worried wealthy” who have the same right to be tested as anyone else. It is on the city to make the facilities logistically accessible and more user friendly to at risk community. As the numbers surge, curbing access to testing in any way is asinine. Not t to mention that trying to arrange testing through insurance providers takes the better part of a day. The answer is always to try city run test sites or free clinics and wait in line for as long as it takes. I learnt that when I had to stop working for 2 days to get my kid tested.

    1. Yes, it is a shame that private providers make it difficult. I hear Kaiser has made it easier, but have not checked. The problem is that when the city has limited testing resources, it probably wants to targe those who are getting sick. If you live in the Mission, it is convenient to go 219 Barlett St five days a week https://missionlocal.org/2020/12/new-bartlett-site-has-long-wait-but-thats-fine-by-mission-residents/ and if you can wait until Thursday to the LTF hub at 701 Alabama. Hope your son is okay,

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