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.
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.”