In Hayward and Fremont, city leaders have learned much about testing for the coronavirus through their drive-thru sites and have been adapting their strategies to match the needs they've seen.
Testing began six weeks ago, spearheaded by the fire chiefs in both cities. Hayward began its tests on March 22 to help take pressure off of hospital emergency rooms and provide quicker answers for health care workers and first responders with COVID-19 symptoms, Chief Garrett Contreras said.
No one who meets the criteria for the illness is turned away regardless of where they live, their immigration status or ability to pay. Of the 4,497 people tested during the first five weeks, 1,481 were Hayward residents and 1,666 live elsewhere in Alameda County, according to the city's website.
About 12% of the roughly 5,500 people tested through May 6 turned out positive, Contreras said. He attributed it to the city's large population of health care workers, first responders, people who work in congregate workplaces such as meat-packing and the wholesale food and beverage industry. Hayward also is home to "tons of long-term-care facilities staff" who commute around the Bay Area, he added.
Although the sites first adhered to strict criteria for symptoms as outlined by the U.S. Centers for Disease Control and Prevention (fever of 100 degrees or higher, cough and shortness of breath, high-risk groups such as seniors or people with heart disease, diabetes, etc.), Contreras said they soon learned that fever was a poor indicator of the illness.
"On the first day, the patient didn't qualify and now it's Wednesday and the disease is worse and they have a fever. They come back and they test positive. The patient has lost two days of potential treatment, and we've had two more days of spreading the disease," he said.
Sheltering in place, while important, is also limiting.
"That's good until you are sheltering in place in an apartment with nine residents," he said.
Hayward expanded its program, adding a mobile unit on April 22, following up on leads they often discover during the daytime testing. After the testing site closes, staff head out in the van to apartments and other places where people live in crowded conditions.
"Right now they are at an apartment (of) a woman whose parent tested positive. She's the breadwinner and cohabits with five construction workers. We're testing her and the five workers," he said on Wednesday.
The mobile unit spends its time early in the morning at long-term-care facilities. If there's been an outbreak, they'll test all of the residents and employees, or they'll do blanket testing if the county has so requested, he said. Sometimes they will test a wing of patients and staff at the request of a facility if it's had a positive case or suspected cases.
Contreras noted that although long-term care facilities are places where outbreaks occur because they are congregate environments, he hasn't found the facilities to blame.
"It's nothing they did," he said.
At one facility, they tested 140 patients and 120 staff members.
"Not one tested positive," he said.
At a food manufacturing site, after a worker there tested positive, the mobile team assessed 160 employees, but they found no further positive cases and the plant was able to continue its operations.
Contreras said they have also done targeted testing. Two other food-processing companies have asked to have their workers tested.
One place they haven't found many COVID-19-positive people: homeless encampments. Contreras said the mobile unit has gone to places where they know homeless people gather and sleep and offer to test them.
Hayward has paid for some of the testing, but Contreras is looking for other sources of funding and ways to reduce costs to keep the program sustainable.
In the first weeks, Avellino Labs, the Menlo Park-based laboratory conducting the PCR tests, charged the city $150 per test. The cost is now down to $75 each as the company has refined its technology, Contreras said. He hopes that with further refinements, the tests will cost $40 or $50.
He's also used volunteers, nonprofit organizations, city staff and personnel from the fire department. On May 18, a graduating class of new nurses may be utilized to do swabbing to help sustain the program, he said.
"One site is a drop in the bucket," however, he said. Alameda County could use seven more sites; Santa Clara County needs six or seven, he said.
"That's what will get to the government's goal to 30,000 a day," he said.
The city of Fremont decided to learn from Hayward, sending four of its personnel from the fire department to volunteer and learn about the testing program at a site adjacent to Hayward Fire Department Fire Station 7., Chief Curtis Jacobson said. Fremont did its testing at its fire training center, near an industrial area where there isn't much traffic and an adjacent feeder street could be used to divert traffic if necessary.
"Location, location, location is very important," he said.
Fremont provided $2.3 million for testing kits, infrastructure, safety equipment, personnel and temporary housing for staff so they would not have to travel home and risk contaminating their families. They used eight emergency medical technicians from a private ambulance service, which cost less than using firefighters and four hospital staff members who had been furloughed.
Like Hayward, there was no cost to the public and no one was turned away based on their immigration status. About 50% to 55% of those who came for testing came from Alameda, Contra Costa and Stanislaus counties; 40% came from Santa Clara County, he said. Among them were firefighters, police and health care workers who weren't able to access tests in Santa Clara County, he said.
Fremont also targeted its testing to these groups and to vulnerable populations. They also did outreach to residential care facilities and focused on workers in those facilities, he said.
"We're open to anyone who has symptoms," he said.
The most people they tested in one day was 181, and they were initially open daily. Currently, they operate Tuesdays and Thursdays from 11 a.m. to 2 p.m. on an appointment basis as well as through a mobile service.
Fremont is now testing grocery store workers and those who work in "big box" stores — groups that will come into contact with many people, he said.
The program is expandable, but that's predicated on receiving additional funding from the federal and state governments and whatever the county public health department provides, he said. He'd like to be involved in a regional program, but that will depend largely on funding.
A large testing program should be mobilized "like mutual aid for wildland fires," he said, where testing groups can be moved to locations where they are most needed and can strategize, he said.
Symptoms of COVID-19
The U.S. Centers for Disease Control and Prevention currently lists the common symptoms of COVID-19 as:
• Shortness of breath.
• Muscle pain.
• New loss of taste or smell.
• Vomiting or diarrhea.
• Sore throat.
This article is part of a larger story on Santa Clara County's efforts to ramp up COVID-19 testing, which can be found here.
Editor's note: This article incorrectly stated which city provided $2.3 million for testing kits, infrastructure, safety equipment, personnel and temporary housing for staff. Palo Alto Online regrets the error.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.