Counties demand help with testing
Kaiser, Sutter, other large providers told to do more
Santa Clara County on Wednesday issued a new order demanding that Kaiser Permanente, Sutter Health and other major health care providers ramp up their coronavirus testing capacity to carry more of the burden that so far has fallen primarily on public health services.
The new order, which takes effect June 15, requires that all hospitals and their associated clinics in the county offer testing to members who have symptoms of COVID19 or have had contact with someone who tested positive, along with all frontline workers who may be regularly exposed to the coronavirus in the community.
Kaiser, the Bay Area’s largest health care provider, specifically has been criticized by Santa
Clara County officials for not providing enough testing to its members. Contra Costa County officials said Kaiser also has come up short in testing residents there.
Kaiser said it is complying with the order and has been testing asymptomatic patients. More than half of the tests it is conducting in Northern California are of asymptomatic people, including first responders, health care workers and others at high risk for exposure, a Kaiser spokeswoman said Wednesday.
But public health officials say it’s not enough. Other large providers, including Stanford and Sutter Health’s Palo Alto Medical Foundation, are also not testing enough of their own patients, they said.
Dr. Marty Fenstersheib, the COVID19 testing officer for Santa Clara County, said the countyrun Valley Medical Center and community clinics have done most of the testing in the county. The county is testing about 2,400 people a day and wants to get up to 4,000 people a day.
“The county can’t do it by itself,” he said. “The small community clinics can’t do it by themselves, but the large health care centers, large clinics in this county need to step up and help provide additional testing so we can meet our goal.”
Kaiser has about 4.4 million members in Northern California, which represents about 30% of the region’s insured population. Kaiser said Wednesday that it has conducted about 12% of the total testing in California and intends to increase testing going forward.
The health system opened a laboratory in Berkeley this month that it expects will double its daily testing capacity to 6,000 tests a day.
“We were one of the first health care providers to offer COVID19 testing starting in early March and we have continuously increased our capacity to expand testing to broader groups,” Tom Hanenburg, interim president of Kaiser Permanente Northern California, said in a written statement. “Our ability to expand our testing capacity even further is based on the availability of testing equipment and supplies, and we are working diligently to obtain those, which are in short supply worldwide.” Sutter declined to comment. Stanford was one of the first Bay Area providers to begin testing, in early March, after developing its own lab test. It has conducted about 72,000 tests so far.
“Since the beginning of the pandemic, Stanford Medicine has been committed to supporting COVID19 testing for the greater Bay Area community and to date has partnered with medical facilities across 14 Northern California counties,” said Dr. Christina Kong, medical director and chief of pathology service for Stanford Health Care. “Within days of our COVID19 test receiving FDA permission for testing, we made it available to other medical facilities who lacked access to timely testing. As these facilities developed their own COVID19 testing, we shifted to providing COVID19 testing to community health clinics, health care workers, first responders, essential workers and congregate living facilities”
Counties are under immense pressure to expand testing for the virus as they reopen local economies and try to keep the spread of COVID19 under control. Bay Area counties, in general, have made significant progress toward reaching their testing goals, but underperformance by private providers is becoming increasingly problematic, public health officials said.
More than 50% — 1 million of Santa Clara County’s 1.9 million residents — are members or patients of large health systems, but the systems are doing just “a small number” of overall tests in the county, Fenstersheib said. Kaiser has been conducting 285 tests a day, on average, for the last three weeks, he said.
Six Bay Area counties, including Santa Clara and Contra Costa, have stated a goal of reaching 200 tests per 100,000 residents a day in order to safely contain the virus. Santa Clara County currently is doing about 120 tests per 100,000 residents a day; Contra Costa County is conducting about 100 tests per 100,000 a day.
“The gap is in the commercial realm,” said Ori Tzvieli, deputy health officer for Contra Costa County, which is considering an order similar to the one issued by Santa Clara County. “Tuberculosis, HIV, even influenza — they do their own testing. COVID is really the only place where they’re not carrying their weight.”
Testing people who are at greater risk of infection — including those who work in grocery stores or pharmacies or in other essential jobs — is critical, public health officials said. Many counties recommend that frontline workers get tested about once a month.
The hope is that by regularly testing those most at risk, new cases can be quickly identified and isolated before they lead to further infections and potentially new outbreaks.
Of recent importance is testing of residents who participated in Black Lives Matter protests. San Francisco and Santa Clara counties are making free testing available for residents who participated in protests, regardless of whether they have symptoms. They do not need to have a known contact with a person with a confirmed case, or be frontline workers.
“I know a family that wants to get tested — they live with an elderly mom and they wanted to go to the protests. And they can’t get the tests at Kaiser,” said Tzvieli. “They’re asking me if I know anywhere they can get tested. That’s a real issue.”
Jan EmersonShea, spokeswoman for the California Hospital Association that represents more than 400 hospitals, said large providers still struggle with supply shortages — including access to swabs for collecting nasal samples and chemical agents to conduct lab tests — that have limited their testing capacity.
She added that testing shortages plagued national and state health care systems from the start of the pandemic, and that shifting responsibility for testing from public health to private providers “is an evolutionary process.”
“We absolutely support the goal of increasing the number of people who are getting tested,” EmersonShea said. “It’s not a matter of not wanting to do more testing. It’s a matter of, ‘Do we have the capacity to do it?’ That’s starting to ease up and it will get better.”
Supplychain problems aren’t as severe as they once were, and the commercial providers need to move faster to reach more of their own members, Tzvieli said. In addition to making tests more readily available, he’d also like to see private providers proactively reach out to members who are at risk and encourage them to get tested.
Kaiser is Contra Costa County’s largest health care provider — covering about 60% of residents — but it’s conducting only about 30% of the tests, Tzvieli said. At some countyrun testing sites, which in theory should be serving people who are uninsured or have no other option for care, about 20% of those tested are Kaiser members, he said.
“We are encouraging everyone to get tested if they need it,” Tzvieli said, but the county testing sites aren’t meant to support people who have other options.
“We really want people who can’t get testing through their doctor or their health system, or who have no insurance at all. That’s really who we set it up for,” he said. “But what it’s ending up with is that more than half the patients are people who have commercial insurance who could have been tested somewhere else.”