Test sites strained by surge in virus
Protocols changing to meet demand as infections spike
Testing and other tools critical to controlling the spread of the coronavirus are being strained as cases explode across the Bay Area, and in some places public health officials are changing protocols to try to keep up with demand.
Several testing centers are fully booked for the next one to two weeks in San Francisco and some other counties. Though walkups are accepted, they are limited to people who are essential workers, who have a known exposure to the virus or who have symptoms.
Some of the recent demand may be due to Thanksgiving and people wanting to get tested before and after traveling to see friends and family, though public health officials have sharply advised against that. But the main reason more people are trying to get tested is because there is more virus in the community as
the pandemic surges locally and across the state and country.
And the situation will almost certainly worsen in the next week or two as postThanksgiving cases appear, public health experts said.
“We’re preparing for, in two weeks, a spike in the number of positive cases. And I know the local hospitals are preparing for increased hospitalizations,” said Dr. Caesar Djavaherian, medical director of Carbon Health, a San Franciscobased urgent care network, noting that demand for testing is up 20% in the past month. “All this means our resources are tapped.”
The increased pressure on public health resources comes amid an alarming spike in cases in the Bay Area and the rest of the state. Daily cases have more than doubled in the region in the past month, and tripled in California. Just this week, an average of 1,760 cases were reported in the Bay Area each day before Thanksgiving, a nearly 50% increase over the daily average the week before.
Contact tracing programs are struggling to keep up with rising case counts. The U.S. Centers for Disease Control and Prevention this week advised local public health authorities to triage cases and attempt to contact only those most at risk of serious illness or spreading the virus to vulnerable populations.
In San Francisco, public health officials said Friday that they have not yet had to scale back contact tracing to that degree and still intend to reach out to everyone who tests positive in the city. But they released an appbased contact tracing program that instructs people to report, through an online portal, the names of close contacts who may have been exposed. The program is meant to ease the burden of persontoperson case investigation on public health staff so the city can keep up with rising counts.
“Each day in San Francisco, 130 more people are being diagnosed with COVID19. That’s some 900 cases week, and the surge has been building for weeks already,” said Dr. Susan Philip, the deputy health officer in charge of contact tracing. “Investigating those cases, that’s how we slow the spread.”
San Francisco leaders reminded residents Friday that they still expect the city to be placed in the state’s mostrestrictive purple tier in the pandemic blueprint. The shift will halt many indoor activities and place the city under a statemandated curfew.
In Los Angeles County, public health officials Friday issued a new stayhome order due to a dramatic rise in cases. The order, which goes into effect Monday and lasts until Dec. 20, bans all public and private gatherings except religious services or protests, limits capacity at almost all indoor spaces and closes most playgrounds.
Three Bay Area counties reported record numbers of daily cases this week, and almost all the others are close to their summer surge peaks. Hospitalizations are creeping up, too. As of Thursday, 707 people were hospitalized with COVID19 in the Bay Area, a 38% increase over the previous week. About 6,650 people were hospitalized in California, a 40% increase.
Across the state, public health officials are worried that some hospitals could hit capacity in two to three weeks. But the rising case counts already are putting pressure on other resources that have been stretched thin.
The turnaround time for test results statewide has remained steady since late August at just over 24 hours on average. But many people have reported long wait times for a testing appointment, at both public and private sites, even though providers said that anyone who needs a test can get one.
Demand for testing is up 20% compared to a month ago, and up 46% from two months ago, said Djavaherian. As a result, wait times for appointments are getting longer. Eight weeks ago, people could book appointments one or two days in advance, but now some are having to wait three to five days, he said.
San Francisco public health officials said they are testing more than 6,500 people a day and results are coming back in a day or two. While online appointments may be full, they said walkups are available at several sites for people without insurance who have symptoms or have a known exposure to the virus. People who have insurance should contact their provider to get tested, and that public sites should not be used for travel or holidayrelated testing, they said.
Alameda County also has seen increased pressure on its testing resources.
“Like we saw during the summer surge, more people are in need of testing because COVID19 is more widespread,” said Neetu Balram, a public health spokeswoman. “Flu season has also started and symptoms of flu and COVID19 are similar. This increased need is being coupled with increased demand due to the holidays.”
Testing is key to controlling spread of disease because people can isolate themselves if they know they are positive. Similarly, contact tracing is critical for reaching people who may have been exposed to the virus and could pass it on to others before they have symptoms.
“We’ve been really proud to say that at most times in this pandemic, (the Department of Public Health) reaches more than 80% of San Franciscans who test positive. We’re seeing it start to slip,” Philip said. “Now we are in a large surge with infections more widespread across the city and reaching different populations.”
San Francisco joined the state contact tracing program,
“More people are in need of testing because COVID19 is more widespread.” Neetu Balram, Alameda County public health spokeswoman
called California Connect, earlier this month, and on Friday started a socalled virtual assistant as part of that program. Everyone who tests positive in the city now will get a text message alerting them to their result, advising them to immediately isolate themselves and asking if they need help isolating.
Then they are invited to participate in a confidential contact tracing survey to identify who they may have been in contact with. The application asks them to supply names and contact information of anyone who may have been exposed to the virus.
Philip said most people who test positive will also get a phone call from the city’s contact tracing team to follow up on their responses and offer assistance as needed. People who live in communities that have been hit hardest, such as the Mission District and other Latino and African American neighborhoods, will almost always get a phone call in addition to the text message.
“The city has been very appropriately focused on hightouch efforts and having personal contact so they can explain everything to people. But as cases go up, you have to find some efficiencies,” said Dr. George Rutherford, an infectious disease expert at UCSF who has consulted with the city on its contact tracing efforts. “The more efficient you can make contact tracing, the better. From the moment someone’s exposed, you have three days to get them into isolation. So every moment counts.”
San Francisco Chronicle staff writer Catherine Ho contributed to this story.