Within San Francisco ambitious universal plan coronavirus tests carry an entire US city

Public health experts can not be said often enough: If the United States COVID-19 is hit, the country needs to ramp up test. But there is no design or unique model for cities and states to follow how they respond to this call. Some, like Los Angeles, are great. End of April was the first major city L.A. free testing living for everyone. Others, like San Francisco are doing things in a progressive style, with goals that are equally ambitious. The latter is Strategizing from a place of strength. Thanks to some of the first stay-at-home orders Nation, San Francisco has, so far, the curve flattened with relative success. Companies around the city were to collect door to door allowed to reopen. And the keys on the road continue to constantly test return to normal residents, city officials say, with the emphasis on “vulnerable” before anything else. In the last 11 weeks, as more of the San Francisco analysis tests have begun in the laboratories of cities as Atlanta DELIVERY, officials were gradually expanding the circle that has the right to get one. The decision not to allow access only to those who have been limited in part by resources. It took time for the city of its supply chain to stabilize. But public health officials wanted to prioritize those who were most at risk. First, the data on risk factors have been restricted, with officials on simple criteria, as if someone had concentrated traveled to China. Since then, the calculation has become more complex. Research and reports suggest that the systemic inequalities viruses can exploit, and deep blue city is obviously taken to heart. Shortness of breath is an indicator of the need to COVID-19 to be tested. According to the health department in San Francisco, income is too. The need for human factors to be considered, a lesson in that city in 1980, learned to fight another time mysterious virus, HIV. “Who is more likely to be in areas where they are unable to protect themselves adequately?” Says Dr. Susan Philip, director of the city’s disease prevention and control. Answering this question is important, an equity point of view, he says, “but it is also very important to protect from the point of view of the whole city.” The strategy has challenges as to identify all those who are vulnerable and in addition to find out, it is to have that test in their best interest, as to convince them. San Francisco has 4,300 machines that tests a day are analyzing the situation, according to the health department. Currently, the analyzes have established some 1,300 health officials to raise a 1600-2000 target in the coming weeks. run on the reasons for this gap is a constant struggle to get these tests it is necessary, in addition to having the need to train personnel and protective equipment. But officials also want to turn anyone away. In the days L.A. announcement, there were reports that a website for sign-ups has fallen and that the appointments were filled before some people are able to get them. “What we have learned that here,” said Philip, beginning that only the most obvious group meant focusing on “is that we wanted to make sure as we expanded, we did not need to contract” .: Those feeling ill . First test was limited to those who felt ill and also went to Wuhan, then the province of Hubei, then China. By the end of April, the city had no trial experience symptoms, including both expanded the nearly 900,000 residents of S. F. and those who commute in from other places for work. Since the city’s ability to test to increase further, officials faced a more complicated movement in setting priorities. Research has always made it clear that it is also important to test people who feel well. Some studies suggest that half of those who tested positive for COVID-19 can be asymptomatic and can spread the virus. Knowing the resources are still limited and a negative result of the test usually is not as useful as a positive sign that asymptomatic people who are looking for? An interpretation of the “vulnerability” of the crown is that someone with a higher risk of dying if they get it. This is the factor leave town when he made the decision to be announced on May 1 that the test for residents and workers at nursing facilities would not only be universally available, but universally mandatory. On May 19, Dr. Grant Colfax, the medical director of the city, announced that about 40% passed all residents and nursing home workers SF so far and proud of the fact that the small number of positive results from a large implant-care four more than 2,000 had a quick search for contacts and isolation that can protect many at risk tested seniors and caregivers. Another way to interpret the vulnerability is focusing on exposure: who are most likely infected or transmitting the virus to others? It is the venture capitalist, who has been able to work from home or met the bus driver, every day dozens of strangers? “Just think through,” says Philip, “speaks of an employee of the grocery store or a delivery driver.” The last part of this city outside: extension to all essential workers to test, regardless of whether they have symptoms, May 4 (E ‘was also the reasoning behind tested offers of asymptomatic close contacts of people who test positive at the end April began.) what he learned the city? Of the 50.533 test results, as reported in the city on May 22, 6% were positive. low-income neighborhoods, men and Latino residents were hit hardest. The city does not will expand testing, offering to a particular race or ethnic origin, says Veronica Vien, information officer of the Department of Public Health. But the city set up test sites, including a piece of furniture, in areas where communities of color are larger where the highest percentage of the population lives in poverty and where people could more challenges in traveling to health centers. Another weakness that become the focus lived in crowded environments, and so the city is preparing to expand as shelters for universal services to homeless trial. The homeless also tend to be older and tend to have health conditions that underlie make them vulnerable in many ways. But even if the looks of the city for the forthcoming enlargement, it is still trying to figure out how to penetrate deeper into the risk groups already identified. Philip can not say exactly how many people are suitable according to the existing criteria, or which of them is tested. But it is not like any other, such as public health officials. “We can not, can not but appear to be an error with the population,” he says. “We have to look and say, What is this that we can do better,” a study conducted in late April in the Mission District, a historically Latinx neighborhood that struggles with income inequality, offered some evidence. In collaboration with the city, local activists and other groups, researchers at the University of California at San Francisco have tried to test each, or work in one census tract, lives in the mission. positive for a total of about 2%. Most of this group, 95%, was Hispanic or Latinx-compared to only 44% of all those tested. About 90% of those who tested positive reported that they were not able to work from home, and infection rates were higher among those who have traveled for work-about 6% -findings in the area which confirms the decision of the city expand to all major exams workers. (UCSF also working on a companion study in the city relatively isolated and predominantly white Bolinas, which found zero infections after almost every resident test.) However, researchers have reached only about half of the people who were trying to test . Dr. Gabriel Chamie, an investigator in UCSF says that while they do not have data to explain why some people do not, despite appeals participated curbside to expect a number of reasons. One is that for weeks the residents were told to stay home what to fear no reasonable people come to test the aim. The district, like others, is located in San Francisco, is also home to undocumented persons who fear their data could be collected. Some might worry about economic consequences. “If you test positive,” said Chamie, “this could mean a stretch of time in which it must isolate”. And if you are the sole breadwinner for a family you may not feel like an option. Then there is the question of “to be called a positive and what it could mean” a topic Chamie do HIV research also from his background in. A central tenet of San Francisco will respond from its efforts to implement HIV epidemic, he says, is to develop “a human side of what it means an infection. It does not happen in a vacuum.” And so the city was trying to respond to a human level, spreading the message that is sure to get to irregular migrants, tested (San Francisco is a sanctuary city) and working meals and replacement income for those who would not otherwise shelter in place for two weeks. people on low incomes who test positive and are concerned about their families infect mission study that almost 90%, the positive experience with three or more people tested can be provided free in a hotel room. In various efforts, officials of government partnership with community organizers, which in some places are known and family who are trying to achieve. This is for Philip, the key is to take away from decades of experience with HIV. “Communities understands how to get the best information that will be useful in our public health efforts to involve these people in research, new discoveries to find,” he says are necessary. Intervention Team card neighborhoods like the mission with more than 80,000 leaflets in different languages ​​that highlight the testing capabilities. The speakers of Chinese teams now go door to door to spread the word among entrepreneurs in Chinatown, the poorest of S. F., denser neighborhoods. Public health officials also know that the shame associated with infectious disease control will help increase the number of people who know their status. To this end racial Mayor of London that they would go to get tested in the Hunters Point neighborhood, an area that high infection rates and where the vast majority of residents are people of color have experienced known. “We also want to make sure that we solve the stigma to do the test,” he said at a press conference on May 18, the virtual mission results are studying come. The researchers did not the people in the census tract tested only approximately 57% of active infections, but also for the presence of antibodies that will propose to the cumulative number of cases that the imprint of the virus in the environment over time and assistance occurred, they reveal in the city. The results are expected by the end of May. Philip says that while looking forward to its findings, the public health department clearly focused on testing for active infection at that point. The reliability of the antibody test is still uncertain, and even though it was not a problem, it is not known whether the human immune system after infected crown, and if so, for how long. “There are many open science and public health issues,” he said. Mayor race said that the current tests will be crucial for the reopening, and the city has given universal access to testing for the goal. But Philip says there is no set schedule for when the City of Hope, the circle has completely developed. In general, their department is less focused on me when every San Franciscan is tested in a position to questions such as how often people should be at high risk. “The reason why the test results we can act,” said Philip. Here is where the program public health follow-up: the investigation, contact tracing, isolation, quarantine. But resources are not unlimited. could test the needs of vulnerable persons are usually someone in time to be sick when he was rounded up and getting the test results, he says, but it is still unclear just how it should be frequent. Since the incubation period of the virus is 14 days, the city at the time a general guide that groups such as essential workers should not tested as every two weeks, but the optimal window every 15 days? Every month? That’s TBD. Since the city is working to find answers, and get more results, they will be made to the health department of a broader mantra. “We must all come together to be healthy,” says Philip, “or we’ll all be together not healthy.”
Image copyright courtesy of Barbara Ries