Trying out LA's new coronavirus testing regime

Los Angeles
While test shortages impede efforts in many parts of the U.S., Los Angeles is now offering testing to all 10 million-plus residents. (Getty Images)

Last week, after Mayor Eric Garcetti announced that Los Angeles was offering COVID-19 tests to all city and county residents, I decided to get one myself—and test Garcetti’s bold new promise in the bargain.

I was surprised how easily I was able to log on to L.A.’s testing website. I answered a few questions about myself, including whether I had any symptoms of the disease—the answer was no—and within three minutes, I had a same-day appointment at one of eight city-run testing sites.

In fact, it was a same-hour appointment. I rushed out of the house unshowered to drive across a large swath of the county to the site—a Los Angeles Fire Department training center next to Dodger Stadium.

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The trip would easily take 90 minutes in non-pandemic times, but I got to the designated freeway off-ramp in under half an hour. That’s when the traffic jam began: It took 75 minutes to snake my way the additional half-mile to a red tent, where a masked fire department employee handed me a zip-close bag containing the testing materials.

She directed me to one of three lanes up ahead, where I sat in my car and performed the test on myself.

I rolled a cotton swab in my mouth for 30 seconds, dropped it into a clear liquid inside a test tube, twisted the cap onto the tube and placed it back in the plastic bag. A protectively swathed attendant plucked the bag from my hand with metal tongs as I held it out of my car window, and deposited it in a large blue bin.

It was all very simple. I was now among 10,000 L.A. County residents who visited a city testing site that day—triple the number of previous days, when tests were limited to those with coronavirus symptoms or those considered high-risk even if asymptomatic.

The mayor is clearly proud of his new strategy. At a news conference last week, he spoke of the praise he had received from doctors, public health officials and other mayors who, he said, told him, “Thank you for leading the way.”

At a time when a shortage of tests still impedes efforts to grapple with the virus in many parts of California and the rest of the U.S., it is noteworthy that Garcetti is now offering testing to all 10 million-plus residents of the nation’s largest county.

“That’s a story in and of itself: that they have the availability and they can make this effort,” Ronald Brookmeyer, dean of the Fielding School of Public Health at UCLA, told me.

But Garcetti’s plan is not a silver bullet. Though public health experts say it is vital to know how many people without symptoms are virus carriers, millions of people may choose not to get tested. And even if you don’t have the virus when you take the test, that’s no protection against future infection.

What officials do with the results is crucial, said Brookmeyer. They need to follow up on the positive cases to reach friends, family members, colleagues and other contacts who may have been exposed—a process known as “contact tracing.” They must also find ways to safely isolate those who test positive and protect vulnerable people in their lives. “We have to get the most bang for the buck of every single test that we do,” Brookmeyer said.

Garcetti said he would hand over COVID-positive cases for contact tracing and other follow-up to public health officials from L.A. County, which includes the city of L.A. and nearly 230 smaller communities.

Testing sites run by the county are sticking to the more restrictive policy of accommodating only those who are symptomatic or at high risk, which now includes people in essential jobs, such as health care employees, first responders and food supply workers.

That decision was made in part because testing capacity is still constrained, Dr. Christina Ghaly, director of L.A. County’s Department of Health Services, said at a news conference.

Garcetti promised the city’s test sites will continue to give priority to those groups, even as testing is opened up to the general population, but he said the city has stockpiled 300,000 tests, with more on the way. Kyle Arteaga, a spokesperson for the supplier, San Dimas, California-based Curative Inc., said the company can meet L.A.’s expanded demand.

The city is paying an average of about $120 for each test, but the price could drop as much as 10% if there were a significant increase in volume. If L.A. ended up doing a million tests, it would likely cost the city between about $110 million and $120 million.

Wider testing of the population will ultimately be critical to subdue the virus, largely because a significant number of infected people have no symptoms and need to know so they can avoid infecting others.

But the testing program has limitations. First, any results will provide a biased sample, since the Angelenos who make and keep appointments will be skewed toward those with the time, inclination and transportation required.

And while Garcetti suggested that negative test results could ease worried minds, any such relief is only temporary. “A negative test one day doesn’t mean that you won’t get infected the next day, or the one after that,” said L.A. County’s Ghaly.

Finally, the accuracy of the self-administered mouth-swabbing tests used in L.A. has not been fully proved. Having a health care worker in full protective regalia plunge a swab all the way to the back of your nose is still the officially preferred method.

The reliability of the L.A. test suffers if you don’t cough forcefully a few times to bring up potentially virus-laden sputum before rolling that cotton tip around in your mouth. A four-minute video I watched before driving to the test site instructed me to do so, but there was no reminder when I got there and no staffers watched me to make I sure I did.

I think I did it correctly, though, so I am confident in the result: negative. But that only means I was “probably not infected” at the time of the test, the notice told me. And it cautioned that I can still be exposed to the virus at any time.

I still see lots of hand-washing and social distancing in my future.

California Healthline correspondent Anna Almendrala contributed to this report.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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