California Governor Gavin Newsom, under increasing pressure to start the faltering launch of the COVID-19 vaccine, flew to Los Angeles on January 15 to reveal a new massive vaccination site at Dodger Stadium that is expected to inoculate 12,000 people a day.
The city-run site was the largest COVID test site in the U.S., administering more than 1 million tests in its nearly eight months of operation – and more than 10,000 a day during the recent spike. Its redistribution to the cause of vaccination, declared Newsom, provides “an extraordinary world-class location for a world-class logistics operation”.
That effort paid off: when the city of Los Angeles ended COVID testing at Dodger Stadium and closed another testing facility to help staff at the new vaccination center, it removed, at least temporarily, about a third of all tests from the government testing in Los Angeles County – the country’s largest county, with a population of 10 million, and one of COVID’s biggest hot spots.
City, county or state-operated sites account for just over a third of all COVID tests in LA County, said Dr. Clemens Hong, who heads the county’s test operations.
The decreased testing capacity can lead to a longer wait for consultations, which means that infected people can expose others for longer before they know they have the virus.
But Los Angeles Mayor Eric Garcetti said that has not happened so far. In what he called “the perfect time,” infection rates in LA County have fallen since Dodger Stadium switched to vaccines, and demand for tests has halved to two-thirds, the mayor said on Thursday. “We are meeting the need – in fact, exceeding the need.”
Even so, he acknowledged that the conversion of the stadium was a risk – a risk that the city took because “vaccines will prevent and cure and finally solve that”.
Many health experts agree that prioritizing vaccination over testing is the right thing to do.
“The best way out of the current crisis is masks, few contacts a day and vaccines, so it makes sense to create a lot more access points for vaccinations, even if it means a little less testing,” said Dr. Bob Kocher, a senior researcher at the Schaeffer Center for Health Policy and Economics at USC and a former member of the state’s COVID-19 Testing Task Force.
But with the number of COVID cases still high, despite their recent decline in peak levels, and mutant strains of the virus threatening to fuel new outbreaks, some senior public health officials say testing remains an equally vital part of the effort to contain – and ultimately suppress – the pandemic.
And it could become even more important in the coming months, as the inoculation campaign gains momentum, as testing can be a valuable tool for assessing how well vaccines are working.
“It is difficult to say now, considering how many people are sick with COVID, that the vaccine is more important,” said Hong. “It is difficult to balance the two against each other, because we really need both of them very much.”
Balancing vaccines with tests and other COVID-related tasks is a significant challenge for public health officials in California and the country, because these functions use many of the same resources – especially the staff needed for administration and record keeping.
At vaccination sites, keeping good records is essential for daily planning of how many doses to remove from the freezer.
“It has to be done the right way, or else you screw up when the second dose arrives,” said Dr. George Rutherford, an epidemiologist at the University of California at San Francisco.
Sara Bosse, director of public health for Madera County, noted that counties across the state asked Newsom for $ 400 million in the current budget year to help defray the costs of installing vaccination sites, including facilities, security, data entry staff and doctors administer the injections and watch for adverse side effects. They are also seeking $ 280 million for COVID testing and $ 440 million for contact tracking and non-group housing to protect residents vulnerable to COVID.
“I think many counties are prioritizing vaccination and, based on the resources at their disposal, they can use various parts of the COVID response, such as tracking or contact testing,” said Bosse. The funding, she said, would help county health officials avoid “those difficult decisions where we have to pull from one part of the COVID response to support the next.”
There may also be federal aid on the way: President Biden has announced plans to establish 100 federally supported vaccination centers and allocate $ 50 billion to expand testing.
In Madera County, a poor rural area of 160,000 people that stretches from the Central Valley to Sierra Nevada, the state has largely taken over the COVID tests, allowing the county to focus its resources on vaccination, said Bosse.
The big challenge on this front, she said, is having enough trained health personnel to run vaccination posts. The county recently listened to 85 trained doctors willing to volunteer for the vaccine effort, “which will be a game changer for us,” said Bosse.
In Los Angeles, the city has the means to add testing capacity elsewhere and reinforce mobile testing, said Garcetti. She was considering a test site at Pierce College in the San Fernando Valley, “which looks like we won’t need to open,” said the mayor.
The city, county and state also discuss the possibility of a partnership to expand testing at Exposition Park in southern Los Angeles.
In San Diego County, health officials hope to face a challenge due to competition for personnel between vaccination and testing, and are hiring to meet needs, said Sarah Sweeney, spokeswoman for the county Health and Human Services Agency. . The county has not yet converted test sites to vaccination sites, but hopes to do so after vaccine supply increases, she said.
San Bernardino County health officials are committed to maintaining testing at current volumes, even while increasing vaccinations, said Corwin Porter, the director of public health. But he admitted that doing both at the same time “is a struggle” because “we don’t have enough vaccine and we don’t have enough staff”.
The county is holding hiring events every week and working with several partners to find additional resources, “because we are trying not to extract anything from testing or contact tracking,” said Porter.
In addition to the resource issue, another major challenge confronts health officials: “There is a question of divided attention,” said Hong from LA County. “We now have two important things to deal with – three if you include contact tracking. I think we will have to be careful with our strategy. “
Once a wide range of the population is vaccinated, which can take many months, the volume of tests is likely to drop dramatically, said Rutherford of UCSF.
“I don’t see hundreds of thousands more tests a day after we start vaccinating,” he said. “You will be testing thousands of people to find dozens of cases.”
In the meantime, LA County is likely to add questions to the exam consultation website, asking people about vaccination status, Hong said. “That way, we can track what is happening to people who are vaccinated.”
Continued outbreaks of COVID may require further testing, particularly in poorer black communities, which have been most affected by the pandemic – and where hesitation about being vaccinated is likely to be more widespread, Hong said. “So the end result is that the tests will not end.”
This story was produced by KHN (Kaiser Health News), which publishes California Healthline, an editorial service independent of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.