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California Governor Gavin Newsom, under increasing pressure to restart the rollout of a failed COVID-19 vaccine, traveled to Los Angeles on January 15 to unveil a massive new vaccination site at Dodger Stadium that is eventually expected to inoculate 12,000 people per day.
The city-run site had been the largest COVID testing site in the United States, administering more than a million tests in its nearly eight months of operation – and more than 10,000 per day in the recent outbreak . Its redeployment to the cause of vaccination, Newsom said, constitutes “an extraordinary world-class site for a world-class logistics operation.”
That effort came with a compromise: When the city of Los Angeles ended COVID testing at Dodger Stadium and closed another testing site to help staff the new vaccination center, it cut, at least temporarily, about one third of all government-run tests. testing in Los Angeles County – the country’s largest county, with a population of 10 million, and one of the biggest COVID hotspots.
City, county or state-run sites account for just over a third of all COVID testing in LA County, said Dr Clemens Hong, who heads the county’s testing operations.
Reduced testing capacity could lead to longer waits for appointments, meaning those infected could potentially expose other people for a longer time before learning they have the virus.
But LA Mayor Eric Garcetti said that had not happened so far. In what he called an example of “perfect timing,” infection rates in LA County have declined since Dodger Stadium switched to vaccinations, and the demand for testing has dropped from half to two-thirds, the mayor said on Thursday. “We are responding to the need – actually exceeding the need.”
Still, he acknowledged that converting the stadium had been a risk – a risk the city took because “vaccines will prevent and cure and finally solve this problem.”
Many health experts agree that prioritizing vaccination over testing is the right decision.
“The best way out of our current crisis is masks, few contacts per 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, Principal Investigator. at USC’s Schaeffer Center for Health Policy & Economics 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 from peak levels and with 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 quell – the pandemic. .
And it could become even more important in the months to come, as the vaccination campaign gains momentum, as testing could prove to be a valuable tool to assess how vaccines are working.
“It’s hard to say right now, given the number of people with COVID, that the vaccine is more important,” Hong said. “It’s hard to balance these two against each other because we really need a lot of both.
Balancing vaccinations with testing and other COVID-related tasks is a daunting challenge for public health officials in California and the country, as these functions draw on many of the same resources – especially the staff needed to support them. administration and record keeping.
At vaccination sites, it is essential to keep good records to plan the number of doses to remove from the freezer on a day-to-day basis.
“It has to be done correctly, otherwise you get it wrong when the second dose is,” said Dr. George Rutherford, epidemiologist at UC San Francisco.
Sara Bosse, director of public health for Madera County, noted that counties in the state have asked Newsom for $ 400 million in the current budget year to help cover the costs of setting up the vaccination sites, including facility costs, security, data entry staff, and clinicians to kick things off and watch for unwanted side effects. They are also seeking $ 280 million for COVID testing and $ 440 million for contact tracing and out-of-group housing to protect residents vulnerable to COVID.
“I think a lot of counties are prioritizing immunization and, based on the resources they have, they can take advantage of various parts of the COVID response such as contact tracing or testing,” Bosse said. The funding, she said, would help county health officials avoid “those tough decisions where we have to pull one part of the COVID response to support the next.”
There could also be federal help along the way: President Biden has announced plans to create 100 federally backed vaccination centers and allocate $ 50 billion to expand testing.
In Madera County, a poor rural area of 160,000 people stretching from the Central Valley to the Sierra Nevada, the state has largely resumed COVID testing, allowing the county to focus its resources on vaccinations, Bosse said. .
The big challenge on this front, she said, is having enough trained health staff to manage the vaccination sites. The county recently heard from 85 trained clinicians ready to volunteer for the vaccination effort, “which is going to be a game-changer for us,” Bosse said.
In Los Angeles, the city has the means to add testing capacity elsewhere and to strengthen mobile testing, Garcetti said. He had envisioned a test site at Pierce College in the San Fernando Valley, “which it looks like we won’t need to open,” the mayor said.
The city, county and state are also discussing the possibility of a partnership to expand testing at the fairgrounds in South LA.
In San Diego County, health officials expect to face a challenge due to the competition for staffing between vaccination and testing, and they are hiring to meet the need, said Sarah Sweeney , spokesperson for the County Health and Human Services Agency. The county has yet to convert testing sites to vaccination sites, but plans to do so after the vaccine stocks increase, she said.
San Bernardino County health officials have pledged to keep testing at current volumes while increasing vaccinations, said Corwin Porter, director of public health. But he admitted that doing both at the same time “is a struggle” because “we don’t have enough vaccines and we don’t have enough staff.”
The county holds recruiting events every week and works with several partners to find additional resources, “because we try not to take anything away from testing or contact tracing,” Porter said.
Beyond the issue of resources, another big challenge faces health officials: “There is a problem of shared attention,” Hong said of LA County. “We now have two big things to sort out – three if you include contact tracing. I think we will have to think about our strategy. “
Once a large part of the population has been vaccinated, which could take several months, the volume of testing is likely to drop sharply, said Rutherford of UCSF.
“I don’t see hundreds of thousands of tests a day anymore, once we’re good on the vaccines,” he said. “You’re going to test thousands of people to find dozens of cases.”
In the meantime, LA County will likely add questions to its test appointment website to ask people about their vaccine status, Hong said. “That way we can track what’s going on in people who have been vaccinated.”
Ongoing COVID outbreaks may require increased testing, especially in poorer communities of color, which have been hit hardest by the pandemic – and where reluctance to get vaccinated is likely more prevalent, said Hong. “So the bottom line is that testing doesn’t go away.”
This story was produced by KHN (Kaiser Health News), which publishes California Healthline, an independent editorial service of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.
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