A nurse conducts a COVID-19 test in the parking lot of the Watsonville Community Hospital.
(Kevin Painchaud / Lookout Santa Cruz)

‘Need a lot of both’: Will California’s vaccine ramp-up squeeze out COVID-19 testing?

California’s ability to multitask is being tested as health officials scramble to find staff for vaccination sites while maintaining testing and contact tracing.

California Gov. Gavin Newsom, under growing pressure to jump-start a faltering COVID-19 vaccine rollout, jetted to Los Angeles on Jan. 15 to unveil a massive new vaccination site at Dodger Stadium that is expected eventually to inoculate 12,000 people a day.

The city-run venue had been the biggest COVID testing site in the U.S., administering more than 1 million tests in its nearly eight months of operation — and over 10,000 a day during the recent surge. Its redeployment to the cause of vaccination, Newsom declared, provides “an extraordinary world-class site for a world-class logistics operation.”

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That effort came with a trade-off: When the city of Los Angeles ended COVID tests at Dodger Stadium and closed another testing site to help staff the new vaccination center, it removed, at least temporarily, about one-third of all government-run testing in Los Angeles County — the nation’s largest county, with a population of 10 million, and one of the biggest COVID hot spots.

Diminished testing capacity could lead to longer waits for appointments, which means infected people could potentially expose others for a longer time before learning they have the virus.

Many health experts agree that prioritizing vaccination over testing is the right move.

“The best way out of our current crisis is masks, few contacts per day and vaccines, so it makes sense to create lots more access points for vaccinations even if it means a bit less testing,” said Dr. Bob Kocher, a senior fellow at USC’s Schaeffer Center for Health Policy & Economics and a former member of the state’s COVID-19 Testing Task Force.

But with COVID caseloads still high despite their recent decline from 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 steam, since the tests could prove a valuable tool for assessing how well the vaccines are working.

Balancing vaccinations with testing and other COVID-related tasks is a significant challenge for public health officials across California and the nation, because those functions draw on many of the same resources — especially the staff needed for administration and record-keeping.

At vaccination sites, keeping good records is essential for planning from day to day how many doses to pull out of the freezer.

“It’s got to be done right, or else you screw up when the second dose is,” said Dr. George Rutherford, an epidemiologist at UC San Francisco.

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Sara Bosse, public health director of Madera County, noted that counties across the state have asked Newsom for $400 million in the current budget year to help defray the costs of setting up vaccination sites, including facility costs, security, data entry staffers and clinicians to give the shots and watch for adverse side effects. They are also seeking $280 million for COVID testing and $440 million for contact tracing and non-group housing to protect COVID-vulnerable residents.

“I think that many counties are prioritizing vaccination, and based on the resources they have, they may pull from 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 difficult decisions where we have to pull from one part of the COVID response to prop up the next.”

There could also be federal help 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 into the Sierra Nevada, the state has largely taken over COVID testing, allowing the county to focus its resources on vaccinations, Bosse said.

The big challenge on that front, she said, is having enough trained health personnel to run the vaccination sites. The county recently heard from 85 trained clinicians willing to volunteer for the vaccine effort, “which is going to be a game-changer for us,” Bosse said.

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San Bernardino County health officials are committed to maintaining testing at current volumes even as they ramp up vaccinations, said Corwin Porter, the director of public health. But he conceded 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 multiple partners to find additional resources, “because we are trying not to pull anything out of testing or contact tracing,” Porter said.

Once a broad swath of the population has been vaccinated, which could take many months, testing volume will probably drop off sharply, said UCSF’s Rutherford.

“I don’t see hundreds of thousands of tests a day anymore, once we get well up on vaccinations,” he said. “You’ll be testing thousands of people to find tens of cases.”

This story was produced by KHN (Kaiser Health News), which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.

This story originally appeared in the Los Angeles Times, a Lookout content partner.

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