COVID-19 testing in Santa Cruz: Success story or debacle?

Tamara Vides first thought she might’ve been exposed to COVID-19 early on in the pandemic. As Watsonville’s assistant city manager, she is an essential worker, critical for the city to keep running but also at higher risk of coming in contact with infected community members.

So Vides, 48, went to get one of those eye-watering nasal swabs at the free OptumServe testing site at Ramsay Park Family Center. The days came and went as she quarantined at home, awaiting the result. “That was a really painful time to be waiting,” she said.

It took Vides seven days to find out she had tested negative.

Her experience isn’t unique. Ramsay Park, the only state-operated COVID-19 testing site in Santa Cruz County, has at times struggled to meet testing demands and get results back to patients within a reasonable time. The Ramsay Park site is designed to meet a specific need: convenient, free testing for anyone who wants it, symptomatic or not. It’s a key piece in the county’s goal that “anyone can be tested whenever they want.”

But efforts to reach this goal have been marked by remarkable successes in some areas, such as the volume of tests processed in the county, and persistent problems in others, including getting results to patients quickly. In the latest twist, county officials say wait times had drastically improved as the pandemic dragged on, but at the beginning of November the state switched testing operators, which was supposed to improve turnaround times even more.

So far, though, that hasn’t been the case, with testing turnarounds taking between five and seven days, which is frustrating to county health officials.

“My goal is to make testing as available as possible and to make sure that we use it strategically so we can keep our community safe as much as possible,” said Dr. Cal Gordon, the director of the county’s testing taskforce. “Our demand has historically outstripped our supply, and that’s not unusual for us locally, but also statewide or even nationally, that’s been a challenge.”

Different test venues, common problems

COVID-19 testing sites in Santa Cruz fall into one of several categories: the state-funded and operated site at Ramsay Park, county-operated “safety net” clinics such as Salud Para La Gente, which serve mostly uninsured and Medi-Cal patients, commercial operations like CVS pharmacies, and private healthcare providers including Kaiser Permanente, Dignity Health and Palo Alto Medical Foundation.

Early in the pandemic, every entity offering COVID-19 testing suffered as supply chains were held up and labs over-taxed. Santa Cruz County was in a worse position than some other municipalities because the county public health lab is too small to process a significant number of tests, so the community clinics relied on Quest, a commercial lab.

“[At] Salud Para la Gente, or Santa Cruz Community Health centers, they were being rationed test kits from Quest because they didn’t have the supply,” said Gordon. “You would have a family presenting at Salud, where the person who was complaining of symptoms was getting tested, but for other members of their family who had similar symptoms, they needed to be tested but they didn’t have the test kits.”

Private providers were similarly limited early on, with many doctor’s offices strictly offering tests only to patients with serious symptoms.

Ginaia Kelly was suffering for weeks in late March and early April, feverish, unable to get out of bed for days on end, and sure that she should be able to get a test. During three telemedicine visits with her Dignity Health primary care doctor, Kelly continually asked to be tested to no avail.

She was too healthy and too young — still in her early 50s — to merit using precious testing supplies on her, she remembered the doctor telling her.

Kelly’s only company at her Davenport home was her dog Reba. A mini-fridge was added for snacks, but she relied on the good graces of her husband and sons to “not forget to feed Mama!” as she holed up in an isolated room.

Ramsay Park suffered from its worst delays in those early days, too. According to Dr. Gail Newel, the Santa Cruz county health officer, people were waiting days or even weeks for their results. “[Wait time] was over two weeks, which makes it useless,” Newel said.

Commercial entities such as CVS didn’t begin offering tests in Santa Cruz County until later in the year, so the over-burdened doctor’s offices, county clinics, and state site, were people’s only options.

As infections were first spreading through the county, it’s likely many of them, like Kelly, went untested.

Kelly didn’t get an answer until after her 24-day isolation period spent watching TV news and half-eating meals she couldn’t taste. In mid-April, she paid $130 to take an antibody test at a clinic in Richmond. The result: She had COVID-19 antibodies.

UC Santa Cruz steps in for the better

A turning point for the county’s safety net clinics came when a group of virologists and researchers at UC Santa Cruz, led by Jeremy Sanford, Isobel Bjork, and Michael Stone, offered to convert their research lab into a clinical operation. Now, they process a majority of the COVID-19 tests for the county-operated clinics and a few other essential facilities, and are able to notify patients who have tested positive within 24-48 hours.

“This is a very heroic band, of not a lot of people, doing remarkable work there at UC Santa Cruz,” said Gordon. Thanks to their work, he said, “I personally believe that lives have been saved.”

Vides, the Watsonville official, heard it first-hand from city employees. Turnaround times for test results shrunk and testing capacity grew, making it much easier for essential workers to get an answer in a timely manner.

“Knowledge is so empowering. Just knowing whether you’re positive or negative brings peace of mind,” she said.

Now, the city of Watsonville is looking to make the process even smoother by designating Salud Para La Gente as its main COVID-19 testing site for city employees. Those samples will be processed by the UCSC lab, guaranteeing fast results.

Private health providers have expanded somewhat who can be tested. “There’s an expectation, if you’re an essential worker — you don’t have to be a physician or a nurse — you can work in the grocery store or you can work in agriculture — the expectation is that you will get access to testing,” said Gordon.

But others in the general public can have lots of reasons to want to get tested, even if they are asymptomatic, and sometimes it’s difficult to do.

Gordon acknowledges this issue. “Access has been challenging. If you want to go to Hawaii, or you’re worried, or even if you have a real concern or you’re symptomatic, it’s been hard to get in in a quick fashion,” he said. “Our work is not over, we need to increase capacity.”

This is the role that the state sites are supposed to fill: convenient, free testing available to anyone who wants it, no questions asked. According to Newel, OptumServe, the lab which was processing the Ramsay Park site, was eventually able to improve its turnaround time, getting most of its tests completed and notifying patients within 48 hours.

A change for the worse?

But at the beginning of November the state switched operators to PerkinElmer, which is operating a large lab in Southern California. This was supposed to improve turnaround times: the company is financially incentivized to return results in 48 hours. So far, this has not been the case.

“We’re hearing five to seven day turnaround, which is not acceptable,” Newel said. Gordon himself was tested at Ramsay Park last week and didn’t get his results for seven days.

“I may have been out on the far end, but for contact tracing and isolation, this is not a particularly good turnaround time,” said Gordon. “For every day that you don’t reach out and make sure that people are isolated and also trying to see who they may have been in contact with. there’s potential risks for continued increase of infection and transmission.”

Requests to increase capacity denied

Recently, the California Department of Public Health sent a survey to county health departments, offering a menu of options for them to request to help their testing efforts. Santa Cruz asked for, among other things, a new lane at Ramsay Park and a new testing site in the northern part of the county. Long waits for results haven’t been the only issue at the Ramsay site: It is consistently operating over capacity, squeezing in walk-ins between appointments.

The extra lane was granted, which means Ramsay Park will soon be able to double the number of tests it offers from 165 to 330 per day, and be open seven days a week. But the second testing site was denied.

“I was on a call [recently] with many of the statewide health officers and health directors,” said Newel. “Most of them were reporting that their requests had been denied.”

Newel says she was told the second lane at Ramsay would be in place by Nov. 30, “but I wouldn’t hold my breath,” she cautioned.

The county also requested and was granted a supply of rapid-results antigen tests, which are only accurate in very specific situations (symptomatic patients about a week into their illness), but can provide results in about 15 minutes.

Those tests are already being deployed in some hospitals, homeless shelters, and community clinics. Senneca Diagnostics, a commercial entity, has set up a new testing facility at Twin Lakes Church in Aptos which offers free testing for both symptomatic and asymptomatic patients.

“All of this is timely since we expect over the next two to three months, a major surge in cases, and we have no doubt that there’ll be increased demand,” Gordon said. “So we’re doing everything we can to continue to increase our testing capacity and be able to apply those in effective areas.”

‘We can’t test our way out of this’

Despite roadblocks, many of which have been shared by counties throughout the state, Santa Cruz has overall done relatively well in terms of the number of tests it has offered. The county’s per capita testing is currently in the top third of California counties.

Newel and Gordon are proud of this accomplishment, as testing and contact tracing are a key element of controlling the pandemic.

Still, Newel and Gordon, and health officers across the country, are quick to remind that testing is not the silver bullet to end the COVID-19 crisis. Modifying individual behaviors — mask wearing, staying home, and hand hygiene — remain the crucial factors.

“We can’t test our way out of this pandemic,” Newel said. “A lot of people are really focused on testing is the answer, and it’s not a solution.”