Months into the spread of the novel coronavirus in the United States, widespread diagnostic testing still isn’t available. California offers a sobering view of the dysfunction blocking the way nationally.
It’s hard to overstate how uneven the access to critical test kits remains in the nation’s largest state. Even as some Southern California counties are opening drive-through sites to make testing available to any resident who wants it, a rural northern county is testing raw sewage to determine whether the coronavirus has infiltrated its communities.
County to county, city to city even hospital to hospital within a city testing capacity varies widely, as does the definition of who qualifies for testing.
Testing deserts, stemming from an overwhelmed supply chain and a disjointed public health system, have hit hardest in California’s rural north and in lower-income urban neighborhoods with concentrations of residents who already were struggling to get quality medical care, long before the pandemic.
In the absence of a coordinated federal response, local health departments, hospitals and commercial labs across the state have been competing for the same scarce materials. Whether they are “haves” or have-nots is determined largely by how deep their pockets are, their connections to suppliers and how the state is allocating emergency supplies.
Compounding these problems is the lack of a state or federal public health infrastructure empowered to acquire and allocate resources on a grand and equitable scale. Hospitals and health systems where many people go for care are, by design, set up to focus resources on their own patients and workers. Their bureaucracies can’t readily adapt to do the community outreach and education that could bring testing to the masses; nor are they set up to do the contact tracing that ensures that people who have been exposed to COVID-19 patients are tested and monitored.
2020 npr