You wake up with a sore throat. Soon you’re coughing and running a fever. Could it be coronavirus? Where should you go to find out?
In the midst of a pandemic, access to testing is critical to preventing the spread of the disease and saving lives. But when people with symptoms flock to the doctor’s office or the emergency department for testing, they could swamp hospitals and infect others, including health care workers who might already be in short supply. Drive-through testing is credited with helping curb the coronavirus outbreak in South Korea — a smart strategy that the United States and other countries are embracing to broaden access to testing while avoiding an overload of their health care facilities.
The U.S. government said it’s ramping up production of coronavirus testing kits, and more drive-through testing sites are popping up in parking lots across the country, with some requiring a doctor’s note. The proliferation of these sites is a welcome development in the fight against the novel coronavirus, but they can’t fill all the gaps and inequities in access to health care. Not everyone has a car, including some people with disabilities, homebound seniors and low-income workers who depend on public transit. With the help of designers, health care leaders must look beyond drive-throughs on hospital campuses by meeting people where they are and bringing testing to community hubs.
Given that the Centers for Disease Control and Prevention has advised people who suspect they have COVID-19 to avoid public transportation, the absence of accessible testing sites for those without cars is likely to be felt more among racial and ethnic minorities. According to 2011-15 American Community Survey estimates, about 9% of U.S. households — more than 10 million homes — had no vehicles available. Only 6.5% of white households lacked a vehicle, compared to nearly 20% of black or African-American households and 12% of Hispanic or Latino homes.
Dense metropolitan areas tend to be outbreak hot zones, and some residents of these areas depend on public transit to receive care. That’s why public health officials and hospital leaders should consider facilitating walkable access points for testing in addition to the drive-through sites. Here are three ways we can use existing spaces in our communities to improve access to health consultations and testing:
Starting health hotspots
Online appointment scheduling for testing supports social distancing practices, but some families don’t have a computer, smartphone or reliable wi-fi. Computers at the local library might not be an option; several library systems have closed to prevent further spread of the coronavirus.
Health care providers might consider offering telehealth options by establishing community-based “health hotspots,” a concept that mimics the wi-fi hotspots that provide internet connectivity to victims of natural disasters when the power is out. These small private consultation spaces can connect people to health professionals in areas where they might not have easy access to a clinic or hospital.
Health hotspots could be offered in shopping centers, pharmacies and community centers. Though many city- or county-owned facilities are closing in response to the coronavirus pandemic, health care providers can approach government authorities about whether it makes sense to keep some of those venues open for virtual consultations.
Adapting community venues
During a crisis, many people rally at their places of worship, community centers and neighborhood stores. Health care workers can approach these venues and engage with their leaders to become allies in the face of a health care crisis, much like sports arenas have provided shelter during natural disasters. In Boston, city officials and a nonprofit partner are establishing temporary clinics outside homeless shelters to test for coronavirus among shelter users, for whom social distancing is not an option. These pop-up clinics are heated tents with beds, not cots. One of those clinics has a dedicated space for testing and separate areas to isolate patients who are showing symptoms and are awaiting results or who know they have been exposed to someone with the disease.
Just as designers help health care campuses plan areas for mass-casualty events, hospitals should assess neighboring spaces to see if they could support their staff in case of an outbreak. Designers are a resource to hospital leaders and public health officials in converting community spaces for use in a crisis. Architects can offer guidance on how those spaces can be adapted to receive waves of people seeking testing or other services. Through a master planning process, designers can also help health care providers see how those community venues might connect to or provide isolation spaces where patients who need immediate care can be transported to a clinic or hospital.
Community partnerships are valuable for more than just space. Consider the language barriers and lack of information that discourage some patients from seeking care, and the cultural preferences that make some groups of people reliant on their families to care for them. Partnerships with local organizations including houses of worship and cultural centers provide important context to support effective outreach.
Nurse-led clinics across the U.S. are another resource that enables underserved patients to get the help they need, particularly in rural areas. These clinics are managed by nurse practitioners, who can provide primary care and prescribe medication, and are more affordable than traditional clinics. In areas that are short on doctors, nurse practitioners can detect health problems early and provide care that keeps people close to home and away from emergency departments. Bringing care to people with few options is important, as it might become too burdensome for them to access health care during a crisis.
Using mobile health units
Cash-strapped individuals and families often make difficult choices, with food and shelter taking precedence over health care. They might go only to clinics that they can walk to so they can avoid transportation costs for health visits. Extreme weather such as triple-digit temperatures and snowstorms might dissuade some of these patients from walking or cycling to an appointment. For certain families, the drive to a health care provider might be too long and inconvenient.
Some health care organizations provide travel vouchers to help people with health visits. But the mobile health model improves access by having caregivers travel to the patient. For example, mobile care units run by different hospitals visit struggling communities in Western Pennsylvania where there are few care options. The RVs pull up to high school, church and store parking lots to provide basic screenings and prevention services.
Health care officials could explore the option of providing a dedicated mobile unit for coronavirus testing in remote areas where people must travel far for health care. Staffed by appropriate health care teams, including those trained in care of vulnerable populations, these units can strengthen ties between patients and caregivers.