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N.J. Isn’t Testing Enough Of Its Residents As Cases Surge To New Levels
By
Nancy Solomon
and
Karen Yi
Published Dec 10, 2020
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Karen Yi/WNYC
By
Nancy Solomon
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Karen Yi
Published Dec 10, 2020
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New Jersey residents are frequently waiting hours to get tested for the coronavirus and are often getting turned away at local clinics that have run dry of supplies—as the state struggles to keep up with rising demand and control the surge of infections.
Governor Phil Murphy said more than 400 sites are providing testing across the state, which is performing an average of 50,000 tests a day. While it’s a huge increase from the virus’s first wave in the spring, New Jersey is still testing fewer people compared to New York, which has screened twice as many residents per capita. And this week, the number of administered tests actually decreased, according to data published by Johns Hopkins University.
“The state is not casting a wide enough net to look for the infections that might be out there and then to diagnose them as cases,” said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security.
Interviews with local and county health officials, as well as health experts, point to a key reason why: New Jersey’s decentralized system of testing leaves a competing hodgepodge of public and private testing sites that can’t be uniformly scaled up to meet rising demand.
Local officials said they need more staff and equipment to be able to increase testing and quickly turn around results. Some counties said they haven’t asked the state for support, while others say there’s little coordination among the dozens of municipalities within each county’s jurisdiction. The state isn’t helping counties purchase testing supplies but they are providing protective gear and sending teams of nurses to test in hot spot cities**—**keeping with Murphy’s preferred scalpel-like approach to addressing the pandemic.
That’s left local leaders largely on their own.
“There's no one one person that can say, OK, no, this is what we’re going to do,” said Bergen County Executive Jim Tedesco, a Democrat. “It’s tough to have a strategy when you have 70 mayors making decisions for 70 towns.”
Listen to Nancy Solomon and Karen Yi's story on New Jersey's testing program on WNYC:
Ramping up testing is crucial to keeping infections down. But without a federal testing strategy or new buckets of funding to carry states through the latest wave of the virus, state officials say it’s hard to dramatically increase testing, particularly when spending decisions are left to counties.
“New Jersey is famous for being a home rule state, so much of what gets delivered when it comes to public health is delivered at a local level by local entities,” said Dr. David Adinaro, the deputy commissioner for public health services at the New Jersey Department of Health. “But we're continuing to try to find ways to provide more resources and more coordination of those efforts.”
Adinaro said he’s proud of the work his department has done to create a COVID-19 testing system that back in the early spring was largely reliant on limited test kits from the Centers for Disease Control. New Jersey met its goal of expanding testing to 20,000 a day in May and 25,000 in June and has now doubled those numbers. The state says it’s working to expand lab capacity and loosened restrictions to allow licensed pharmacists to administer FDA-approved tests.
“Literally every day we are bringing on more capacity, whether it's some of the mobile testing teams that the state's doing or these public and private partners who are bringing testing on their own,” Adinaro said.
The state will receive 2.6 million rapid tests from the federal government by the end of December that they’re deploying to long term care facilities and federal qualified health care centers that serve the uninsured. Teams of nurses set up pop-up testing in cities like Newark, Elizabeth and Lakewood. And the state has hired a private contractor, OptumServe, to conduct 100 tests a day at five to seven sites focused on at-risk populations.
Most of the money for testing, Adinaro said, comes from federal funds sent directly to large counties or passed through the state to smaller counties.
In New York State, counties are also responsible for coordination, but testing is more available partly because so much of the state’s population is in New York City, which is under the guidance of one large and well-resourced health department.
“The whole problem around the whole country is the lack of investment in public health infrastructure,” said Denis Nash, an epidemiologist at CUNY. “Testing is the weak link as to why we are where we are with this endemic across the country, across the world.”
Nash said the New York City health department learned from its experience with the HIV epidemic. “We learned a lot about the importance of testing in controlling pandemic spread and have tried to put our money where our mouth is,” he said.
New Jersey’s rate of positive tests has skyrocketed to 13%, according to a 7-day rolling average crunched by Johns Hopkins. New York’s positivity has mostly remained under 5%. The World Health Organization recommends that before any country or state re-opens, the rate of positivity should be 5% or lower. Experts say anything over that benchmark means a state isn’t testing enough.
“Ideally, you'd like to see positivity low and remain stable or declining no matter what its value,” said Nuzzo, the researcher at Johns Hopkins University. “If it's increasing, that suggests that something is changing and that there probably is a need to go out and do more testing to figure out what's happening.”
New Jersey’s weekly testing average lags behind states like Connecticut, Massachusetts and Rhode Island, data from Johns Hopkins show.
New Jersey health officials, however, said the data doesn’t paint an accurate picture of the state’s testing capabilities because the figures don’t include most rapid antigen tests. The state’s reporting system is primarily limited to polymerase chain reaction or PCR tests, the more invasive nose swab that goes to a lab to be analyzed. Those labs are large and have the technology to report the results directly into the state system. Antigen tests, on the other hand, are simpler to use (similar to a pregnancy test) and tend to be conducted by smaller outfits that can’t seamlessly report results to the state.
“That's a huge problem and frankly, one that you really should not stand,” said Nuzzo. “We can't lose our surveillance just because we're using newer and faster tests.”
State officials are working to fix the problem but don’t think the absence of the low-tech antigen tests will dramatically change the positivity rate.
“The current positivity that we're seeing in PCR probably accurately reflects what's going on out there in the community,” Ed Lifshitz, the state’s medical director, said this week.
But the localized system of testing shifts the onus onto individual New Jerseyans to navigate what can be a confusing web of pharmacies, urgent care clinics, private doctor’s offices, pop-up sites, and drive-thrus. Some require a doctor’s referral, others just an appointment, and some are purely done on a walk-in basis.
Newark residents lining up at a City MD for COVID-19 tests, November 2020.
Seth Wenig/AP/Shutterstock
“The patchwork is difficult to navigate and then the other piece is it’s all rapidly evolving,” said Shawna Hudson, a professor of family medicine and community health at Robert Wood Johnson Medical School. Hudson received a federal grant to expand testing to Black and Latino communities.
“When we don't have a crisis, it's nice to really be able to control things at the local level and you can do things very specifically that are tailored to your community. But it makes it much more difficult when there is a much broader scale problem for which we need larger systemic implementation.”
The state lists available testing sites on its website where residents can search by zip code. On another page, they list county testing locations and pop up sites. But not all locations are included, including private doctor’s offices.
Jake Sinsky, 22, who tried to get tested last week said the website is easy to navigate but the problem is many of the urgent care centers run out of tests early in the morning and appointments at big pharmacy chains like CVS and RiteAid are booked five days in advance.
“It's harder to plan when it's kind of impossible to find out whether you're infected or not,” he said. Sinsky, who is a piano player currently working in the food service industry, said he finally found an open appointment about an hour south from his Montclair home, likely due a last-minute cancellation.
RiteAid is offering testing at 29 locations and recently expanded to test children under 13 years old. CVS is offering testing in 108 locations, about a third of all its stores.
Governor Murphy has said he’s aware of the frustration around long wait times and has encouraged residents to get tested on weekends when crowds are smaller.
“We have enormous sympathy for folks waiting in long lines, which is why we’re plussing up more testing resources,” he said recently.
The higher demand for tests across the regions is being driven by the increase in COVID-19 cases in the state and the number of people who wanted to get tested before traveling or spending time with family for Thanksgiving.
“The doors are blowing off,” said Deb Visconi, CEO at Bergen New Bridge Medical Center. The hospital’s mobile testing sites had been conducting 200 tests on Saturdays, but suddenly had a line stretching for blocks. And tests surged to 1,400.
Drivers wait for COVID-19 tests at mass drive-thru test site at Bergen Community College in December 2020
Karen Yi/WNYC
Alexander Salerno of Salerno Medical Associates in Newark is running seven sites that test 600 people a day. He says many clinics could offer to do the same**—**but they don’t want to.
“Because they're getting pushback probably from staff because of the risk. And then it all of a sudden kind of creates the perception that you're a COVID clinic,” Salerno said.
This month, Tedesco, the Bergen County executive, reopened a mass drive-thru testing site at Bergen Community College that will process 1,500 tests three days a week. He used some federal CARES money but otherwise deployed a dozen of his county health care workers, EMTs and paramedics to work alongside staff from Bergen New Bridge Medical Center, which is processing the tests.
“Everything you see here is all Bergen County,” he said on the first day the site opened. “There's not been state help. There's not been federal help. There's not been any help.”
Tagged
COVID-19
testing
new jersey
pandemic
Nancy Solomon
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Karen Yi
Karen Yi covers homelessness and poverty. She joined the WNYC and Gothamist newsroom in 2020. Before that, Karen covered Newark for the Star-Ledger and spent almost a decade working for newspapers in New Jersey and Florida. She grew up in Miami and has a dog named Cashew. Got a tip? Email [email protected] or Signal 917-589-1460.
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Gothamist is funded by sponsors and member donations
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