Testing must become more accessible, experts say

Boston Statehouse

Doctor hand holding positive Coronavirus test. (Taechit Taechamanodom/Getty Images/Royalty Free)

BOSTON (SHNS) – Public health experts argued Monday that Massachusetts needs to make universal COVID-19 testing available to reduce the outbreak’s disproportionate impact on low-income and nonwhite communities, and the Baker administration believes it can respond best with a more targeted approach.

After several local and regional health officials told a Senate panel they want more funding to be directed to health boards, Sen. Cindy Friedman asked what else besides money they needed to better protect the state’s residents.

Three speakers in a row all offered similar responses: testing needs to be far more accessible than it currently is, and at no cost.

“If we’re going to have universal reopening, we need to have universal testing for free, period,” said Damon Chaplin, health director for the city of New Bedford.

Newly confirmed COVID infections in Massachusetts have been decelerating for weeks since the mid-April peak, with only a few hundred cases confirmed every day compared to the thousands seen on a daily basis earlier in the crisis.

However, Chaplin cautioned that the statewide trend may obscure ongoing impacts to vulnerable communities.

In New Bedford, he said Black and Hispanic areas are likely experiencing higher-than-average infection rates, but with many afraid of receiving a bill for a test, Chaplin said, “We haven’t had the ability to test at a level to show it.”

Dr. Matilde Castiel, the city of Worcester’s health and human services commissioner, echoed Chaplin’s call for universal testing, particularly for essential workers who remain at the highest risk of contracting the virus.

Castiel said she has spoken with preschool leaders who had one employee test positive but are reluctant to get other workers tested because “they’re afraid to lose their staff” to sick leave.

She also tied access to testing to broader health disparities, a key area of focus on Beacon Hill amid a push to correct centuries of racist inequities.

“If we can’t even do testing, what does that say about the abilities to do mammograms and the ability to do colonoscopies if that’s not offered to the community in the same way?” Castiel said. “If we’re looking at communities of color and disparities in health care, that’s a huge piece.”

The Baker administration included a significant expansion in testing capacity, to 45,000 people per day by the end of July and 75,000 per day by the end of December, as one of its pillars for keeping the state on a path toward a new normal over the next six months. Over the past week, the number of new molecular tests reported by the Department of Public Health varied from about 6,700 to 12,000.

During the same Senate hearing on Monday, Public Health Commissioner Monica Bharel said the state’s testing capacity may not ultimately match the testing output because public demand for tests may be lower depending on the severity of the outbreak.

Reaching those milestones — and ensuring Massachusetts contains the outbreak more generally — will require federal funding, Bharel said. The Baker administration has sought support from Washington to expand access to testing sites, use all available laboratories, and enhance contact tracing.

Asked about earlier calls for universal access to testing, both Bharel and Acting Health and Human Services Secretary Dan Tsai did not endorse the policy and instead touted work the administration has already done to broaden eligibility for getting tested.

Bharel said state officials also planned to increase “surveillance” of where COVID outbreaks occur, similar to ongoing annual influenza monitoring, and will also seek provider partners to help increase testing in communities with higher infection rates.

“We’re really currently targeting our approach to increasing testing in areas where we most need it, and then doing surveillance,” Bharel said. “There’s pros and cons to different approaches, and that’s the current approach we have.”

Another challenge public health experts flagged is the state’s fragmented approach to health enforcement. All 351 cities and towns have their own local health departments or boards, which Franklin Regional Council of Governments Director of Community Services Phoebe Walker said leaves communities vulnerable.

Because of the decentralized system, Walker said, Massachusetts spent millions of dollars to stand up a statewide contact tracing apparatus to do “what local health departments should have been doing.”

Bharel said a special commission on regional health she led compared Massachusetts to other public health models around the country and concluded that local departments could share some specialized services, such as data analytics, at a regional level.

“That was really the desire of the local Board of Health, to go more towards that then creating a new regional structure,” Bharel said.

Tsai, who before taking over as acting secretary focused on managing the state’s Medicaid program, also argued at Monday’s Senate hearing that some services should countinue to be delivered via telehealth and not traditional in-person visits even after the COVID emergency subsides.

Asked about what pandemic-era policies he would like to see made permanent, Tsai named access to telehealth, which Baker required commercial insurers to cover at the same rate as in-person visits in a March executive order.

“Allowing and expanding and covering full telehealth, not just for video capabilities, but also for telephonic capabilities, was absolutely, absolutely critical,” Tsai said. “We do not want to see a reversion back to things that could be done well via telehealth to go back to in-person just because that’s the way it’s always been.”

Some providers, he said, are now performing up to 80 percent of their usual care through a range of telehealth channels.

The Senate passed a bill Thursday that would mandate insurers cover the telehealth version of any in-person services they cover at the same rate for the next two years. House lawmakers have expressed support for telemedicine more broadly but flagged concerns about several details, such as credentialing providers and prescriptions.

Copyright 2020 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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