“We did this based on our moral obligation and our mission because our focus is on addressing racial and ethnic disparities in health and in healthcare.”
When the Boston Public Health Commission released its coronavirus demographic data, some were startled to see the high number of people of color who are directly impacted.
Even before those statistical revelations, Frederica Williams, a member of the city’s COVID-19 Health Inequities Task Force, and her team at the Whittier Street Health Center were already providing testing to that demographic and others who are vulnerable.
Now they’re ramping things up. On Monday, the health center launched rapid response COVID- 19 testing at its Roxbury site, and on the next day it began running tests on its mobile van.
“We are trying to end the pandemic,” Williams, CEO and president of Whittier Street, said in an interview. “You need to screen more people and also to do contact testing so you know the range of the exposure.”
Increased testing has been a priority for elected officials including Massachusetts Governor Charlie Baker and Boston Mayor Marty Walsh. Specifically, it’s a way to identify positive cases and trace those who may have been exposed to the virus. Although a significant number of positive cases have been detected in communities of color, according to city data, Williams said screening rates had been low in those places.
On Wednesday, Walsh announced that the city would begin sharing racial and ethnic data about those who died from the virus. “It’s important for us to get these numbers so we can make sure that we’re getting messaging out to the different communities,” the mayor told reporters outside City Hall. That day, 4,528 people were positive for coronavirus in the city, with 40 percent of those cases being black and African American residents.
Melissa Leston, director of nursing and an infection control officer at Whittier Street, said reducing fatalities requires expanded and rapid testing along with educating the public on what they need to do to keep themselves and others safe.
“Knowledge is power,” Leston said, “so once you know [your status] then you can kind of do better. We’re hoping to get out there [and] get people tested so that they’re aware, so they can get treatment plans that they need, [begin] quarantining [and get] other resources that they may need.”
Prior to rapid response testing, which can deliver responses within 24 hours, people tested for COVID-19 had to wait a week for results.
The rapid response test looks similar to previous testing, which required someone to display a high fever and other symptoms, such as a cough, shortness of breath, or a sore throat to qualify. Once the person qualifies, they are taken to trailers outside the facility to register, and then are tested with a nasal swab for the virus. A prior phone call is preferred, though the center also welcomes walk-ins for rapid testing.
Williams said rapid results can expedite the patient’s linkage to care and allow them to go into quarantine, as recommended by the Centers for Disease Control and Prevention. Once a patient tests positive, for example, they are notified along with the Massachusetts Department of Public Health, which will then get in touch with the patient.
Liston said the process is especially important for those who are asymptomatic, or aren’t showing signs of the virus. Carriers can also be told if they have the virus and act accordingly to reduce the spread of the disease, while test results can also allow for tracing to begin sooner, so people who have been in contact with the virus can undergo testing themselves.
If someone tests positive, Liston said, the staff engages. People are asked if they are symptomatic, when they became ill, and who they’ve been in contact with.
“What were you doing at the time? Were you at work? Who were you exposed to?” Liston said. “[We would] kind of have you recount it back through that time in order to get appropriate time for, say, [when] you needed to quarantine.”
In addition to the on-site program, the Whittier began running its Mobile Health Van to hotspots citywide on Wednesday to provide testing to more people. It will service areas including the intersection of Mass Ave and Melnea Cass Boulevard, where there are a number of people experiencing homelessness, and Blue Hill Avenue, where they can test more people of color. The van schedule runs for six hours a day, Monday through Saturday.
Leading up to this, Williams said it took her team two weeks to form a plan to test members of the community who are minorities and low-income. Patients at their health center overwhelmingly live below the federal poverty line, need to be served in another language, and have high rates of comorbid conditions, Williams said.
“We were looking at all of these testing sites popping up across the city and we’re looking at the data, so we felt that we needed to take action, and the mayor and the city agreed with us,” Williams said.
At the same time, Williams said she didn’t need to see the data to know that her patients would be the ones most impacted by coronavirus. She noted mortality and morbidity rates for black and brown people in Boston.
“We did this based on our moral obligation and our mission because our focus is on addressing racial and ethnic disparities in health and in healthcare, and also addressing social justice issues and economic disparities so we felt compelled [to act],” Williams said.
Walsh said the virus “is shining a light on long standing health inequities,” in Boston and across the country.
Liston described her patients as having limited personal transportation and speaking little to no English in some cases. In addition to testing, there’s a need for information about things like social distancing and wearing masks.
“[N]ot using them correctly, a lot of times, that can do more harm than good,” Liston said. “So we’ve been doing a lot of education around donning a mask appropriately and the difference between a respirator and N95 versus a mask. I think the language is kind of synonymous and people get confused simply because they just don’t know.
“Some people put it on upside down, they don’t realize the metal piece kind of is form fitting to the nose … A lot of time[s] what people don’t realize is [with] your hands you can self inoculate, which means you can give yourself germs or the coronavirus in this case.”
Liston, who speaks Spanish and English, said a lot of the staff are bilingual and multilingual which is beneficial to those trying to overcome a language barrier. Williams said their population includes people from 25 different countries, so cultural competence, or ability to understand and communicate effectively across cultures, is important.
On Wednesday, Walsh announced areas, including Upham’s Corner and Codman Square in Dorchester, Mattapan, and East Boston would expand testing.
As other community centers begin to provide similar resources in Boston, Williams is hopeful that more testing and rapid results will improve outcomes for minority communities—this after testing rose from 13 people to 35 over the course of two days.
“[W]e’re optimistic that if people know their status and they’re connected to care that it will make a huge impact,” she said. “We’re positive that this is one of the many mitigating strategies that would work.”