New research from Tulane University and the New Orleans Health Department suggests that last spring, city-run walk-up testing sites significantly increased testing in low-income and minority neighborhoods, which are less likely to have pharmacies and clinics. City officials say the study validates the city’s approach on both testing and vaccinations.
The study, published last week in the peer-reviewed journal BMC Public Health, examined which census tracts were near public testing sites from March 20 to June 23, 2020, and how far patients travelled to get tested. Walk-up testing locations, which opened April 21 beginning with a site in Hollygrove, served far more residents of Orleans Parish than drive-through tests. And Black, Asian, and elderly people were all more likely to seek testing at their nearest site.
“We have an idea that accessibility of the health system can be difficult, because [someone has] had bad experiences there, or they expect it to be expensive,” said Julie Hernandez, a geographer at Tulane’s School of Public Health and Tropical Medicine, who led the study. “The beauty of community-based intervention is that we can put a free, friendly site in people’s neighborhood. The research shows that when you do this, people will take advantage of it.”
Dive-through sites, run in partnership by the city and National Guard, opened on March 20 at the University of New Orleans. Before it even opened, said Dr. Jennifer Avegno — the city’s health director and a co-author of the study — her department realized that it would leave gaps.
“The earliest days of testing were helpful in helping us understand the outbreak, but right off the bat did not provide an equitable approach to containing the outbreak,” she said. Twenty percent of New Orleans households don’t have access to a car, and that’s concentrated among Black families.
After a few weeks of drive-through testing, Avegno said, it became apparent that people from some neighborhoods weren’t going to the sites.
“And they’re the neighborhoods that we were the most worried about. They were what we would now know as the highest social vulnerability neighborhoods,” which have suffered a disproportionate number of COVID deaths.
“The entire country is dramatically racially segregated, and New Orleans is no different,” said Thomas LaVeist, the dean of Tulane’s School of Public Health and Tropical Medicine. “And health care facilities are not sited based on need. So we have places all over this country that you could call health care deserts.”
To reach those neighborhoods, the city opened its walk-up sites in partnership with LCMC in late April last year. But according to Avegno, “we just didn’t know if it was crazy, or if it was going to do what we hoped.”
Hernandez was a volunteer at the drive-through testing sites almost from the day they opened, and realized that she could answer that question. The testing programs were taking down home addresses during the registration process, and using those, she could figure out which neighborhoods’ residents were being tested, and how far any individual had to travel.
Her analysis found that the walk-up sites served a much higher proportion of people from Orleans Parish than drive-throughs. Seventy-eight percent of patients at walk up sites were from Orleans, compared to 45 percent at drive-throughs.
The median distance to the nearest walk-up testing site was only one mile, and the sites were more likely to be located in Black neighborhoods.
The average person didn’t actually travel to their nearest testing site, even with the walk-up sites available. People who tested positive travelled about three-quarters of a mile further, which Hernandez suspects is because they were willing to seek out testing after symptoms or an exposure. But Black people, Asian people, and anyone over the age of 50 were more likely to use their closest site.
“This was the right way to shift testing,” Avegno said. “There are people who may not have gotten tested if these sites had just continued to operate as big drive throughs, not in neighborhoods.”
However, the study found that people who identified as Hispanic were more likely to travel further, and to test positive. According to Hernandez, that reflects the fact that many of those people were travelling into the city from Kenner and Metairie, as well as high rates of community transmission in the Hispanic community in the spring.
“Besides the cliche of the construction crew, a lot of the Hispanic population, men and women, work in the service industry,” Hernandez said, and were more likely to be working in person, on the front lines, while the rest of the city was shut down.
She also believes that the sites may have attracted people by providing translation services, and by not requiring ID. She volunteered as a Spanish translator, and said that she encountered at least one man who said he was wary about getting tested because of his immigration status.
There are several limitations to the study. It doesn’t include any information on commuting habits or other non-residential factors that might have made testing more or less difficult to access.
“We had a situation where a construction crew was two blocks away from where we were testing, and their supervisor sent them all in,” said Hernandez.
The analysis ends on June 23. That date, said Hernandez, was chosen to make sure that the study captured a similar amount of data before and after walk-up testing opened. And over the summer, as the country began reopening, Avegno said different people began to seek testing.
“We got into the summer surge that was largely fueled by young people. … And then we started seeing a shift in demographics,” Avegno said. “We started to see more white residents travelling to wherever we had [testing] that day: Central City, Gert Town, New Orleans East.”
The data hasn’t been formally analyzed yet, but Avegno said that travel distances to testing increased during that time.
Hernandez attributes that change to other factors as well, including the fact that workplaces began reopening. “You have a higher population that needed to get tested,” she said. “So people were willing to go a long way, to be the first in line.”
Hernandez said she has only received data through Thanksgiving, so it’s not clear what happened during the winter surge.
On March 8, however, the city closed its COVID testing sites, citing falling demand and a need to shift personnel into vaccinations. Since then, between 50 and 60 percent of weekly COVID tests in New Orleans have come from Tulane University, which screens undergraduates every few days.
Even excluding the Tulane tests, the city is well ahead of daily testing benchmarks, and Avegno pointed out that there are now several community testing options available that didn’t exist in the spring. Both Ochsner and a nonprofit, CORE, run their own mobile testing sites.
“We also have testing in schools,” Avegno said. “That is a resource that didn’t exist last year.”
Still, it’s not yet clear who is accessing existing testing citywide: in response to a public records request, the Louisiana Department of Health said that it doesn’t keep demographic information on testing.
Avegno said that the city is using the same community strategy for its own vaccine outreach.
“It’s our elderly population that’s at the highest risk. And when we’ve put vaccine sites in neighborhoods where elderly people live, it’s so much easier for them to get there. When you expect them to get a ride halfway across town, they’re not going to get tested, and they’re not going to get a vaccine.
The city has been visiting two to four sites every week with a mobile vaccination clinic, often in Central City and the Ninth Ward. Those sites distribute a small proportion of the overall doses in the city, but are vaccinating people of color at a higher rate. They also often work with community groups and churches, and incorporate door-to-door canvassing.
So far, Avegno said that she has not seen data on where people who get vaccinated at the Convention Center live. “I’ve asked for that, and I don’t have it yet. I do know that we’ve done thousands of Uber rides.” According to an LCMC spokesperson, LDH is responsible for compiling all vaccine records at the Convention Center.
“The mass vaccination sites, they’re going to be great for a certain number of people and we need that,” Avegno said. “But cities and communities that are just relying on these big sites are never going to get to herd immunity, not in any length of time.”