CEO SUMMARY: After seeing the largest cluster of confirmed coronavirus infections in one location, New York State took emergency measures “to attack the hotspot at its source.” The state opened a drive-through specimen-collection site offering free testing without an appointment or doctor’s order. In partnership with two labs, Gov. Andrew Cuomo ordered the site be operational within three days. At one point, it was collecting more than 1,200 specimens each day.
NEVER BEFORE HAS THE NATION NEEDED DRIVE-THROUGH SPECIMEN COLLECTION to contain an infectious disease outbreak.
But on March 10, as the novel coronavirus spread quickly, New York Gov. Andrew Cuomo asked Northwell Health Laboratories to set up such a site in Westchester County, saying it needed to be operational three days later. Across the state, the number of positive tests for the coronavirus was rising, especially in the New York City suburb of New Rochelle.
On that day, there were 173 confirmed cases statewide, including 108 cases in this community of 80,000 residents.
Cluster of Infections
To contain the cluster of infections, Cuomo announced emergency measures including a partnership with Northwell Health to establish the drive-up site in a city park. Northwell and BioReference Laboratories (BRLI) would do the testing.
On the recommendation of state Health Commissioner Howard Zucker, MD, Cuomo also deployed the National Guard to help manage the outbreak, and ordered the closing of schools, houses of worship, and other large gathering places.
“The largest cluster of confirmed coronavirus cases in the country is located in New Rochelle, and as the numbers continue to go up, we need a special public health strategy to contain it,” Cuomo announced. “We are moving from containment to mitigation, and because much of the transmission of this disease tends to happen on a geographic basis, we are attacking this hotspot at the source.”
For Christopher Zavala, Northwell Laboratory’s Director of Business Development and Marketing, Cuomo’s plan left him with less than three days to learn about how to run a drive-through specimen-collection site and then get it staffed and operational. In an interview with The Dark Report, Zavala said those challenges were the first of several more that he and a team of phlebotomists had to overcome.
Since then, the numbers show the drive-through specimen collection operation has been a success. On the first day of operations, the Northwell team served 287 patients. Within 10 days, that volume rose more than four-fold to 1,200 per day.
As of March 26, Northwell had collected specimens from more than 8,500 patients. “When we got the word, health system leadership said we needed five phlebotomists prepared to collect specimens at a new drive-through testing site by that Friday,” he said. “We didn’t have any other information about its location, the hours of operation, how to set it up, or how to run it. We also didn’t know who else would be there except possibly officials from the state Department of Health (DOH).
“So, our first step was to reach out to our team of phlebotomists and ask them if they would participate,” added Zavala. “We knew we could do it because we had already trained some phlebotomists about how to do the nasopharyngeal (NP) swabs.
“Still, uncertainty about how the process would work caused some reluctance among staff to volunteer,” he said. “People didn’t know what they were getting themselves into. “That initial hesitation was understandable, but after they saw the operation, getting volunteers was easier because we knew this was the right thing to do,” noted Zavala. “Our lab team wanted to be part of the solution. That’s why we’re in healthcare.”
Once the staff was in place, the next hurdle was gathering the requisite resources, such as personal protective equipment (PPE), NP swabs, and universal transport media (UTM).
Following the example of do-it-yourselfers, Zavala searched for information about drive-through collection sites that health systems had posted on the Internet. “There are videos and pictures online—especially from South Korea and from the University of Washington describing drive-up testing programs,” he said.
“When you’re tasked to put something together so quickly, things can fall through the cracks,” warned Zavala. “We wanted to make sure that we had everything possible—meaning we should at least bring what we could.”
The Northwell team brought extra sets of PPE, and Zavala loaded his car with 1,000 swabs and UTM. “Just in case the people from the state DOH didn’t bring those items,” he said.
That Friday, at 6:30 am, Zavala arrived at the site on Glen Island Park in New Rochelle and was relieved to find that state officials brought all of the necessary equipment. What’s more, the National Guard had set up traffic cones and three lanes for testing.
The site is ideal because the park is closed “due to National Guard activity,” according to the city’s website, and the only access is via one drawbridge from the mainland. The first day of specimen collection was scheduled to run from 7 am to 7 pm. After that first day, the hours were reset at 8 am to 8 pm. Testing continues daily.
Sample Collection Issues
The next hurdle that morning was identifying the best way to do an NP swab on a patient in a car. “In the videos, you can see that the collection itself is challenging,” noted Zavala. “An NP swab requires the patient to tilt the head back so that the collector can get the swab in far enough to get an adequate sample,” he explained. “The headrest impedes a person’s head when they tilt back. So, we instructed patients to lean forward and then tilt the head back.”
To protect against contaminating the swab collectors, DOH officials, or the National Guardsmen who directed traffic and checked patients’ identifications, state officials decided that all patients would remain in their cars with the windows closed. All communication was done through closed windows. “The National Guard also assisted patients with filling out requisitions and collecting patients’ phone numbers so that the DOH could follow up with results,” Zavala explained.
Once in the queue, each driver was instructed to place identification on the dashboard so that a Guardsman could check it at the first stop. No appointment is needed, but strongly recommended. Also, the testing is free, although Northwell expects the state to pay at some time in the future, Zavala said.
Collections with NP Swabs
“Originally, we thought we’d have one phlebotomist per car, meaning we’d need three phlebotomists, one for each lane,” Zavala said. “But that was difficult because the phlebotomists had to instruct the drivers, do the collection, and hold the media.
Therefore, it was best to have one person do the collection and one person hold the universal transport media. “After the patients check in at the first station, they proceed to station two,” he reported. “That’s the hot zone where we do the actual collection.”
At the second stop, the driver rolls down the window for the collector to take a specimen. Initially, the CDC required two swabs: one each in the back of the nose and throat. “About a week ago, the CDC changed their guidance so that now we just need a nasopharyngeal swab,” Zavala said.
Station three is where patients checkout and get instructions about next steps and when to expect the results.
“When we started doing the collection, we realized it was a lot to ask of one person,” he added. “Even though we work in tents, everyone is outside in the elements. And that first day it was raining and very windy. “That made it difficult for our phlebotomists to have one hand reach into the car to do the NP swab while holding the UTM with the other hand—all while making sure they’re not spilling anything or contaminating themselves,” Zavala said.
“That’s why we decided to have two people per car for each collection,” he added. “Someone needed to assist the phlebotomist by holding the specimen and writing the patient’s name on the sample. Before we started collecting specimens, we didn’t realize we’d have these challenges.
“That first day we were scheduled to start at 7 am, but we didn’t begin seeing patients until about 8:30 to 9 am,” he reported. “We actually had some walk-ins that day and I don’t know how many cars, but we collected samples from 287 patients.
“Very few people drove in by themselves,” he reported. “Most cars had two people, and some cars had three or more. Sometimes there were two parents in front and three kids in the back seat because a lot of patients came with their whole families.
Van Arrives with 10 People
“I wasn’t there one day when a van drove in with almost 10 people,” he said. “But we couldn’t swab them all because we could only reach a few through the window. The rest of them had to return at another time.”
Since the first days of the operation, demand for COVID-19 tests has risen. By March 19, Northwell collected specimens from 1,200 patients—in part because state officials doubled the number of traffic lanes to six.
The 12-hour shifts made for long workdays, but the phlebotomists got breaks because Northwell scheduled four phlebotomists and four assistants for each set of three lanes of traffic, and state DOH officials provided some assistance as well, Zavala said. Also, the PPE equipment that the phlebotomists wear—which the team refers to as ‘bunny suits’—includes a battery- powered ventilator to help maintain a comfortable temperature.
After the specimens are collected, they are stored onsite in a refrigerated truck. Each day, BRLI picks up the samples and then performs the testing.
Contact Christopher Zavala at 516-719-1540 or firstname.lastname@example.org.