Via Financial Times

Orson Hood was passing through Gert Town, a predominantly African-American neighbourhood in New Orleans, in April when he spotted a pop-up clinic doing coronavirus tests. 

He knew the city had been offering tests at a drive-through site but had not found the time to make a visit. “The walk-through was a lot easier because it was in the neighbourhood that I grew up in and I just happened to be going by,” said Mr Hood, 67. “I thought: ‘Let’s see how I’m doing with the virus’.”

Public health experts say New Orleans’s decision to switch quickly from a drive-through testing model to mobile walk-in clinics, mostly located in deprived areas that are virus hotspots, is one of the reasons the city managed to flatten its curve more quickly than other urban areas in the US. 

The city’s experience holds important lessons at a time when the coronavirus case count is rising in states across the west and Deep South, and as public health experts warn of a second wave in the autumn or winter.

When coronavirus hit the US, New Orleans appeared to be on the cusp of one of the worst outbreaks in the country on a per capita basis, in part because its annual Mardi Gras celebration on March 5 is thought to have been a “super spreader” event.

Line chart of Cumulative cases per million showing Confirmed Covid-19 cases in New York City and New Orleans

At one point, the city’s death rate was higher than in New York, on many measures the global epicentre of the pandemic. Like many of the communities hardest hit by the virus nationwide, New Orleans is home to a large African-American population — the city is 60 per cent black.

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“New Orleans got off to a much steeper start, but bent their curve very quickly,” said Dr Jonathan Quick, head of pandemic response at the Rockefeller Foundation. “The remarkable sharp decline in new cases is prima facie evidence of rapid, effective epidemic control.”

At the start of the outbreak, New Orleans health officials were quick to secure testing supplies thanks to their strong ties to the Federal Emergency Management Agency, forged during natural disasters such as Hurricane Katrina in 2005.

They promptly set up a drive-through clinic. But when Dr Jennifer Avegno, head of the New Orleans health department, started poring over the data from the testing site, she noticed something strange: lots of people were not showing up, and most of them lived in the same areas.

“We opened the mobile testing centres after analysing thousands of addresses from the drive-through site, and we saw the spots where people were missing,” she said. “That’s where we’ve ended up putting the walk-through sites.”

After an initial scramble to secure supplies because of a national shortage, local officials across the US encountered a new problem — underutilisation. A survey published by the Washington Post last month found that at least 12 states had testing capacity that outstripped demand.

Line chart of Cumulative deaths per million showing Covid-19 deaths in New York City and New Orleans

Underutilisation can be partly explained by the fact that much of the testing in the US is administered via drive-through sites. This is an ostensibly sensible move given that many Americans perform lots of everyday tasks without leaving their car, such as picking up coffee and pharmacy supplies, or depositing a cheque at the bank.

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But it has also precluded public officials from designing testing programmes that address the needs of people living in poorer areas, which have been hit disproportionately hard by the virus. 

“If you are going to do testing for a new disease, you have to be part of the community,” said Dr Quick. “It is worth nothing unless you are able to stand up a good force of testers.”

More recently, officials in other parts of the US have started opening more walk-through sites and offering tests at local pharmacies, but few have embraced the roving pop-up model that has proven so successful in New Orleans. The city offers hundreds of tests a day at a variety of different sites, including churches, community centres and high-risk residential buildings. 

Driving to get a test has proven unpopular with some for the obvious reason that many do not own or have access to a car. The drive-through centres, which are often manned by armed police or guards, are also off-putting to those who mistrust authority figures, especially at a time when the killings of George Floyd and other African-Americans have unleashed national outrage over police brutality.

“The first person you were greeted with at our drive-through testing site was a national guard dressed in fatigues,” said Dr Avegno. “They were fantastic, but not everyone wants to confront that. In many cities there is a huge mistrust of the police system, for very good reason.” 

Dr Avegno and her colleagues have also used the pop-up sites to educate people about the virus and address other disparities in public health. While someone is waiting in line, a health department employee does a “social needs assessment”, during which they ask people whether they have the prescription drugs they need and if they are eating properly. After the test has been done, they are given a “gift bag” containing face masks and hand sanitiser, and sometimes offered baby formula or a hot meal.

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“You have to be giving more than you’re getting,” she said. “Just going into a neighbourhood and sticking Q-tips into people’s noses is not a good model of community health.”