By Nick Graetz
- Massive scale-up in uniform COVID-19 testing is needed over the coming months in order to most effectively control the virus, but also because it is the fastest way to ease social distancing and reopen businesses. Health experts generally agree we need to scale up testing capacity to screen 2-6% of the population daily. Roughly 2% of Philadelphians have been tested for COVID-19 in total since the beginning of the pandemic.
- COVID-19 testing is already, and will continue to be, an equity issue. Risk of infection and likelihood of being tested varies dramatically by neighborhood based on factors such as the proportion of essential workers and proportion uninsured. In many drive-in testing locations, you still need a physician referral. We should prioritize testing and contact tracing for hardest-hit areas, which are disproportionately communities of color, and remove obstacles related to testing such as insurance status.
- While we need to target testing in neighborhoods we know are more vulnerable, we also need geographic data on testing, cases and deaths by race-ethnicity. The Philadelphia Department of Public Health needs to commit to disseminating these data. “PA released figures on the coronavirus and race, but not specific geographic data. Experts say that’s a problem.” April 17, 2020, The Philadelphia Inquirer.
The big problem looking forward: We need to be testing way more people (2-6% per day), and we need equitable testing regardless of race, income, or insurance status. It’s not enough to just get to that number of daily tests across all of Philadelphia. We have to make sure that testing is targeted and equitably distributed, and more concentrated in neighborhoods that are less connected to existing healthcare infrastructure.
Though many predominantly Black and Latinx neighborhoods are at increased risk of infection, mobile testing sites in cities throughout the country are disproportionately located in high-income, White areas and patients with COVID-19 symptoms are less likely to be tested if they are Black. Universal testing is the cheapest, fastest, and most efficient way to reboot the economy, but existing racial inequality in access to care and treatment is an obstacle – especially documented and insured status.
Massive scale-up with eye towards equity: The neighborhoods that need the most community-based testing are those with 1) large proportions of essential workers, who are at the highest risk, 2) lower-income neighborhoods with highest rates of known infection. “Essential” work is chronically underpaid and includes janitorial jobs, grocery workers, and transit workers. In the map above, a higher proportion of the total population in Center City has been tested for COVID-19 compared to lower proportions in neighborhoods across the south and northeast. This is despite the fact that the latter neighborhoods are at higher risk of infection, with much larger proportions working essential jobs in healthcare, food services, and construction.
Scaling up testing means coming to people where they are – not necessarily just providing hospitals with more tests for who comes in to get them (and tied to insurance status). For example, some have the privilege of driving to testing locations but others must use public transit. We don’t want to push people to get to far away testing sites – we want accessible sites in their neighborhoods, including mobile testing options. Besides lack of insurance and ease of accessibility, there is also evidence that people may avoid seeking hospital care for risk of acquiring infection, further pointing to the need for community-based testing.
Scaling up mobile testing while targeting for equity. Some groups in Philadelphia such as Black Doctors COVID-19 Consortium have organized to deliver mobile testing to marginalized neighborhoods least connected to existing healthcare. This group has raised close to $50,000 for van transportation, personal protective equipment, educational materials, and testing supplies.
But we shouldn’t have to rely on GoFundMe donations to groups like this in order to get uniform testing to those at highest risk. The CDC Director is moving to mobilize Census workers as well as Peace Corps and AmeriCorps to see if they might be able to provide the thousands of workers needed for potential mobile and at-home testing and contact tracing moving forward.
Check out this map created Researcher Nick Graetz to explore the impact of racial capital and inequity amidst the pandemic in State Senate 1st District
COVID-19 testing data is pulled from the City of Philadelphia website: https://www.phila.gov/assets/covid/CovidCasesByZip.csv.
For the sake of confidentiality, tests and cases are only reported in aggregated counts at the zip code level rather than at the individual level. Here we are comparing these aggregated counts to other aggregated data from the American Community Survey, such as the proportion of people in a neighborhood who are working in an occupation deemed essential. It is always possible that aggregate relationships do not reflect relationships at the individual level (this is termed the “ecological fallacy” in statistics). While certain characteristics may be highly correlated at the neighborhood level, we don’t know exactly which individuals in each neighborhood are being tested. However, aggregate comparisons can speak to broader macro patterns that exist at the neighborhood level, such as how systems of historical and structural racism have distributed risks related to labor relations, access to healthcare, and housing across marginalized communities.
COVID-19 “essential workers” are defined using the following categories in the U.S. Census 2018 American Community Survey 5-year pooled dataset:
- Healthcare practitioners and technical occupations (S2401_C01_015)
- Construction and extraction occupation (S2401_C01_031)
- Farming, fishing, and forestry occupation (S2401_C01_030)
- Installation, maintenance, and repair occupation (S2401_C01_032)
- Material moving occupation (S2401_C01_036)
- Production occupation (S2401_C01_034)
- Transportation occupation (S2401_C01_035)
- Office and administrative support occupation (S2401_C01_028)
- Sales and related occupation (S2401_C01_027)
- Building and grounds cleaning and maintenance occupation (S2401_C01_024)
- Food preparation and serving related occupation (S2401_C01_023)
- Healthcare support occupation (S2401_C01_019)
- Personal care and service occupation (S2401_C01_025)
- Protective service occupations (S2401_C01_020)
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