On Wednesday, my son drove me from Berkeley out to Bolinas where I have lived for the past twenty-plus years, to take a Covid-19 test. The test involved two parts: the first drew a blood sample to test for antibodies; the second involved a throat and nasal swab to test for the actual virus (PCR). I would be one of the 1600 residents that organizers hope will be tested, though the tests are not mandatory, but voluntary.
It’s remarkable really. How did this tiny out-of-the-way town at the south end of the Point Reyes peninsula manage to become the first community in the nation to manage community-wide testing? The testing was apparently the brainchild of several Bolinas residents—venture capitalist Jyri Engstrom, and biotech exec Cyrus Harmon, as well as Dr. Aenor Sawyer, an orthopedic surgeon with the University of California in San Francisco (UCSF). An initial seed of $100,000. was put up by gaming company founder Mark Pincus, and then Bolinas residents (not all town residents are wealthy, but enough now are to make it work) chipped in some $300,000 through a GoFundMe campaign. The originators used connections to UCSF to make the proposal, and that renowned medical center saw the usefulness of testing a single community to see how transmission occurs, how antibodies work, and so on. The model for testing an entire town came from the Italian town of Vo, population 3,000, in northern Italy. UCSF plans to duplicate its testing effort in the Mission district of San Francisco, a very different community from the isolated community of Bolinas, not only due to population makeup, but also because there is no real border separating the Mission from the rest of San Francisco. UCSF will then have two very different community types to use for data and transmission patterns. This is the kind of data that will be needed to really get a sound grip on how the coronavirus operates, the data that will be necessary before communities can feel reasonably safe.
The testing site in Bolinas is similar to other drive-through testing facilities. Tents are set up in a parking area next to the volunteer firehouse, with about four different bays set up for cars to drive through. Beside each testing bay is an enclosed area of the tent where supplies are stored and the completed tests are kept before being transferred to San Francisco for analysis. Hand-printed signs direct one into the lot, kept orderly by several volunteers who direct cars to appropriate bays. A volunteer in a mask comes to each car and asks for identification to check against the pre-registration data. We had already selected Wednesday at 1:30 pm for our test, and our data checked out, so we were given a medical-type mask, and told to proceed to one of the bays. Two cars preceded us, so we could see the occupants putting their hands out the window for the blood test.
In a very short time, we entered the bay (the tents, by the way, were white canvas or plastic, pyramid-shaped, with a point at the top flying flags; almost festive). I was the only one being tested, so I rolled down my window (instructions were to remain in cars at all times) and stuck out my right arm for the blood draw. One quick pin prick and the blood was allowed to flow into a small test tube identified as mine. My only problem was that, being on blood thinners, I had a hard time stemming the blood flow, which went on for some time. Nothing serious though. Then the tester told me to pull up my mask so he could swab my throat, once on each side. Easy. Next came the nose swab, for which I had to pull down my mask so he could push the swab into my nasal cavity and hold it there for ten seconds. Uncomfortable, yes, but not painful. The swab was then put into another identified vial, and I was done. Took maybe ten minutes all told.
Now the medics have two samples for each person tested—as of Thursday, 1844 Bolinas residents plus some W. Marin County first responders had been tested. The blood samples will be analyzed for antibodies, to see, ultimately, if the presence of antibodies provides immunity against new infection. This sample can also provide information about which tests are best, and what exactly antibodies mean for this virus. As Dr. Sawyer, who is coordinating the effort, explained,
If you have the antibodies that your body produces in the early stages of the infection, you could actually still be infected and pass the virus along to others. Another type of antibody may indicate you’ve had the infection and fought it off, but that doesn’t necessarily mean you’re fully immune – we don’t know how long immunity lasts (quoted from The Guardian, 4/22/20).
The testing protocol also made provision for any residents who are unable, for health reasons, to leave their homes. Trained testers will go to such homes and administer the test in relative safety. Prior to testing time, no one in Bolinas had had any symptoms of the virus. But since some people are asymptomatic even with the infection, no one could conclude anything until all were tested.
The big issue, of course, is when will one get results? Word is that anyone who tests positive for the virus will hear by phone, probably within 72 hours of the test. Makes sense. If you’ve got it, you’ll want to know so as to get yourself to a hospital or a doctor, and to isolate so as not to pass it on. And perhaps give some tracking information---where you might have picked it up, whom you might have passed it on to, and so on. Once such data is collated, the healthcare facilities will have a better idea of transmission lanes, hot spots, and speed and method of transmission. The results of the antibody test will take somewhat longer. There is a website, bolinastesting.org, where test results, including antibody data, will be made privately available.
What strikes me most about this is the fact that such tests, which every respected health care professional maintains are necessary before the nation and the world can really control the spread of Covid-19, can be done (and should have been done long ago) with the proper support from government. Supplies can be gathered, personnel can be trained, and the necessary facilities can be erected in a very short time. Local hospitals or medical schools indicate that they would be willing, as with UCSF, to provide the analysis, once the tests are administered (the UCSF tests were developed in house so as not to use tests and materials needed more urgently elsewhere; materials such as masks and swabs were also sourced locally). Then, and only then, can life be returned to something approaching normalcy. And clearly, the more data that is collected from around the country and the world, the safer we can all begin to be. Indeed, until the federal government stops denying that it has not taken the necessary testing steps to control this pandemic, the sooner we can stop losing lives unnecessarily, and get back to safety as a nation. And the United States, a nation that pretends to be ‘advanced,’ can start acting truly advanced, instead of passing the buck to individual states and to small communities like Bolinas to do their work for them.
Lawrence DiStasi
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