As coronavirus cases began spreading across the country, the police department in Carmel, Indiana, took social distancing seriously. It cut administrative staff at the station to a third of the usual number, used video conferencing for meetings from its offices and wiped down desks, door knobs, phones, keyboards and other surfaces twice daily.
So when Carmel Police Chief Jim Barlow tested positive on April 7, he was stunned — not only because he had worked so hard to reduce his risk but because he also had no symptoms.
“I was floored — I work out and do a lot of cycling and had just ridden over 20 miles pretty vigorously,” the 60-year-old Barlow said. “If I hadn’t gotten that call, I’d be interacting with my family. That’s the scariest thing — that I might have infected my wife and children.”
Fortunately, his family all tested negative. But the reason they could so easily get tested at all is the extensive testing program Carmel’s mayor, James Brainard, began the first week of April.
“I really appreciate him being so proactive in his approach to this,” Barlow said. “The quicker we identify people who have it, the better we’ll be overall.”
As the country at large falls far short on providing enough tests for COVID-19 — the No. 1 thing experts agree we need to do to effectively track and stem the spread of the disease — Brainard’s strategy represents the near opposite: decisive action and testing, testing, testing.
The calculus is complicated, Brainard told HuffPost — are there enough tests? Who should get tested? How do we test them? — but the answer is simple: “We’re trying to save people’s lives by cutting down on the spread of this virus.”
With the help of Aria Diagnostics, a local biotech company, Brainard put in place a plan to test all 700 Carmel city employees for the virus weekly — and opened it up to their dependents, as well.
In fact, so flush with tests is the Indianapolis suburb of 99,000 people that Brainard and Aria’s co-founders reached halfway across the country (and across the political aisle) to offer New York’s Mayor Bill de Blasio 50,000 test kits — and a contract to buy more.
Brainard moved quickly on the coronavirus, issuing an executive order limiting travel within Carmel on March 18, about a week before the Indiana governor issued the statewide order. But water mains still break, construction still requires building inspections, and EMS workers still transport people to the hospital, so Brainard saw a need to test workers who were out on the job while the rest of the city was social distancing. “We still have an awful lot of employees out there dealing with the public,” he said. So far, two firefighters, Barlow and a few other city employees have tested positive, despite not having symptoms.
Brainard’s plan to test city workers came about after Aria’s co-founders, Zak Khan and Vipin Adhlakha, who both grew up and live in Carmel, began to refocus their company on coronavirus testing in late February.
“We saw what was happening in Wuhan and Italy and that this disease was moving west quickly,” Khan said. “No one took it seriously enough. We took it quite seriously.”
“You really don’t know what your enemy is in the field, and the only way to get intel is to test,” said Khan, a former U.S. Marine. “If we don’t test everybody, you won’t get the people who are positive.”
Aria spent several million dollars in late February to buy testing machines, reagents (the chemical mixtures used in testing) and test kits for the coronavirus and to prepare the company’s labs for widespread testing. Khan shared the news that Aria was offering COVID-19 testing in a Facebook post on March 21. Less than a week later, Brainard reached out.
The mayor had spoken with state health officials and administrators at four major hospitals in and around Carmel to ensure they had adequate testing supplies for hospital workers and patients — they did. After confirming he wouldn’t be taking testing away from the health care facilities, he told Khan his plan. In early April, Aria started tests of all Carmel first responders and city employees.
When a shortage of tests dropped its supply, Aria began making its own kits following Food and Drug Administration guidelines. The company hired furloughed Carmel residents to assemble the test kits, churning out 100,000 each week, with enough materials on hand to make 250,000 to 500,000.
As positive tests on people not showing symptoms rolled in, word reached the leaders of neighboring cities. Other mayors in the state called the company to use Aria’s testing services in their cities, and Aria now has contracts with more than 20 municipalities and three senior care communities. The company currently runs about 3,000 tests a week with a 24- to 48-hour turnaround. (This turnaround time is standard, though some parts of the country have experienced backlogs with much longer waits.)
Aria charges $175 per test ($150 for front-line workers in Carmel, a negotiated rate), and it accepts Medicare. Khan says the company loses some money on each Medicare patient.
“If I go bankrupt, I’ll find people to invest in my new company because they’ll know one thing,” Khan said. “I did the right thing at the right time, and if I go bankrupt doing that, I’ll be happy going bankrupt.”
Part of Khan’s commitment to doing the right thing included donating the 50,000 test kits to New York City, where there’s a shortage. The first shipment of kits arrived in Manhattan on Monday (delivered by two recently laid-off Carmel locals ― one a bartender, the other a house cleaner), and Aria has a contract to sell the city another 50,000 a week for eight weeks. The company has also begun working with Indiana’s State Department of Health to help meet the state’s testing needs.
But the simple truth is that most cities cannot afford widespread testing, which public health experts say underscores inequities in testing and treatment for poorer communities.
“Testing the entire first responder pool of a small city is very different than testing all first responders in, say, New York City,” said Harvard-trained epidemiologist Dominique Heinke. “In many major cities, the testing capacity isn’t even covering all people with symptoms or people who have died with likely, but unconfirmed, COVID-19.”
Carmel is among the wealthiest cities in Indiana, and its small size makes its plan cost effective. Brainard said the city so far has spent about $180,000 testing city workers and their family members, noting that a single hospitalization avoided could save over $100,000 in health care costs.
Epidemiologist Molly Rosenberg, an assistant professor at Indiana University in Bloomington, said Carmel’s strategy is wise, but if it’s not implemented across the whole state, it could end up worsening existing inequalities.
“The major concern I have with individual towns and municipalities undertaking this strategy without a more coordinated state or national response: How could this heighten the racial, ethnic and class disparities we are already seeing emerge in the COVID-19 pandemic?” she said.
Rosenberg worries that mounting shortages of both testing kits and supplies needed for kits, such as swabs and certain chemicals, will be exacerbated by aggressive testing in certain areas and not others.
Admittedly, it’s tough to say what the best use of resources is in such an unprecedented situation as this pandemic. “One of the reasons COVID-19 is such a tricky problem is that it’s not like our usual natural disasters or even most novel disease outbreaks, which are far more localized,” Heinke said. “Since the virus is so widespread, testing is needed everywhere, and lots of it. While sharing of resources needs to happen, right now it’s a bit of the Wild West.”
In Carmel, the long-term plan depends on how many positive tests the city sees as time goes on.
In the first couple weeks of widespread testing, it took longer than expected to get results back, and a few tests had to be repeated. Aria and the city are working out the kinks, and as of this week, about 1,200 Carmel employees and dependents have been tested. Of those, 1.3% have tested positive.
Brainard said officials still don’t know when the county — which includes two smaller cities and five towns — will hit its peak and see cases start to decrease. On Wednesday, 2,692 people had been tested in Hamilton County; there were 510 COVID-19 cases and 27 deaths, a 5% mortality rate, in line with statewide trends. (The city doesn’t track its own hospitalization data; that’s done on a countywide basis.) Carmel’s hospitals are comfortably at 50% capacity, having deferred nonessential surgeries.
“Once we see the curve go down, we look at the slope of that line, and if it’s quick, we know our efforts are successful,” Khan said. “The plan is probably two full months of testing and let’s reassess at that time.”
Brainard is encouraging the city’s 17 elder care facilities to test all staff members, and, if any resident tests positive for COVID-19, to test all residents. At least three facilities have complied with his requests (he doesn’t have authority over them, so he sent them emphatic letters) and several are waiting on corporate approval. But others have balked at the cost, instead testing only those with symptoms, an approach Brainard sees as short-sighted.
“It’s about human lives, but it’s also financially risky,” he said. “One lawsuit from a family costs far more than the testing.”
If all goes well, Brainard would like to see testing expanded to the city’s retail workers, since employees at grocery stores, pharmacies and fast food restaurants interact with the public daily.
“We’re learning this as we go,” Brainard said.
Ideally, Carmel and other cities will soon begin antibody testing to see who has already had the virus. Aria has just partnered with Ohio-based Lucid Diagnostics to become one of four sites in a clinical trial that will run 100 immunoassay tests to validate their accuracy, Khan said. Each finger-prick blood test costs $20 and takes 10-15 minutes to accurately show whether someone has had the coronavirus.
Until then, the weekly city employee testing continues in Carmel. Barlow still isn’t showing symptoms, but he can’t return to work until he tests negative twice in a row to account for possible false negatives. He tested positive on Thursday, April 16 — and is awaiting the results of his most recent test. But he’s sequestered in one room of the house and using his own dedicated bathroom to protect his family.
“You don’t want to get exposed, but you know there’s a chance in the job when you might be and might unwittingly bring that home to your family,” Barlow said. “I signed up for that — they didn’t.”
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