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From eight to 10 drivers at a time waited in line Tuesday afternoon at 41st and Market Streets, all seeking the same thing: a coveted chance at a coronavirus test.
Within a tent, masked and gloved Penn Medicine staff approached each car, swabbed the passenger’s mouth or nose, and dropped the samples into a container to be sent for testing at a specialized lab. It’s a scene that was repeated all over the region Tuesday at sites run by Penn, Jefferson Health, and Main Line Health as people exhibiting worrisome symptoms queued up, doctor’s referral in hand.
Taking a cue from South Korea, makeshift collection sites that can collect swabs to send to a specialized laboratory for molecular testing have been popping up across the country. One big reason is that doctor’s offices don’t want to collect samples, because they lack the protective gear, the safety protocols, the will — or all three. It takes several days for test results to be completed.
Another reason is that molecular testing is more readily available now, thanks to the advent of commercial versions. But the biggest reason is that the coronavirus is becoming a runaway train, spreading from person to person in communities without any apparent source of infection. Expanding testing beyond the meager capacity of federal and state public health labs is vital to preventing a disaster. Public health officials have confirmed that “community spread” — transmission that can’t be traced — is now occurring in some parts of Pennsylvania, notably Montgomery County.
The collection sites are not taking swabs from just anyone. Test-seekers must have symptoms such as fever, cough, and trouble breathing.
But a lot of people fit the description.
About 410 people were seen at Penn Medicine’s two collection sites, one in West Philadelphia and the other in Radnor.
Penn has developed a test that the government has green-lighted, and has also been sending samples to a commercial lab.
One man who declined to be identified wore a yellow mask when he pulled up to the West Philadelphia site.
“About to get tested,” he said. He had been to his doctor at Penn Medicine and was pretty sure he just had a cold, he said, “but they wanted me to get tested, so here I am.”
The sites are designed to serve patients as they sit in their cars — a strategy to limit person-to-person contact. But Penn workers also assisted a short line of walk-up patients, most of whom wore face masks.
A sign outside the collection site emphasized that testing is intended for people who have a doctor’s referral, and included instructions for obtaining one. But at the bottom, the sign also noted that patients with symptoms and no referral would be “assessed on a case-by-case basis.”
Penn’s sites will be open daily this week, as long as they have sufficient test kit supplies.
Also, 250 people flocked to Main Line Health’s Newtown Square and Radnor sites on Tuesday, the first full day both were open. Swab collection began on Saturday at Newtown Square; the Radnor site opened for part of the day Monday.
“So far the process has been running incredibly smoothly,” with people waiting between 10 and 15 minutes, said Bridget Therriault, a spokesperson for Main Line Health.
In addition to a doctor’s referral, patients must schedule an appointment at the Main Line collection sites.
The health system is discussing increasing the number of appointments scheduled in a day and how to accommodate symptomatic patients who don’t have a primary care doctor to give them a referral.
Jefferson Health has opened collection sites in Abington, Center City, Northeast Philadelphia, and South Jersey — all for patients with a referral from a Jefferson doctor.
Research has shown that the infection can be spread by people before they begin to have symptoms, so expanding from diagnostic testing to screening people with no symptoms could help with containment efforts.
But U.S. testing capacity remains too limited and laborious for that kind of screening. In the coming months, experts say, big diagnostic companies will be offering rapid molecular analysis that can be done at or near where the patient gets care.
Another challenge with screening asymptomatic people is that scientists don’t know enough about the incubation period of the virus and how easily it can be transmitted.
“Let’s say you were exposed to this yesterday, and you test today. You’re going to test negative. You may still be incubating the infection. You could develop symptoms a few days later. That negative test may give you a false sense of security that you’re fine, and you may go out there and come in contact with people,” Philadelphia Health Commissioner Thomas Farley said.
Meanwhile, the state is in talks to open two federally supported public testing sites in Philadelphia and Montgomery County, said Randy Padfield, director of the Pennsylvania Emergency Management Agency.
The state has not yet said exactly where those sites will be, and it was unclear if people will need a doctor’s note to get tested. But they will also focus on testing individuals with “symptoms that would lead us to believe they may have COVID-19,” Padfield said.
Philadelphia City Councilmember Mark Squilla said he had been briefed on plans by Mayor Jim Kenney’s administration to set up a drive-through testing site in the parking lot of the stadium complex. City, state, and federal officials were working together on the site, he said, which was expected to open this week.
Val Arkoosh, a physician and chair of the Montgomery County Board of Commissioners, said she hopes to have her county’s site open by next week, but declined to say whether patients would need a doctor’s referral.
She encouraged people with mild symptoms to stay home and not worry too much about whether they might test positive for the virus. There’s no cure beyond treating the symptoms, so for mild cases, that means over-the-counter cold and flu medicines, fluids, and rest.
“Knowing you’re positive or not is not going to impact your treatment," she said.
And now that everyone has been advised to stay home as much as possible and practice social distancing, chances of spreading the virus should be limited.
Ideally, everyone with symptoms would get tested quickly, but for now, Arkoosh said, “people who can isolate at home are not our top priority.”