How One New Jersey Doctor Tests the Underserved for Coronovirus

Author: News Media
May 8, 2020

by Leslie Brody – Wall Street Journal – 5/8/2020

Alexander Salerno, a primary-care doctor who has served New Jersey’s urban poor for decades, was so dismayed by the dearth of coronavirus testing that he took matters into his own hands.

Shelling out $42,000 for a van with a sink and a generator, he launched a pop-up clinic this week to test hundreds of people a day in parking lots around Orange and Irvington, low-income communities near Newark. Wall Street Journal – 5.8.2020

In the U.S., only New York has more coronavirus cases than New Jersey, which said 133,635 people have tested positive as of Wednesday, and 8,801 have died.

In Dr. Salerno’s view, the Covid-19 crisis has laid bare the U.S.’s lack of a proactive public-health system. Having “100,000 tests a day for a country of over 300 million people is not something to boast about, it’s something to be embarrassed about,” Dr. Salerno said. “We were flat-footed.”

He hopes grass-roots efforts like this mobile testing clinic can be a model for filling in gaps.

While running a private practice in East Orange and Newark, the 52-year-old also oversees a nonprofit, the Urban Healthcare Initiative Program. It offers education on health issues to residents, who have disproportionately high rates of diabetes, asthma, hypertension and other conditions that can make them more vulnerable to the infection.

Because of shortages of tests, early testing efforts in the U.S. were largely limited to essential workers, the seriously ill and those thought to have been exposed to the virus. But supplies are increasing, and some experts say broader testing is vital to understanding the virus’s spread and containing it.

Some communities are stepping up. The small California town of Bolinas, for example, has tried to test every single resident.

People seeking tests in Orange have waited for hours outside the white van, which is decorated with red spiky balls depicting the powerful virus. A medical team offers oral swabs to check whether people currently have the infection and blood tests to check for antibodies that might indicate they already had it.

A few fights have broken out as some in line accused others of cutting in. “Tensions are high,” Dr. Salerno said. “People have been cooped up for weeks with nothing except listening to the news and getting scared.”

On Wednesday’s cold, damp morning, the van and a staff of about 10 were humming next to the police headquarters in Orange, a city of roughly 31,000. Mayor Dwayne Warren had notified constituents by robocall about the free tests.

Residents who arrived for testing—many older adults—sat on chairs 6 feet apart. Their backgrounds reflected Orange, where 95% of residents are black or Hispanic, according to census data.

Large cities around the country have found higher rates of coronavirus among some minority communities. Experts say that could be because of economic disparities, including working in jobs that can’t be done from home, and living in multigenerational households, which can expand exposure.

Jamila Ya-Sin, a 76-year-old retired teacher, brought her 93-year-old mother, who has diabetes and a heart condition, and who had suddenly shown signs of confusion.

“I’m happy they’re doing this,” Ms. Ya-Sin said. “Everyone’s working on a hope and a prayer these days.”

Carlos Ramirez, who works as a security guard in Midtown Manhattan, came because he felt “a little under the weather.” He said he kept commuting in on NJ Transit as an essential worker though it was Wall Street Journal – 5.8.2020

depressing to lose his routine of stopping at a friend’s deli for a pastrami sandwich and a newsstand for a lottery ticket. Both had closed.

“It’s a shame,” he said. “It’s their livelihood.”

Medicare and other insurance covered the testing without a copay. Those without insurance could also get tested free if they had a Social Security card. Others had to pay $152 for the tests and laboratory fees.

Dr. Salerno said his office made no profit on the service: He pays his exhausted staff for long days and has had to resort to buying overpriced masks, gowns and gloves. Early on, markups were 700% of regular prices. Now he says he pays $5.25 for N95 masks that would usually cost about $1 each.

He estimates his practice has spent nearly $60,000 so far on personal protective equipment for 106 employees, who staff the van and three medical offices. To his frustration, he had to compete against public agencies to buy PPE, he said, and one of his vendors’ shipments was diverted for government use.

To Dr. Salerno’s delight, however, only nine of 198 people tested at the van Monday were positive. He was still waiting for results on antibodies. Having them might offer little comfort: The World Health Organization said April 24 that there was currently no evidence that people who recovered from Covid-19 and have antibodies are protected from a second infection.

Dr. Salerno aims to bring the van to senior housing sites in coming weeks. It is crucial to find “silent spreaders” of the contagion who are unwittingly making matters worse, he said, especially since many doctors’ offices have shut during the pandemic.

Scrambling to add staff is a daily battle. About 40 of his employees have gotten the virus and recovered. Three more were diagnosed with it this week. To gear up for a second wave predicted for the fall, Dr. Salerno bought an airfreight container to store personal protective equipment that he hopes to stockpile when prices come down.

Covid-19 “continues to be a very humbling disease,” he said.