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Testing 4-1-3, Testing 4-1-3…Is This Thing on?…

The homeless triage tent on Worthington Street while under construction last month. The construction is done, but still no high-stakes testing happening here, yet. (via Springfield City Hall)

SPRINGFIELD—As the commonwealth continues to ramp up its COVID-19 testing infrastructure, city officials here appear poised to finally begin testing one of Springfield’s most vulnerable populations. Plans to test the homeless fell through last week and a launch set for Wednesday was delayed. Still, the city and its hospitals are poised to start testing at the city’s two main shelters by Friday.

Overall testing in Western Massachusetts has ramped up considerably, too but it is unclear how much is actually happening in the 413. Key to reopening the economy while the novel coronavirus lurks is the capacity to test, trace, and—hopefully—isolate outbreaks. Despite standout tragedies like the Holyoke Soldiers Home, what data exists suggests Western Mass has been spared the calamity found in Metro Boston. Adequate testing is essential to maintain that.

As of Wednesday, Springfield had 1310 COVID-19 cases, or over a third of Hampden County’s 3700 cases. Another 1300 were reported among the other Western Mass counties.

During the lockdown, COVID-19 has continued to spread, namely in institutional settings like correctional centers, nursing homes and long-term facilities, among the homeless and in crowded housing units. Aside from the Hampshire County jail, the region’s correctional facilities have been largely spared, but long-term care facilities like the Soldiers’ Home have been hit hard.

Thus far, overcrowded housing has not unleashed the kind of torrent Chelsea has experienced, though Springfield officials have said they are watching that.

Spread among the homeless is inevitable in shelters and likely on the streets. Hence the decision in cities like Boston and Worcester to test their homeless populations en masse, regardless of symptoms. Cooley Dickinson Hospital is working with Amherst and Northampton officials to test the homeless in those communities.  Springfield has been late to this party.

“The homeless population is at high risk for contracting the coronavirus, and have less of an ability to socially distance or self-isolate given their lack of independent shelter,” said at-large Councilor Jesse Lederman in a statement to WMP&I.

Lederman, a former chair of the Council’s Health & Human Services Committee, noted that Boston and Worcester have found high percentage of their homeless populations were infected, but asympomatic.

“We must test for the protection of these individuals, shelter staff, and the entire community,” he added.

It is unclear what if any role the state plays in this lumbering effort to test Springfield’s homeless, but the city has been flailing for weeks. Though it erected a testing tent outside Friends of the Homeless’s Worthington Street facility, it took weeks longer than the Boston and Worcester to obtain testing kits. In the end, US Rep Richard Neal had to intervene for Springfield to obtain the kits.

Mask no delay? Springfield HHS Commissioner Helen Caulton-Harris, pictured here last week, said a union issue had delayed testing planned to being last week.  (WMP&I)

Last week, the city announced it would begin testing. Then nothing. The testing, it was reported over the weekend, had been delayed by a “union issue.” The issue flared from there. Outside City Hall during Monday’s COVID-19 briefing, Pioneer Valley Project had organized a rolling protest—mostly consisting of honking horns—that could be heard during the briefing inside the Aldermanic chamber.

Springfield Mayor Domenic was unusually contrite about the delay, but few additional details about the delay surfaced.

Springfield’s Health & Human Services Commissioner Helen Caulton-Harris confirmed that the entity with which the city had partnered to do the testing had the issue, not the city. She also expressed confidence the issue would be resolved either by the partner or a new partner would be found. By Tuesday the commencement of testing was again announced, now  with Baystate Health as the partner.

However, Baystate Health was not the original partner. Baystate’s Springfield health care workforce is not unionized. Sources say the prior partner’s unionized staff was not consulted until last week, suggesting the city April 20 announcement of homeless testing was premature.

Another turn came on Wednesday. City officials announced Springfield would partner with Mercy Hospital—which City Hall sources say was the original partner—to test the homeless at the Taylor Street Rescue Mission. Baystate will test those at Friends of the Homeless—but starting Friday to clear up issues with protective equipment and consent forms.

The city is not the only one overpromising. Last week Governor Charlie Baker and state HHS Secretary Marylou Sudders announced 12 community health centers across the state would increase testing capacity for COVID-19. None of the centers were in the 413.

On Monday, Springfield Mayor Domenic Sarno said he complained to Baker’s office about the omission. Whether due to Sarno’s call or backlash that brewed online and elsewhere, Sudders later announced that Caring Health Center in Springfield was joining the testing site list—until it wasn’t.

Mayor Sarno on Monday feeling the heat on homeless testing, unaware, at that minue, Baker had left him out in the cold on community health testing again. (WMP&I)

During Sarno’s briefing, Masslive reported that the South End-based provider had not joined any testing expansion in the Massachusetts occident. They would continue to test their patients, but would not be a general testing site.

The mayor’s office did not return a request for comment on Monday.

A spokesperson for the state’s COVID-19 Command Center said there would be more testing in Springfield.

“We are working to expand list of Community Health Centers. We can also state that we have been working with the city of Springfield and Baystate to increase testing capacity–more to come in the next few days,” said Tom Lyons, the Command Center spokesperson.

Still, the entire situation underscores persistent fears about testing inequity in the 413. Caulton-Harris herself last week, particularly in regard to Springfield.

According to the state’s COVID-19 dashboard released on Wednesday, over 265,000 tests have been processed in Massachusetts. The state is now processing between 8,000 and 11,000 daily now, almost the bare minimum experts say a population the size of Massachusetts would need to reopen.

However, these figures do not clearly show how much testing is happening in Western Massachusetts. Without that information, it is more difficult to measure the size of the outbreak or follow it post-reopening.

The state HHS and its Command Center did not provide information about how many of the state’s tests occurred in the 413 and referred WMP&I to the COVID-19 webpage. The page has a wealth of information, but no breakdown of testing by county.

Dr. Mark Keroack, masked in this week’s photo, said, Baystate’s load of COVID-19 patients compares favorably to those of hospitals in/around Boston. (WMP&I)

Dr Mark Keroack, CEO & President of Baystate Health and Dr. Robert Roose, Chief Medical Officer at Mercy Hospital, have reported that COVID-19 hospitalizations are decreasing, on the whole, at their facilities. They also indicated the 413’s other hospitals have experienced the same. If anything, they have worried non-COVID-19 patients have avoided care for other life-threatening conditions.

Although data does show Hampden County has a very high number of deaths per capita—and terrible breakdowns at the Holyoke Soldiers’ Home—the region has made important strides battling COVID-19 that expanded testing would protect.

There are wide-range of testing sites throughout the region, but almost all testing is limited to symptomatic individuals or, at best asymptomatic essential workers.

Hospitals have taken a prominent role in testing in Western Massachusetts communities. Many have either drive-through or ambulatory testing locations throughout the 413.

Dr. Roose said Mercy has seen COVID-19 patients as a share of its overall patient load drop dramatically. (WMP&I)

Baystate’s Keroack said Monday the entire network, including some remote sites, had conducted about 5000 tests with about 1000 coming back positive. Across its network of four hospitals in Greenfield, Palmer, Springfield and Westfield and nearby remote testing sites, Baystate can test about 400 people a day.

Also on Monday, Roose of Mercy said his hospital had tested about 4300 individuals. He did not give an exact daily testing figure, but it was implicitly in the hundreds.

In an email, a Berkshire Medical Center spokesperson referred WMP&I to a chart that showed the hospital had performed over 3400 tests. The spokesperson said the Pittsfield hospital’s testing capacity is about 80 a day at its drive-through site. Most specimens are then sent to either Quest Diagnostics or the state laboratory. The hospital has some limited in-house testing capacity, normally reserved for inpatients and emergency patients. The on-site capacity varies based on supplies vendors can provide.

Cooley Dickson told WMP&I that it had performed over 3100 tests. A hospital spokesperson said it processed about 65-75 a day on-site. It can send out an additional 150 kits to its affiliate, Massachusetts General Hospital, or other testing partners daily.

Cooley Dickinson Hospital in Northampton has been testing Hampshire County’s homeless population and using its affiliation with MGH and Partners Healthcare to expand testing capacity. (via cooleydickinson.org)

Holyoke Hospital did not respond to a request for comment about the tests it had performed or its daily capacity, if any.

In addition to a lack of sufficient testing supplies, processing results had been a bottleneck earlier in the crisis, too. Like Berkshire Medical Center and Cooley Dickinson, Baystate had been sending its specimens to third-parties for processing. It began large-scale in-house processing of tests collected from drive-through sites only recently. Prompter turnaround on processing is crucial

There are other testing locations in the region, including some for essential workers. However, guidelines from the Centers for Disease Control and local testing capacity do not allow for even asymptomatic individuals who have been in contact with those who tested positive for COVID-19.

The state’s test and trace program is set to launch Friday. Springfield’s Health Department has tried to chase down the contacts of COVID-19 positives. At this point, Caulton-Harris said Monday, they can only recommend 14-day quarantine for such individuals. The testing capacity does not exist to clear them.