CareSTL Health received an alert in late February regarding the COVID-19 pandemic.
As a federally qualified health center (FQHC), CareSTL got word that they needed to put their emergency response plans in place and get ready to be emergency responders, if needed. CareSTL Health has four locations in North St. Louis city, where the residents are overwhelmingly African-American. And the health centers don’t turn anyone away.
“It was a normal process for us to actually set up a COVID-19 preparedness team, and that’s what we did,” said Angela Clabon, CEO of CareSTL Health. “But what we were not expecting was to have a lack of supplies and Personal Protection Equipment (PPE) that made it very difficult for us to respond. And we are still in that space.”
As the St. Louis region began confirming positive cases on March 7, CareSTL immediately volunteered to provide a testing site and facility. However, it only received five testing kits — a total of five tests — on March 20, which it ran through quickly. Clabon became “very concerned” that North St. Louis lacked the supplies to test the community.
“Our patients were coming in, some were showing symptoms, and we were sending them to the emergency rooms,” she said, where the bills for getting tested were high. “North St. Louis deserves to be tested.”
To date, CareSTL has only been able to test 15 people, and one came back positive. Clabon is in regular communication with two other FQHC systems in North city — Betty Jean Kerr People’s Health Center and Affinia — and their testing numbers are similar, she said.
In early March, Clabon reached out to Missouri Governor Mike Parson and the St. Louis Mayor Lyda Krewson asking for testing supplies, and their offices gave what they had, she said. But the lack of supplies nationwide was a barrier for everyone.
Clabon saw how hospitals in the region’s central corridor established testing sites —as they should, she said — but she worried about her patients, about 90 percent of whom are African American.
In the next week, three testing sites will be opening at FQHC locations in North St. Louis city — after black elected officials, clergy and community leaders were “very vocal” about the matter. And there is potential for more. But the lag has taken a toll.
“It has cost us a lot of anxiety and fear,” Claybon said. “I fear for my employees and not knowing who may or may not be infected. It’s still there.”
Leaders in North St. Louis County share a similar frustration. On March 27, Mayor Reggie Jones of Dellwood announced that he had arranged to open a testing site on West Florissant Avenue — near Ground Zero of the Ferguson unrest. However, on the day the phone line opened on March 30, they had received more than 400 calls before noon. They decided to postpone the opening of the testing site that same day.
According to FQHC doctors, patients with symptoms of the virus are being told to stay home and quarantine because the only place they can go to get tested is at a hospital — and doctors don’t want to bog down the hospital systems. Clabon and elected officials worry that North St. Louis will face a similar problem as New York — they won’t know how bad it is until it’s a catastrophe because they couldn’t test people.
‘Testing is not being done equitably’
The first reported COVID-19 case in St. Louis County was on March 7, and the City of St. Louis followed with its first case on March 16. As of March 31, the county had reported 436 cases and the city had reported 195.
Early on, Mercy and BJC HealthCare hospital systems had testing capacity in the Central West End and Chesterfield. However, a testing site wasn’t opened in North St. Louis County at Christian Hospital Northeast until March 21 ― two weeks after the county reported its first case.
Now, almost four weeks into the crisis with now more than 600 cases regionally, North St. Louis city is finally getting three testing sites. One will open near downtown at Affinia, an FQHC, on Thursday, April 2 at 1717 Biddle St.
Two more will open on Monday, April 5 at CareSTL locations ― 5471 Dr. Martin Luther King Drive and 2425 North Whittier St. All testing is free. Clabon said the city health department will be providing them 2,500 tests on Friday.
These locations will come more than two weeks after St. Louis city had its first case. In essence, Black St. Louis is lagging an average of two weeks behind in testing.
The region has no way of knowing how many tests are being conducted and where, St. Louis County Executive Sam Page said in an interview with The St. Louis American on March 23. City officials confirmed this as well.
The American pressed Page that the lack of information poses a challenge in determining whether or not testing is being conducted equitably. Area medical experts believe it’s not.
“Testing is not being done equitably — it’s unequivocal,” said Dr. Will Ross, a dean and professor at the Washington University School of Medicine who is also part of a team of experts who are advising regional leaders on the COVID-19 pandemic response and racial equity.
“While individuals who are symptomatic can access testing at medical centers and some of the area hospitals, they still may be unduly burdened with travel, the costs of the testing and the unduly delays in receiving testing results,” Dr. Ross said. “That begs the need to have access to testing within the [African-American] community.”
There are 11 main testing locations in the region. BJC HealthCare has two locations: one in the Cortex corridor in the Central West End and one at Christian Hospital Northeast in North County. SSM Health has three locations: at St. Joseph’s Hospital in Lake St. Louis and in St. Charles and then at St. Louis University Hospital in Midtown. Mercy has three sites: in Chesterfield, Washington and in Hillsboro. St. Luke’s has two locations: at St. Luke’s Hospital in Chesterfield and at St. Luke’s Hospital Des Peres. Finally, the VA St. Louis Health Care System is testing.
Page also said that there are Total Access Care locations, which is an urgent care company, and private labs that are also testing, but didn’t know where. A spokesman for the health department also did not know the private testing locations.
The introduction of private lab testing has posed a challenge in analyzing where and how much testing is actually happening in St. Louis city as well, a spokesman for Mayor Krewson said. Health officials are “not at the point yet” where they can determine the COVID-19 hotspots on a map, he said, but they believe there are cases in every zip code in the city.
The lack of information and transparency is troubling.
On March 24, Dr. Emily Doucette, the county public health department’s chief medical officer, signed an executive order requiring any laboratory company or healthcare provider to report any positive COVID-19 test results within four hours.
However, the order didn’t require the reporting of negative test results.
Hence on March 31, Doucette updated the order requiring negative results to be reported within 24 hours and every positive result within six hours. It also requires hospitals to report the admission of every COVID-19 patient as well as any deaths within 24 hours.
A county spokesman said the order would help clear up any “ambiguities” in reporting and ultimately keep the public as informed as possible.
COVID-19 cases are doubling every three days, Ross said, and it’s important to move quickly to ensure that the region’s most vulnerable populations are not going to feel a devastating impact.
“It’s not there yet,” Ross said. “We are putting a racial equity lens on what we’re doing going forward. We are looking at the case rates across the population. We are looking at this more broadly. Then we can identify the hotspots and the areas that are not lighting up at all because we have no data. The area that has no data is North St. Louis predominantly.”
Local leaders frustrated
Dellwood Mayor Reggie Jones has been very concerned about the lack of access to COVID-19 testing in North St. Louis County and North St. Louis city, he said.
“We need those tests,” Jones said.
Two weeks ago, he started “working hard” to try to find a solution. He spoke with Mike Jones of Platform Health Care Solutions, who reached out to a testing laboratory. This week, Jones said the City of Dellwood was supposed to start providing mobile testing for COVID-19. Mayors from surrounding municipalities were “100 percent behind me,” he said, noting that it has provided a solution to lack of testing access for many North County mayors.
However they were overrun with calls the first morning.
“We were prepared for 100 a day,” said Mike Jones of Platform Health Care Solutions. “It just put so much pressure that we had to back away and re-evaluate. The patients are emotional and scared.”
Mike Jones said the calls came from throughout Missouri and Illinois. They are now referring North St. Louis County residents to call Christian Hospital Northeast at 314-653-5000. Mike Jones said that they evaluated the number of calls that Christian Northeast receives and gaged their potential traffic on that. In Mayor Jones’ statement, he said, “Based on the number of calls it shows that there is an overwhelming need to add several locations in North County to help people become more aware and to help stop the spread of this virus. We will continue to advocate making sure that happens.”
St. Louis Alderwoman Sharon Tyus (D-Ward 1) has been pushing to get two locations set up on North Kingshighway, which she believes would be centrally located for North St. Louis residents. Prior to the announcement of the CareSTL sites, city officials had been focused on opening up the testing site on Biddle Street near downtown. Tyus told them that it was “out of the way.”
“This strategy may not be in the best interest of a great majority of residents in North St. Louis,” Tyus wrote to Public Safety Director Jimmie Edwards on March 25. “I am sure the people making these decisions do not live in North St. Louis. We are always the afterthought if we are included in the process at all. We will not be treated as such in this medical crisis.”
Tyus said Edwards has been responsive to her concerns, and she has support from black elected officials throughout the city for additional testing sites at 3330 North Kingshighway at the parking lots of a church and elementary school.
“One virus is getting ready to transform the way to deliver care,” Dr. Kanika Turner, associate medical director at Family Care Health Center.
The FQHC has two locations in South St. Louis. And like its North City counterparts, Turner said it has “very limited” testing capacity. She has been advising her patients to stay home and quarantine if they have symptoms and go to the hospital only if they have “red flags.” As with CareSTL, her patients have challenges with transportation. If they have to go to a hospital, they will most likely be traveling on a bus or other family members, which could risk infecting other people.
However, the pandemic has produced a valuable tool that FQHCs didn’t have before — telemedicine. And it’s expanding service for her patients, something she hopes sticks after things calm down.
“There are some positive things that will come out of this,” Turner said. “Unfortunately, it will take the lives of many people. We are going to see some transformation.”
Dr. Hari K. Nallapaneni, chief medical officer at CareSTL Health, has been working on creating a processing lab for COVID-19 tests at CareSTL. The analyzer machines are high in demand, but he believes he will be able to get them by mid- to late April — which is the same time when they expect the St. Louis region to hit its peak. He hopes to be able to have the capacity to run 100 tests a day.
Every day, he calls his suppliers for medical supplies, he said. But, he is fighting with other medical systems across the nation to get them. When asked if he is frustrated, he said, “If you lose the stability of the mind and decision making, then our patients will suffer. The patients have a right to be frustrated. My workers have a right to be frustrated, but I have to provide that balance. No matter what it is, we will do the best we can.”
North St. Louis COVID-19 testing sites
Affinia: 1717 Biddle Street. Call 833-2777.
CareSTL: 5471 Dr. Martin Luther King Drive and 2425 North Whittier St. Call 314-633-6363
Note: There will be no cost to the patients. People must call ahead for phone screening and appointments to drive up (or walk up). If people arrive without calling, they will be asked to call from their cars (or go someplace to make the call) for the phone screening first, and depending on the criteria, they will be given an appointment time to come through.