Consideration 3

3_Type

3. Determine the type of OSCTC

High capacity drive through centers

Consideration

High capacity drive through centers can test a large population quickly and efficiently but may not be accessible to the population at highest need. 

Voices from the Field

“We use them because of high velocity and high capacity.”
“They very quickly created high velocity testing [to address] the size of their population”
“Drive-thru places … are still performing 200 up to 1000 tests a day.”
“A very high velocity site, at this point it is doing a thousand plus tests a day.”
“So, the drive-thru allows us to again see high volumes of patients at lots of local convenient locations for people and they don't have to get out of their car in order to be swabbed.”
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Walk-up center capability

Consideration

Some communities may benefit from walk-up accessibility for testing.

Voices from the Field

“They can walk-up or they can drive-up or I suppose they could bike-up.”
“Where people don't have to have a car, they can come by public transportation to get tested...”
“Drive-thru testing created more walk-up access points.”
“New sites are a combination of a high velocity site [and] walk-up site [to support] additional communities.”
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Indoor vs outdoor

Consideration

Outdoor sites minimize the need for PPE, but weather extremes may be challenging for staff. Some OSCTCs are considering moving inside. 

Voices from the Field

“We went from extreme [heat to] extreme cold… My ideal testing situation if I had my way and I had funds to be able to do it, would be to do it indoors where I can have a negative pressure room because of so many of the uncertainties [with weather] … it still has to be outside because outside is the best negative pressure you can get.”
“The sheer volume of people that we are going to have to take care of … how to do that efficiently and safely without freezing to death … is hard unless you are in your car.”
“The challenge for us right now is figuring out how you introduce that asymptomatic person into your store without creating fear and sort of, a false sense of, oh, my gosh, I am going to get sick just because that person was in the store and does that now create this whole new set of concerns from general population because you have introduced this element of risk.”
“We've actually moved indoors. Now we are moving the other site indoors next week. And, they're very good reasons why we are no longer doing it outdoors. The employees were getting very hot and overheated working in the PPE. The rain was becoming a very big factor working in the rain and thunderstorms. The elements were really untenable to manage, the unpredictability of them. We would have to shut down sometimes and turn patients away and have to make all the phone calls and let them know they couldn’t come. So, it's very unpredictable …we have been doing it now at one site for about two or three weeks and it can be safely and effectively managed.” 
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Community pop-up sites

Consideration

“Pop-up” sites can rotate locations to broaden access across a region.

Some communities may not want testing to occur in their catchment area.

Voices from the Field

“…we have set up purposefully several community-based testing sites that are point-of-care testing sites in underserved communities where the prevalence rates have been quite high, and these are more inner-city locations that don't necessarily have easy access to testing.”
“They have put these community testing sites in communities with the most vulnerable populations … these sites are free testing.”
“First of all, [how do we] get land? And some of the landowners refused to lease to us because they didn’t want COVID in their neighborhood. Like literally, “not in my backyard” type thing.”
“We’re having an outbreak in the southeast corner city we’ll send a team there, or in churches on the weekends, or a jail had an outbreak, or nursing home has outbreak this is a more of a strike team.”
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Mobile van

Consideration

Mobile vans can adapt quickly to cover outbreaks and make testing accessible in geographic regions in most need.

Vans may be repurposed from prior health related uses or acquired through philanthropic means.

Adding clinic services to sample collection can increase reimbursement making this option more financially sustainable.

Mobile vans may support adding on additional services such as immunizations or health screenings.

Voices from the Field

“We have one van focused on homeless patients, going to the shelters and we have another van that’s really focused on other vulnerable populations, on limited English proficiency communities, racial ethnic minorities.”
“…we have [automobile company] working closely with us to design vehicles that are going to be upfitted to meet our needs… the vehicles that we are getting … are going to be upfitted with generators and the necessary Wi-Fi infrastructure to support a 300-yard or 300-meter radius around the central testing site. In addition, the vehicles are upfitted so that they have locked cabinets for the computer assets that we have…we have also medical grade refrigeration and centrifuges. So, we can process blood samples but that also we can use the refrigerators as this pandemic response evolves for things like vaccinations and the like.”
“Convenience is sort of the game.”
“We are a centerpiece of the state’s task force to reduce health disparities with our mobile testing platform.”
“We really want to be able to do mobile testing as well, and one of them said that is pretty much all they are going to do…. to go to that outbreak or maybe … [test] people who are from the minority community.”
“We can send a portable lab out to sites to be able to do kind of military grade testing … they took on a few of our Abbott machines, so when we get an outbreak say at a nursing home, we can send that team out almost daily and they’re able to run the rapid test on those patients and get real-time answers so that they can make more informed decisions about moving patients or isolating them versus waiting 48 hours for results…”
“…drive-thru testing programs … are important, but somewhat limited in what they are able to do. I see more of the mobile program as the way forward, because it allows us to target areas of the community and expand services that can be provided.”
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Congregate living facility testing

Consideration

Setting up an OSCTC at a facility with an outbreak or known to have a high-risk population may be the most efficient way to test certain populations.

Active surveillance programs can be used to minimize spread of COVID-19 in congregate living situations.

Assisted living facilities present different challenges around ordering tests and sharing results than skilled nursing facilities.

Homeless shelters present challenges around getting results back to patients.

Voices from the Field

“We have an active surveillance program that is on the ground in skilled facilities”
“…Sobering Centers… Interim housing, shelters… there has been a team from our housing policy team, from public health that have been working to develop an active surveillance structure”
“When we go into a long-term care facility, by licensing, they have to have a medical director assigned to that facility who can write the order … we can send the results and they can be the one who tracks the positives and negatives ... When you get into a lot of the assisted living facilities they don't have one unified medical director overseeing that facility and so to try to coordinate with 80 different physicians overseeing the folks who are living in the living facilities, that's been one of the challenges on how to get consent to be able to release results because it's not a facility medical director it's their own PCP that follows them...”
“Assisted living is starting to become a hot topic … It’s likely that we will institute some type of testing…Our goal would be a program that mirrors our long-term care facilities…”
“Homeless shelters are really one of those challenging ones because we may test you on a Monday and then never see you again to be able to give you your results on a Wednesday… we don't have a permanent address that we can mail the results to we don't have a phone number that we can contact them.”
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Community pharmacy

Consideration

Pharmacies with drive-through windows can be repurposed for COVID-19 testing.

Community pharmacies could play an important role in expanding testing access.

Voices from the Field

“…the drive-thru allows us to see high volumes of patients at lots of local convenient locations for people, and they don't have to get out of their car in order to be swabbed.”
“I do not see how it is feasible to be offering the level of testing that's required that's going to be needed unless you get more of your community pharmacies involved because the clinics that are doing it and some of the labs that are doing it and your few local health departments that are set up, is not going meet the capacity in order to test.”
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Home testing

Consideration

Testing at home is currently resource intensive and requires OSCTC staff to conduct in-person visits.

Partnering with VNAs may streamline home testing.

Voices from the Field

“It’s fairly simple, although it looks weird to the neighbors, but we go in with full PPE and gown up and gear up outside somebody's home, and go in and introduce ourselves, perform the swab, bag it, and those are usually like triple bags so that we know that it is completely secure. The swab gets transported in a cooler with some ice and then you strip off all of the PPE and dispose of it at the patient’s home, usually, unless it is not appropriate to when we do it on site.”
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Off-Site COVID-19 Testing Project home page
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Off-Site COVID-19 Testing Toolkit home page
1. Identify and prioritize the population to be tested
2. Identify and mobilize your partners
3. Determine the type of OSCTC
4. Offer the right type of test
5. Adapt to variations in laboratory capacity and turnaround time
6. Staff Required for OSCTC
7. Build efficiencies into your OSCTC
8. Promote positive patient experience and community awareness
9. Address potential patient access limitations
10. Manage patient results​
11. Plan for weather extremes
12. Provide PPE to staff
13. Financial viability/ sustainability
14. Explore a broader role for your OSCTC
Methodology
Additional Resources
Acknowledgements