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Which Cities Have The Biggest Racial Gaps In COVID-19 Testing Access?

When the coronavirus outbreak threatened to rock Philadelphia’s predominantly Black neighborhoods, Dr. Ala Stanford knew that access to COVID-19 tests was going to be a problem.

So she rented a van, loaded it up and headed to the areas of the city where residents needed tests the most. Every test conducted was free.

When Stanford began distributing tests in early April, she saw only a handful of testing centers in the city. Only a small share were in majority-Black neighborhoods, and the bar for actually getting a test was high.

“We’ve been to locations that are predominantly African American where everyone had insurance and they couldn’t get tested,” said Stanford, referring to the often strict requirements providers had of those seeking tests as the outbreak began, such as doctor referrals, appointments and symptoms consistent with infection.

Stanford, a pediatric surgeon, quickly assembled a group of doctors and volunteers called the Black Doctors COVID-19 Consortium to help meet the challenge of testing the city’s underserved residents. Together, the group has issued Philadelphia’s residents more than 7,000 tests. But even with the intervention of medical professionals like Stanford stepping in to meet the rising demand, many communities of color across the country still face a dire situation in terms of getting a COVID-19 test.

With nearly 4 million coronavirus cases across the United States and hospitalizations surging in different parts of the country, there continues to be a growing demand for tests. Today, Americans routinely wait for hours to get an exam — if they can get one at all. Access is not available equally nationwide. Simply put, where Americans live and how much income they earn can still determine the ease with which they get a COVID-19 test.

According to a new, extensive review of testing sites by ABC News,1 FiveThirtyEight and ABC-owned television stations, sites in communities of color in many major cities face higher demand than sites in whiter or wealthier areas in those same cities. The result of this disparity is clear: Black and Hispanic people are more likely to experience longer wait times and understaffed testing centers.

This nationwide review is one of the first to look at testing site locations coast to coast, in all 50 states plus Washington, D.C., using data provided by the health care navigation company Castlight Health (the same data that Google Maps uses to surface COVID-19 testing sites). An assessment of city and state health department websites also revealed, over and over, fewer testing sites in areas primarily inhabited by racial minorities.

Importantly, our analysis does not factor in the capacity of testing sites, which can vary from just 50 tests at one site to 2,000 at another, meaning that one site might be equipped to serve a larger number of people than another site. Instead, it looks at the potential demand for each site based on the number of people and sites nearby. The data we used is also less likely to reflect tests done in private physicians’ offices than federally-funded community sites, local government-run mobile pop-up sites, urgent care clinics and hospitals. Additionally, this analysis doesn’t take into account other factors that could determine testing accessibility, such as staffing and wait times, as well as other restrictions on testing like appointment or insurance requirements.

When the outbreak began, testing posed the most immediate challenge to states, as a shortage of supplies, testing kits and processing backlogs created capacity problems. Since then, states have vastly increased their bandwidth to perform tests, but even now, experts from the Harvard Global Health Institute say daily testing needs to nearly double to help mitigate the pandemic. And states and cities are still struggling to determine how to allocate testing resources and where to place testing centers.

The Trump administration struggled early on in the pandemic to expand testing nationwide. Reliant on off-shore manufacturing that limited access to supplies like swabs and reagents, and armed with little data about who was getting sick and where, Trump’s political appointees quickly embraced that the federal government’s job would be mostly managing the logistics of testing such as supplies and distribution of state funds, as opposed to overseeing the coordination of state testing plans.

But critics say that strategy left many states scrambling to meet the rising demand that health experts say will only grow more urgent in the fall, when students return and flu season starts.

The Department of Health and Human Services recently released a comprehensive strategy to address the disparate access to COVID-19 testing, including expanding testing at federally qualified health centers as well as supporting public-private partnerships that establish testing at retail pharmacy companies to accelerate testing within vulnerable populations. CVS and Walgreens — two of the retail pharmacies listed in the HHS plan — both said in statements to ABC News that more than half of their store locations issuing COVID-19 tests are now located in areas most in need, based on the Centers for Disease Control and Prevention’s social vulnerability index.

Residents wait in line for the drive-thru COVID-19 testing center at the Ellis Davis Field House in Dallas.

TOM PENNINGTON / GETTY IMAGES

WHAT OUR ANALYSIS FOUND

The novel coronavirus itself does not distinguish between Black and white Americans. But virtually every other aspect of U.S. society does, including the nation’s response to COVID-19.

Our analysis revealed that, in many cities, testing sites in and near predominantly Black and Hispanic neighborhoods are likely to serve far more patients than those near predominantly white areas.2

A similar disparity exists between richer and poorer neighborhoods, our analysis showed: Testing resources were more scarce in poorer areas, with fewer sites per person and sites located farther away. And the disparity could be even greater in real life, considering wealthier people could also get tested by private practitioners who are less likely to be reflected in our analysis.

Kevin Ahmaad Jenkins, a fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics who has been researching the impact of COVID-19 testing center availability on communities of color, told ABC News and FiveThirtyEight that his team found that testing sites serving minority communities in big cities are fewer in number, have longer lines and often run out of tests. The impact of such disparities, he said, is evident in the pandemic’s disproportionate effect on people of color.

“It’s just as clear as George Floyd’s video. These numbers are right in front us: We are dying at disproportionate rates,” he said.

To better understand the extent of this problem, we looked for cities whose broader “urbanized area” had at least 1 million residents. (“Urbanized area” is a census designation for cities and the densely populated areas immediately surrounding them.) We then calculated the potential level of demand at each testing site in that area, based on the number of people living nearby and additional sites in the area.3

We assumed that people would want to get tested at nearby sites, so we compared the number of patients a site would serve if the population of each census block group tried to visit sites that were close to them. This value, which we will refer to as potential patient demand, reflects how many people live near a given site and how many other options those people have.

The disparities we found varied in severity across the country. In some major urbanized areas, they’re small or nonexistent. But in others — from Dallas to Miami to San Diego and many places in between — majority-Black and majority-Hispanic neighborhoods faced far more competition for COVID-19 testing than their white neighbors. Disparities were also seen in some predominantly Asian or Pacific Islander communities, such as those in Washington, D.C., Minneapolis and Riverside, Calif., but they weren’t as widespread as those among Black and Hispanic communities.

And our calculation of potential demand for testing at some sites in those underserved neighborhoods is likely an underestimation: Based on our reporting, many of the testing sites in those neighborhoods are government-funded community sites. These sites are set up to close the gaps in testing access in different communities, but they tend to be very popular among people from all across the county or urban area because they are often free and don’t require an appointment.

We used data from the U.S. Census Bureau’s 2014-18 American Community Survey five-year estimates to figure out if, within urbanized areas, block groups that were majority Black or majority Hispanic were more likely to be close to sites with higher potential patient demand than majority-white block groups. To compare neighborhoods, we created a measure that we call potential community need, which is an average of the potential demand at nearby test sites. We also examined how block groups with a median income in the top 25 percent compared to those with median incomes in the bottom 25 percent.

Castlight’s set of testing site locations is among the most comprehensive data available, but compiling every testing location in the nation is a massive undertaking, as sites are constantly opening, closing and moving. Given that, the data set is likely missing some testing sites. Additionally, our analysis is based on testing site data as of June 18, so many new sites have been added nationwide since then — and others have likely closed or moved. We conducted separate analyses using a different source of testing site locations and examined other testing-related data to corroborate our findings.

We’ve highlighted some of the cities with the most emblematic trends below. While we’re confident in the trends we’re presenting, we’d encourage you to think of them more as estimates (akin to a fire marshal’s approximation of the size of a crowd at a political rally) than exact measurements (such as a baseball player’s batting average). For more detail on our methodology, and some of the limitations in the data and thus this analysis, see here.

However, this analysis still provides a vivid snapshot of the hurdles, complications and shortfalls in American efforts to slow the spread of COVID-19 this summer, a time when increased testing capacity in minority and low-income areas could have slowed the disease — a point widely acknowledged by public health experts.

“Testing site distribution and capacity is a direct reflection of the inequalities in our existing health care system,” said John Brownstein, a professor of epidemiology at Harvard Medical School whose team of researchers at Boston Children’s Hospital’s Computational Epidemiology Lab also looked into the health care disparities underlying geographic access to testing. “The lack of access for those most vulnerable to infections will only serve to intensify the impact of this pandemic.”

Patients wait in line at a walk up COVID-19 testing site in the Redbird neighborhood of Dallas.

MONTINIQUE MONROE / GETTY IMAGES

TEXAS

Kenneth Hamilton, 31, had been waiting for four hours in the line to take a COVID-19 test at Houston’s NRG Stadium.

Eventually, after spotting several people not wearing masks or practicing social distancing, Hamilton — a small business owner and father of seven — decided that continuing to wait wasn’t worth the risk of being exposed to coronavirus in the line itself. So he left, and looked for other testing options in his neighborhood.

But as a Black resident of Houston’s Third Ward, the line Hamilton left was, at the time, his only nearby option. Three months after he first sought a test, he says there are considerably more testing centers in his neighborhood.

“One of the schools that my kids go to, and one of the schools close by in the neighborhood, and a couple of churches now have them,” he said. “They ramped up, to an extent.”

The Houston urbanized area is just as diverse as many other major Texas metropolitan areas, but the city’s initial plans to spread testing centers out equally across its neighborhoods while still operating at capacity helped to reduce site demand. As a result, the community demands of various neighborhoods were fairly equal. ABC News and FiveThirtyEight’s analysis showed that, on average, predominantly Black Houston neighborhoods faced similar levels of potential need as white neighborhoods. Hispanic neighborhoods had slightly higher potential community need than white neighborhoods, but not by much.

But the disparities are still clearly visible in the San Antonio and Dallas areas.

SAN ANTONIO

In the San Antonio urbanized area, testing sites in poorer, majority-Black and majority-Hispanic neighborhoods in the south, east and west are estimated to have to serve far more people than sites in more affluent, whiter neighborhoods in the north, resulting in a disparity in potential community need.

According to our analysis, of the roughly 45 sites that were actively testing in San Antonio in mid-June, several sites with the lowest potential patient demand were concentrated in the northern neighborhoods of Stone Oak and The Dominion, as well as the areas surrounding Friedrich Wilderness Park, which are all majority-white communities that boast median household incomes ranging from around $100,000 to $150,000.

In comparison, many of the busiest sites are scattered in San Antonio’s more densely populated downtown, where the median income ranged from just $15,000 to about $40,000.

Throughout the San Antonio urbanized area, predominantly Hispanic neighborhoods had an average potential community need twice as large as white neighborhoods; the disparity in between majority-Black and majority-white neighborhoods was even larger.

Experts say that the disparity can be attributed to a long-standing gap in the health care system and an unequal distribution of health care facilities in the San Antonio area, which is one of the most economically segregated cities in the country.

San Antonio residents are tested for COVID-19 at a free walk-up site set up by the San Antonio Fire Department.

ERIC GAY / AP PHOTO

Recognizing testing disparities in different communities, the city identified underserved neighborhoods based on its equity matrix, and put together three cost-free pop-up sites that rotate around different parts of the city every week, according to its health department.

Not only are government sites falling short of their ability to meet the public need for tests, but they themselves have become part of the disparity by concentrating demand even as they seek to address it in underserved neighborhoods. San Antonio’s walk-up sites do not require a doctor’s referral and, as a result, have become massively popular among those who do not otherwise have access to testing.

In late June, Jennifer Herriott, the deputy director of the San Antonio Metropolitan Health District, told us that people have lined up hours before these pop-up sites even open and that one time they had to turn down 275 people after running out of tests.

Herriott said that as the demand for testing spiked, with cases and hospitalization rates across the state setting new records on an almost daily basis, the city and the county have been working to ramp up testing capacity. The pop-up sites that used to run only three days a week now operate six days a week, and each site’s capacity has been increased from about 150-200 tests per day to 350.

Still, the long lines remain in some places, and sites continue to run out of tests.

“Public health and our partnership with San Antonio Fire [Department] has consistently had its eye on making sure that we’re serving our Black and brown communities,” Herriott said. “As our needs increase here, we’ve increased free testing and those walk-ups and the Freeman drive-thru so we make sure that communities that might not be able to access testing are able to access testing.”

DALLAS

Dallas County and Tarrant County, two counties of nearly 4.7 million people that cover much of the Dallas urbanized area, have together reported over 64,000 confirmed cases of the coronavirus so far. Our data showed that in early summer, the testing infrastructure of the Dallas urbanized area — which encompasses the cities of Dallas, Fort Worth and Arlington — resembled that of San Antonio: Local and state providers, as well as private hospitals, favored people living in whiter and wealthier parts of the county, towards the north, more than those living in the less affluent areas in the south.

Across the Dallas–Fort Worth–Arlington urbanized area, our analysis found that majority-Black neighborhoods had a potential community need 46 percent higher than majority-white neighborhoods; majority-Hispanic neighborhoods had a potential need 24 percent higher.

“There’s a compounding problem beyond just where the sites are,” said Judge Clay Jenkins, the chief elected official in Dallas County. “The people that tend to have insurance are in the north and those that tend to not have insurance are in the south. We’ve planned to put the majority of our testing in places where there’s high uninsured.”

Take the University Park neighborhood of Dallas, where the median household income is $214,000 and almost 90 percent of the residents are white. It has at least five testing sites around the neighborhood, according to Castlight data. Appointments are required at most of them, per Castlight, which helps organize the speed at which people are able to get tested every day (walk-in testing centers tend to have longer lines).

It’s a vastly different situation in Lancaster in southeast Dallas County, which has about 15,000 more residents than University Park but where Black people make up 69 percent of the population and the median household income is $53,000. Residents hoping to get a coronavirus test in the Lancaster area had to travel at least seven miles to the nearest drive-thru testing center until recently, when a nearby Walmart Supercenter opened up a drive-thru site.

To address the disparities, the city of Dallas asked the private sector to step up its support in the areas of the city most in need of more testing.

“A lot of the private providers are set up in northern Dallas, and it does highlight the existing disparities in the city,” said Tristan Hallman, a spokesman for Dallas Mayor Eric Johnson. “In response, we’ve asked Walgreens, CVS, Kroger to locate their facilities in southern Dallas, and they’ve done so.”

A pharmacist checks in vehicles at a drive-thru Walgreens COVID-19 testing site in Dallas.

TONY GUTIERREZ / AP PHOTO

Indeed, public health experts said the issue of unequal access to testing is a direct result of long-standing decisions made by private-sector companies and entrepreneurs when selecting which neighborhoods to open new businesses in. And the disparity is exacerbated by the fact that underserved communities are less likely to have the health insurance or financial resources necessary to seek costly testing from private providers when community sites are not accessible.

“This is certainly driven by systematic health care injustice and it’s actually very clearly delineated in Dallas because of gentrification and all of the social aspects of our community,” said Katelyn Jetelina, a professor at the UTHealth School of Public Health in Dallas. “We need to figure out how to supplement the cost so that families in south Dallas don’t have to decide whether they’re having dinner or have to go get a COVID test.”

Even as more testing sites have been set up in underserved communities, new coronavirus hot spots flared up over the summer as communities began to reopen; now, a lack of tests and long lines have created major problems all over the country.

Further south, along the border in Hidalgo, Texas, Isaac Garza waited 10 hours in line to get a coronavirus test after visiting several recently reopened restaurants he oversees. As he has diabetes, an underlying condition, he didn’t want to take any chances, and was relieved when his test results came back negative.

But the limited testing options in his community creates problems for Garza’s staff, too. Every day, Garza said, he receives calls from employees showing symptoms consistent with COVID-19 who tell him that they might have to miss critical work hours to wait in line for a test.

“It’s really been challenging to do business and just to live day in and day out with all this because you’re trying to protect your family, you’re trying to protect your employees,” he said.

Members of the Black Doctors COVID-19 Consortium prepare to provide COVID-19 tests in West Philadelphia.

MATT ROURKE / AP PHOTO

PHILADELPHIA

Funeral director John Price, 72, had just gotten a break after a long day picking up bodies of COVID-19 victims from local hospitals in June. So he thought it was the perfect time to get tested himself for the coronavirus.

Price pulled his car into a line of approximately 300 others waiting for a test at a church parking lot on Cheltenham Avenue in North Philadelphia. Two hours in, he started getting calls from clients who had just lost loved ones to COVID-19. Another hour into his attempt to get a test, Price realized that he just couldn’t wait any longer.

“I had to pull out of the line, because I had people who were calling me,” he said. “It was probably going to be another two or three hours before they got to me. If they got to me.”

He went another week without getting a COVID-19 test until he stumbled upon a walk-in testing site organized by Dr. Ala Stanford’s Black Doctors COVID-19 Consortium, which was offering the tests for free.

“A lot of people weren’t notified of how they can actually get testing,” said Price, recalling confusion amongst residents when the outbreak first began in the predominantly Black neighborhood of West Powelton, where his funeral home is based. “It was more like word of mouth, ‘Oh this organization is doing it today over here, or so-and-so is doing it today over there.’”

The Black Doctors COVID-19 Consortium has focused on increasing access to tests in predominantly Black neighborhoods in Philadelphia.

MATT ROURKE / AP PHOTO

Even today, as the coronavirus crisis intensifies nationally, predominantly Black neighborhoods in the Philadelphia urbanized area, which extends into New Jersey, Delaware and Maryland, have fewer testing centers than their wealthier and whiter counterparts.

Other researchers, conducting independent analyses of other data, observed the same phenomenon we did regarding the demands placed on testing sites in majority-white and majority-Black neighborhoods at the city level, despite the fact that Black Philadelphians make up a plurality of COVID-19 test recipients in the city.

Drawing on his own study of access to COVID-19 tests in various Philadelphia neighborhoods, which he has been tracking since the outbreak began, Drexel University epidemiologist Dr. Usama Bilal found that testing disparities are often a product of existing systemic inequalities. Rates of testing, he said, were lower in poorer areas and areas with higher proportions of residents who are racial minorities. Testing access improved throughout the city in April and May, Bilal found, but as cases start to resurface and the demand for tests rises, he worries the city will backslide.

“We’ve been observing that testing access is going the wrong way again,” he said. “Testing is becoming more concentrated in wealthier areas in Philadelphia, and we have observed a similar pattern in Chicago and New York.”

A Philadelphia public health department spokesman denied that testing is increasingly inaccessible to racial minorities and said that the city has been focused on expanding resources in underserved communities, citing services like the Black Doctors COVID-19 Consortium, which recently received city funding to conduct free coronavirus tests.

But Stanford, the surgeon who heads the consortium, said she worried that as the demand for testing increases nationwide, the share of tests she will be able to offer free of charge will fall.

“We’re out here in the sun, in the rain, doing whatever we can do in a mobile unit begging for supplies from everywhere else in the United States, waiting 10 days to get our results back,” she said. “But yet, in some of the best hospitals in the nation you have an in-house test that the residents of this city do not uniformly have access to. That’s a problem.”

According to the city’s public health department, Philadelphia has conducted more than 166,000 COVID-19 tests. Black residents account for 40 percent of the city’s COVID-19 tests, more than any other racial group tested and about equal to the share of Philadelphia that is Black, per city data.

Bilal’s research, however, now finds that in predominantly Black and highly populated areas like the Oxford Circle neighborhood of Philadelphia, where the median household income is $41,000, just 60.9 per every 1,000 people are now getting tested. Compare that to the more affluent and plurality white Center City neighborhoods, where testing rates are now 133 per every 1,000 people, according to Bilal.

“The epidemic that we really need to control long term is social inequality,” said Bilal as the coronavirus outbreak in Philadelphia first took hold. “It has many different intersecting axes. So there is racism: that is places, that is classism, that is gender discrimination, there are many, many things going on there.”

Dr. Ala Stanford administers a COVID-19 test in Philadelphia earlier this year. Stanford said the way COVID-19 tests are being administered “points to some of the racial injustice we know exists at our health care centers.”

MATT ROURKE / AP PHOTO

Indeed, the Philadelphia area illustrates the extent to which disparities in coronavirus testing access grow out of systemic inequality in American society. Philadelphia is one of the poorest big cities in the nation, with about 25 percent of residents living below the poverty line. Bilal found that while the distribution of testing sites in Philadelphia has vastly improved from where it was at the beginning of the outbreak — with multiple options now available for residents in even the poorest areas — Black Americans in many low-income areas are still likely to find it difficult to get a COVID-19 test. Our analysis of the sites active in mid-June confirmed this.

In Kingsessing, a southwestern neighborhood that’s around 80 percent Black, there’s only one COVID-19 testing site, and that site has limited testing hours. Meanwhile, in the Center City area, there are several sites — some within a short walking distance of each other.

As is the situation in Philadelphia, many cities are now responding to calls to provide more resources to communities of color by increasing the number of pop-up sites to accommodate residents and ease the demand for more tests.

The Florida National Guard set up a testing site at Hard Rock Stadium in Miami Gardens, Florida.

MATIAS J. OCNER / MIAMI HERALD / TRIBUNE NEWS SERVICE VIA GETTY IMAGES

SOUTH FLORIDA

Martin Torres waited seven hours in line for a COVID-19 test at Hard Rock Stadium, an open-air venue best known as the home of the Miami Dolphins, while showing what he believed to be symptoms of the virus. When he finally reached the front, he was told he’d get results back in five days.

Two weeks later, he is still waiting.

“I am kind of in a limbo waiting for when I can have a response for that,” Torres said. “It’s important.”

In a statement responding to the demand in testing and the slower turnaround times, Quest Diagnostics, one of the major labs processing COVID-19 tests, said it will “continue to ramp up capacity to reach 150,000 molecular diagnostic tests a day.”

Florida, where the pandemic has recently spiked to nearly 370,000 confirmed cases, expanded testing capacity in response to problems surrounding testing access equity. But being a resident of a lower-income neighborhood still presents a challenge in terms of getting a COVID-19 test.

The South Florida region, which the census refers to as the Miami urbanized area, contains at least part of Miami-Dade, Broward and Palm Beach counties, and has deep disparities in testing site availability in majority-Black, majority-Hispanic and majority-white neighborhoods, according to our analysis.

The neighborhoods included in the Miami urbanized area also have massive economic inequality, and disparities exist within different Hispanic communities. Yet the few testing sites in wealthy areas — such as Cooper City, a majority-white town located in Broward County just north of Miami-Dade — had a much smaller potential patient demand than sites in many of the more densely populated lower-income neighborhoods, many of which are majority Black or Hispanic.

On average, majority-Black areas had a potential community need 13 percent larger than majority-white census blocks. In majority-Hispanic areas, it was 29 percent larger, with the densely populated, predominantly Hispanic areas around South Miami showing a particularly high potential need.

Just 10 miles south of Cooper City is Miami Gardens, a predominantly Black area in Miami-Dade County where the median household income is less than half that of Cooper City. If residents there want to get a test, they have to travel to Hard Rock Stadium and wait in a line that officials have advised could be as long as four hours in a summer heat that sometimes nears 100 degrees.

The long lines cause other problems, too. On most days at the Hard Rock Stadium testing site, it is not uncommon for testing to temporarily pause due to lightning in the area or because a car waiting in line breaks down due to mechanical issues.

“We have seen cars run out of gas at some of the busier test sites, but we tell people that a little bit of planning and a lot of patience are required,” said Mike Jachals, a state spokesman for several of the federally supported testing sites across the state.

Lines at the Hard Rock Stadium testing site can stretch for hours, creating further problems as residents sit in the summer heat.

MATIAS J. OCNER / MIAMI HERALD / TRIBUNE NEWS SERVICE VIA GETTY IMAGES

In an emailed statement to ABC News and FiveThirtyEight, a state emergency management spokesman said Florida “is continuing to increase COVID-19 testing daily.”

A spokesman for Miami-Dade Mayor Carlos Gimenez said the county has made “a concerted effort” to put more testing facilities in lower-income communities throughout the county. As part of that effort, new pop-up sites at the Joseph Caleb Center in central Miami and Harris Field Park in south Miami-Dade, both located in predominantly Black or Hispanic areas, have been installed.

In Miramar, a city of about 140,000 just north of the Hard Rock Stadium, there’s only one public COVID-19 testing center even though it happens to be the city with one of the largest percentages of Black people in Broward County. The city received the state funding necessary to open its first state-supported testing site just over a month ago, which local officials believe was far too late.

“Initially, I was very concerned, very upset,” said Miramar Mayor Wayne Messam in response to a question about the lack of urgency in establishing testing facilities in the city. “It was very disappointing and upsetting, but I was actually happy once we did get the call notifying me that we would have the site and since that determination was made, we’ve made the best of that site. It would have been ideal to have it up since the onset.”

The COVID-19 testing site at Dodgers Stadium is the largest city-funded site in Los Angeles, testing up to 6,000 people a day.

BRIAN VAN DER BRUG / LOS ANGELES TIMES VIA GETTY IMAGES

SOUTHERN CALIFORNIA

After touting a massive expansion of testing and stable case counts earlier this summer, California has in recent weeks been rolling back on its earlier promise of easy access to testing for every resident.

Coronavirus hot spots in Southern California, in particular, are now putting back restrictions on community testing to prioritize symptomatic patients or those most at risk, such as nursing home residents and staff members.

Based on ABC News and FiveThirtyEight’s analysis and reporting, communities of color and lower income-level neighborhoods in the San Diego and Los Angeles urbanized areas — where some of the biggest gaps in potential community need were seen between majority-white and majority-Black neighborhoods — are expected to suffer the most from the testing restrictions.

According to our analysis of site locations in mid-June, in both the San Diego and Los Angeles areas, majority-Black neighborhoods were estimated to have around 30 percent higher potential need than majority-white neighborhoods.

SAN DIEGO

In the San Diego urbanized area, much of which falls within the coastal section of San Diego County, many of the sites with lower potential patient demand are located in the predominantly white and wealthy neighborhoods along the northern part of the coast, while the sites expected to serve more people were all in the poorer, predominantly Black communities in the southern end of the city of San Diego.

Most of the community sites in San Diego County, which tend to be busier than private sites, are by appointment, county Health and Human Services Agency spokesperson Tim McClain said, and with the recent spike in cases people have had to make appointments a week or more in advance.

That was the case for Holly Young, who lives in La Mesa, a suburb just east of the city of San Diego. Young, 60, said she sought testing earlier this month after she discovered that her son and his girlfriend had been in contact with a COVID-positive friend prior to seeing her.

She said her health care provider was unable to test her because she didn’t show any symptoms, so she turned to a county testing site, for which she had to wait almost 10 days just to book an appointment and then drive an hour and 15 minutes to get to the site.

“I am in an essential industry, and part of my job is making the bank deposits, going to the post office and other routine tasks that were outside the business,” said Young, who is a self-employed accountant with clients in retail. “So even though I was always masked, I still felt very vulnerable. I’m overweight, take blood pressure medication and I smoked for 20 years, so I am not at all confident I would survive COVID-19.”

San Diego is offering widespread free and public testing access, but has been having difficulties keeping up with the increasing public demand in parts of the city.

MIKE BLAKE / REUTERS

Young was tested on July 11, and told she’ll get her results in five to seven business days. But she went off a two-week self-quarantine last Thursday, meaning she had to return to work before getting her test results.

The disparity in access to tests hasn’t been lost on Young, who said she is on Obamacare and does not get health care from her job: “We all know people who just call their doctor and get a test the next day. It shouldn’t be this way.”

McClain said San Diego County is exceeding state guidelines and offers widespread free and public testing access, but intends to do more to meet increasing public demand and reach deeper into at-risk communities. As of July 6, the county was surpassing the state goal of 4,950 daily tests — 1.5 tests per day per every 1,000 residents — by 56 percent.

“As tests became more widely available in spring, the county placed the greatest concentration of testing in our communities of diversity, and those near the border, and continues to bring more sites online,” McClain said. “Testing access is widely dispersed but we intend to make it more convenient with new locations, will add sites to address hotspots and will bring more no-appointment locations online.”

LOS ANGELES

The Los Angeles area has also managed to at least narrow some of the disparities. The poorer urban centers of Los Angeles were estimated to have greater community need than the relatively wealthier suburbs outside the city, as well as in Pasadena, though to a lesser degree.

Since California Gov. Gavin Newsom announced an aggressive expansion of the statewide testing capacity back in late April, the state has also significantly ramped up testing in underserved communities, setting up close to 100 state-supported community sites in its communities of color and lower-income neighborhoods. According to our analysis, predominantly Asian communities actually had less potential demand than other groups, including white neighborhoods.

That expansion appears to have helped collapse testing disparities in the region, according to our analysis of testing data from the Los Angeles County Department of Public Health.

At the end of April, mostly white cities and communities in Los Angeles County had, on average, more than 1,200 tests completed per 100,000 people. That was more than 65 percent more completed tests than communities of color.

After Los Angeles Mayor Eric Garcetti announced free COVID-19 testing for everyone in the county and expanded testing operations, the number of tests administered tripled.

The Los Angeles Fire Department has set up free COVID-19 testing services to reach vulnerable populations in Los Angeles.

AL SEIB / LOS ANGELES TIMES VIA GETTY IMAGES

A month later, the racial testing gap had shrunk to just 24 percent between the most-white areas and the least white. About 6,200 tests per 100,000 people were completed in whiter areas and about 5,000 tests per 100,000 people in less white areas, according to the analysis of the city’s testing data.

There was a similar pattern in wealthier and poorer areas. At the end of April, people were tested at a rate 60 percent higher in areas where the median household income was in the top quartile versus the bottom quartile. But by May 31, that gap had shrunk to just 13 percent.

Since April, California has scaled up its statewide testing capacity from just 2,000 tests per day to more than 100,000 now, and has completed nearly 4.8 million tests since the pandemic began, the state’s health department spokesperson told ABC News and FiveThirtyEight.

As cases and hospitalizations hit new records in the past couple weeks, however, the state is again struggling with testing capacity. The governor last week issued a new advisory to hospitals and labs, asking them to prioritize testing turnaround for individuals who are most at risk of spreading the virus to others, including those in nursing homes and congregate living settings.

The Castlight data analysis has helped shed light on the racial, ethnic and income disparities in the allocation of COVID-19 testing resources, and ABC News and FiveThirtyEight’s reporting shows how gaps created by systemic inequity in the health care system continue to persist even as states, cities and counties step up efforts to address them.

As cases rise and states across the country begin to face testing constraints, more local governments and private providers say they are considering going back to prioritizing testing access to symptomatic patients and those most at risk. In some places, such as Sacramento, Calif., and Omaha, Neb., testing sites are even closing because of supply shortages. This is expected to create additional strain on testing for underserved communities as state or county-sponsored public sites and labs further limit testing access.

“Our response to COVID is a reflection of the existing biases we have in our healthcare system,” said John Brownstein, the epidemiologist at Harvard Medical School. “While governments are trying to close the gap, we still have a long way to go to make sure Americans have equal access to testing resources.”

For Dr. Ala Stanford and her colleagues at the Black Doctors COVID-19 Consortium in Philadelphia, the choice early on was clear: adjust to a new normal of life indoors, or move swiftly to implement testing on the streets of Philadelphia to combat a virus that was proving deadly to Black communities.

Stanford says she felt compelled to respond as she did because she knew that the same health care disparities she learned about in medical school, and as a practicing doctor, were still at play in Philadelphia during the coronavirus crisis — the city in which she’s spent her entire life.

“I stopped and said to myself: I’m a business owner in private practice, I have access, I can order these lab kits like anybody else, I know where the people are that are hurting,” she said. “And I am not afraid to go there.”

ABC News’ Briana Stewart and FiveThirtyEight’s Rachael Dottle contributed reporting.

CLARIFICATION (July 23, 2020, 3:50 p.m.): This story has been updated to avoid using the phrase “people of color” for Hispanic people, some of whom are white.


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Footnotes

  1. ABC News owns FiveThirtyEight.

  2. We used the U.S. Census Bureau’s census block group — the smallest unit for which we could obtain demographic data — to represent neighborhoods. We are also using census definitions for categorizing race and ethnicity. White refers to non-Hispanic white people and Black refers to non-Hispanic Black people.

  3. We’re focusing only on big cities here because in examining the data, we found that the issues in other parts of the country are different; the farther you get out of cities, the more distance becomes the biggest limiting factor, rather than patient demand. The data set provided by Castlight contained some sites that shared geographic coordinates, and Castlight indicated that many of these might be duplicates. Running our analysis both with and without the duplicates yielded extremely similar results. We are displaying the analysis without the duplicates.

Soo Rin Kim is a politics and investigations reporter for ABC News.

Matthew Vann is a producer and reporter for ABC News.

Laura Bronner is FiveThirtyEight’s quantitative editor.

Grace Manthey is a data journalist for ABC Owned Television Stations in Los Angeles.

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