The city of Lawrence has become a coronavirus hot spot, with the fourth-highest per capita rate of infection in Massachusetts. But for the past few months, the main hospital for the city of 80,000 has been able to test only about 90 residents a day, not nearly enough for public health officials to understand the true extent of the virus’s spread or to effectively contain it.
Now Lawrence General Hospital is dramatically increasing testing of the city’s residents, after smoothing out supply chain issues and securing funding from the city. Governor Charlie Baker plans to visit Friday to join city officials in announcing the expanded testing, which may reveal that the spread in Lawrence is much worse than previously known.
“That there is an undercount is an understatement," said Mayor Dan Rivera, suggesting that the rate of infection may be at least 10 times higher than city officials know.
“The more we test, the more we can isolate, and hopefully our positives for tests go down," he said.
Lawrence’s struggle to expand testing reflects the obstacles that many cities have faced in trying to get an accurate picture of the virus’s toll. Even though they could not test many residents, city leaders could for weeks see that the virus was pummeling the community. At the peak, 70 to 80 percent of in-patient adult beds at Lawrence General Hospital, the city’s major health care provider, were occupied by COVID-19 patients.
“Lawrence has just been hit very, very hard,” said Deborah Wilson, the president of the hospital, which runs the only testing site in the city.
Lawrence also had a disconcertingly high positive test rate from the limited tests it was conducting. While the statewide positive test rate hovers around 9 percent, 33 percent of those tested in Lawrence were positive, according to Rivera. Those positive rates are a useful metric for public health officials.
“If the percentage of tests that are positive is too high, it suggests a need to expand testing," said Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins COVID Testing Insights Initiative, in an e-mail. “We track the percentage of tests that are positive because it can give an indication as to whether we are casting a wide enough net to find infected people.”
It’s difficult to know how Lawrence’s rate of testing compares to the rates in other hard-hit cities in the state. Most local leaders don’t know how many residents are being tested in their towns, because the state doesn’t widely disseminate that information to them. City officials in Brockton, Lynn, and Chelsea all told the Globe that they did not know how many residents had been tested in their cities.
Some cities have used testing numbers from local health care providers to cobble together an estimate of how many residents have been tested. At Lawrence General, roughly 180 patients have been tested each day, but only half of those are Lawrence residents, and other providers elsewhere may be testing some Lawrence residents. Over 6,000 people, not all Lawrence residents, have been tested in total at the hospital.
Boston is one of the few municipalities that has released testing information weekly. Around 41,600 residents had been tested as of last week, with a positive test rate of 27 percent. (That number is high, Nuzzo said, pointing out that the World Health Organization has advised governments to maintain a positive test rate below 5 percent for 15 days before reopening.)
Boston averages 925 tests per day, and that number is expected to go up this week, according to the Boston Public Health Commission.
The barriers to ramping up testing in Lawrence varied over the course of the crisis. First, Rivera and Wilson said, the problem was acquiring testing machines for rapid in-house hospital testing. The state helped Lawrence General get an Abbott testing machine in April. Then the hospital faced a shortage in the materials needed to process the tests — things like chemical reagents and swabs, which were in demand across the country.
“The limitation of supplies has really managed the amount of patients that has been tested," Wilson said.
The hospital was able to secure some of those lab materials, but not enough to do full-scale in-house testing. Instead, it turned to commercial labs, which have the supplies to do 1,000 tests a day. The hospital will be reimbursed by insurance companies for a portion of the cost of testing, but still faces a wide financial gap.
“Without the help of the city, we just would not be able to do it,” Wilson said.
The city has promised to pay $1 million to cover the difference so that the hospital does not lose money. The money will fund testing for about two months, Rivera said, at which point Lawrence General may be able to begin doing in-house testing at a lower cost.
A Lawrence resident with a doctor’s referral can sign up to make an appointment to be tested. The testing will prioritize people who are symptomatic or who have been identified through contact tracing, Wilson said, and potentially expand from there.
The Lawrence Community COVID-19 Testing Center, as it is officially called, will be a nine-lane drive-through site at the hospital. One lane will be for first responders, front-line workers, and other priority cases, even if they are not Lawrence residents. The others will be reserved for people from Lawrence.
Public health officials say widespread testing is one of the best ways to contain the coronavirus.
Otherwise, said Laura White, an associate professor of biostatistics at Boston University, “you end up with a lot of people who are walking around and they’re infectious, and they may not know it.”