Plan on getting tested for COVID-19? Bring your mask, a bottle of hand sanitizer, and, if you have it, a heap of patience.
Driven in part by holiday plans and fears of exposure amid a second wave, a record number of Massachusetts residents are seeking tests. At many sites, particularly the appointment-free locations meant to offer convenience, test-seekers are greeted by long lines that wind around buildings and blocks, through parking lots and playgrounds. Waits can extend for hours as staff struggle to test hundreds of people who suddenly — and urgently — want to know whether they have COVID-19.
But don’t expect the lines to dissipate anytime soon. Experts warn that serious shortcomings in the state’s testing infrastructure, including inadequate space and staffing, have left providers ill-equipped to meet the demand for testing as the pandemic’s second wave crashes over the state.
“It’s logistics,” said Stacey Gabriel, who oversees testing at the Broad Institute, a lab that works closely with many of the state’s Stop the Spread campaign sites in high-need communities. “The bottleneck is collecting samples, not so much doing the test.”
Massachusetts’ testing infrastructure is among the most robust in the country. Over the course of the pandemic, the Commonwealth has performed more tests per capita than all but three states — North Dakota, Rhode Island, and Alaska — data from Johns Hopkins shows.
There are about 300 testing sites in the state, ranging from privately run urgent cares and pharmacies to community health centers that partner with the state to provide no-cost tests in high-risk communities. The variety can be overwhelming. Some take referrals from primary care doctors. Others provide tests for the asymptomatic or presymptomatic exam. Some require appointments, while others offer more flexible time slots through pre-registration. Some welcome walk-ins or drive-ins for same-day service.
But lately, nearly all are full.
More than 160,000 tests were performed in Massachusetts in the week leading up to Thanksgiving, marking a 33 percent increase from the weekly count a month before.
Governor Charlie Baker said in a press conference Monday that a large part of the surge was probably driven by people hoping to test negative before traveling to see family for Thanksgiving, even though he and the Centers for Disease Control warned that wouldn’t prevent the spread of infection.
“I did not expect or anticipate that we would go north of 100,000 tests on average for three or four days in a row here,” Baker said in a Monday press conference.
Despite the current surge, he said the state would hold off before expanding its roster of sites to see if demand subsides.
But experts and health care professionals said the long lines do not reflect a temporary holiday season nuisance, but rather a series of longstanding logistical hurdles and inadequacies that have left the state scrambling for resources amid a second wave.
Gabriel, of the Broad Institute, said the state and communities have wrestled with how to best organize lines of cars and people to make them move efficiently, and with finding locations large enough to accommodate tents and the traffic. Most sites require a clinician to administer each test, a staff-intensive problem the Broad hopes to help alleviate with self-administered collection kits that allow nurses to supervise multiple test-seekers at once.
The wide range of test providers in the state, and the various services each offers, means some sites are better positioned to tackle inefficiencies than others, said Dr. David Hamer, a Boston University infectious disease expert and physician at Boston Medical Center.
“Some of them are just facing immense volume,” Hamer said, noting that the multi-step testing process lends itself to inefficiency. “Having the swab done, collecting the swab, coding it, and then getting them out [to labs]” — all of these must happen seamlessly for testing to work well, Hamer said.
At Boston University, that process takes three minutes, and an appointment-only system avoids wait times, he said, but sites with fewer resources, less structure, or more community needs might perform each of these steps under significant pressure, leading to a more complex process.
The staff of Lynn Community Health Center serves a community hit hard by COVID-19. In recent weeks, they said their rewarding but difficult work has become even more demanding.
The center, which administered about 1,600 tests the first week of November, conducted 2,400 tests this past week, a 50 percent increase. The center’s previous high, in mid-August, was just under 2,000 tests per week.
David Schaffner, medical director of the center’s urgent-care team and COVID-19 testing program, said he does not expect that demand will decrease significantly anytime soon, as the state’s high level of community spread and employer requirements are also driving more people to seek testing. Schaffner added that even if demand drops after Thanksgiving, a surge in infection related to holiday travel would easily and rapidly offset any decline.
“Our main concern right at the moment is staffing, because it is staff-intensive,” Schaffner said. “It’s really challenging work, and it’s not always appreciated.”
Leidy Pimentel, a Lynn resident and lead medical assistant for urgent care at Lynn’s community health center, described the daily stress of diverting test-seekers with severe symptoms to the emergency room, and of gently but firmly turning people away at closing time. Amy Sanchez, who manages appointments, said she tailors her approach to each patient, assisting those who cannot stand for long periods while they wait, and sometimes translating, reading, and writing for patients. The women calm the anxious and impatient, day in and day out.
“We love what we do,” said Sanchez, also a Lynn resident. “Lately, demand has been more stressful. We need to be more organized and effective.”
Efficiency will take investment, Pimentel said. “The more funding we have for the community, the more service we can provide for the patients,” she said.
Her staff’s wish list was simple: adequate shelter after working outside all day for months, particularly as the weather gets colder, and more hands on deck to keep lines moving and allow them occasional breaks.
As demand surges, test-seekers exasperated with fully booked clinics and sluggish lines are beginning to echo health care workers’ demands for investment in testing infrastructure. But which entity will provide such support — and when — seems to be an open question in Massachusetts.
Baker on Monday pointed to the lack of federal investment in testing as one stumbling block on the way to adequate infrastructure. Billions of dollars in COVID-19 funding approved by Congress remains unallocated and unspent, he said.
“This is a perfect example of why the current sort of stalemate in Washington, both legislatively and administratively, is such a problem for people who are trying to wrestle through this pandemic,” he said. “Even a state like ours, which has as much access to testing per capita as you’re going to find anywhere in the country, is struggling to deliver on demands and expectations of an appropriately concerned public.”
Marty Martinez, Boston’s chief of health and human services, said that local, state, and federal government alike are still “figuring it out along the way.”
One month ago, Martinez and Mayor Martin Walsh appealed to Boston residents to get tested more often. Now, they are facing crowds of up to 1,000 people per day at some public testing sites, with wait times climbing and demand outstripping capacity, a problem the city plans to address with new sites and institutional partners after Thanksgiving.
“We don’t want to see a decrease [in testing] anywhere,” Martinez said. “That doesn’t mean it’s not straining the system. . . which is a tough thing to have, and not what you want to see, but I’d rather have that than less testing.”
Correction: An earlier version of this story had an incorrect figure for the number of tests completed in the week leading up to Thanksgiving.
Dasia Moore is the Globe Magazine's staff writer. E-mail her at email@example.com. Follow her on Twitter @daijmoore.