On Sunday, Karen Thornburg, a volunteer nurse who is coordinating a new initiative to test homeless people for COVID-19, got a call on her cell phone as she drove toward a beachfront tent community in Waimanalo.
It was bad news.
Lavina Aina, the homeless camp’s leader, had just held a vote. The camp decided they would block Thornburg and her small team of health care workers from entering their community.
“She said that they don’t have the virus in there and they don’t want it in there,” Thornburg explained. “They feel that they have self-quarantined in there and they don’t want to let anyone in.”
Thornburg went to see Aina, who was guarding the camp’s perimeter. But she didn’t try to persuade Aina to let her in. Instead, she tried to develop a relationship with the camp leader and, with any luck, a modicum of trust.
The latter effort, Thornburg said, seemed to be a success.
“You have to honor the homeless,” she said. “You can’t push your way in.”
Thornburg is part of a colossal effort to ramp up COVID-19 testing in Hawaii led by Dr. Scott Miscovich, a private physician, and dozens of health care workers, many of whom are unpaid volunteers.
Since mid-March, Miscovich’s mobile testing brigade has conducted dozens of drive-thru COVID-19 screening events on Oahu, Maui, Molokai and the Big Island, testing as many as 700 people in four hours. According to Miscovich, the group is responsible for giving about 10,000 tests, or roughly a third of all tests statewide.
“We need to find everybody in the state who could be positive,” said Miscovich, who is a senior adviser on Lt. Gov. Josh Green’s COVID-19 Task Force.
To be screened for a COVID-19 test by Miscovich’s operation, you just need to show up. You don’t need an advance referral from a doctor, proof of insurance or any form of payment.
The test is free for the person being tested.
Now, as the virus starts to come under control in Hawaii, Miscovich and his team are rethinking their strategy. The public demand for COVID-19 testing appears to be dropping, if the waning turnouts at the group’s pop-up testing events are any indication.
Of the 51 people who were tested in the parking lot of a Mormon church in Wahiawa last week, there was one positive result — a 17-year-old who had no known exposure to the virus.
So Miscovich is adjusting the project’s focus, going after first responders, essential workers, rural residents and people living in homeless encampments and shelters.
“We’re not trying to be the test masters,” Miscovich said. “We are showing the light. We’re just happy people are seeing that this is the way to flatten the curve and save lives.”
After Thornberg’s first attempt to test members of Waimanalo’s homeless community ended before it began, her team found better luck by traveling mauka.
At Hui Mahiai Aina — a new community of 28 adults and three children who live in tiny aluminum shelters about the size of a backyard shed — she and her team were happily welcomed in. Residents eagerly accepted gifts of free masks. They introduced medical staff to their dogs and invited them to peek inside their tidily kept homes.
“We want to know that it’s not here,” said Tara Mossman, who got tested Sunday along with her 7-year-old son Luke.
Mossman said the prospect of knowing that she and her son are virus-free would help put her a bit more at ease — a feeling that’s difficult to cultivate amid so much emotional turbulence stirred up by the pandemic.
Last week one of Miscovich’s teams tested the residents of a Big Island homeless shelter. There were no positive results.
“That’s what we want,” Miscovich said. “We’re not wasting resources when we use the tests we have to prevent a catastrophe. It’s the difference between prevention and waiting for it to spread.”
Miscovich started stockpiling hand sanitizer, surgical gloves and face masks in January, when China’s coronavirus outbreak exploded and health officials detected the first known infection in the U.S.
At the time, the federal Centers for Disease Control and Prevention, as well as President Donald Trump and other high profile politicians, rendered the risk to the American public as low.
But Miscovich thought otherwise, at least for Hawaii’s population.
“Knowing how close we are to China and how many visitors we have coming from Asia, I was very concerned,” said Miscovich, whose Premier Medical Group Hawaii employs about 100 people at five clinics on the Big Island and Oahu.
So he readied himself for a public health catastrophe, forging new relationships with N95 mask suppliers and ordering thousands of pocket-sized hand sanitizer bottles branded with his medical practice name and logo.
When one of his patients, an employee at Kualoa Ranch, tested positive for COVID-19 on March 15 and became Hawaii’s first case of community spread, Miscovich stepped in to fill what he saw as a troubling lack of state initiative to test people at risk of being infected.
He established a series of drive-thru COVID-19 screening operations on Oahu and, eventually, across most of the state. He deployed his medical staff, as well as his wife, son and daughter, to aggressively test people at these events if they had any COVID-19 symptoms. They also tested recent travelers and people who had been in close contact with an infected person.
“My big call to action was when I was seeing patients coming through with fever, cough and shortness of breath who were working in tourism,” Miscovich said. “At that point I just realized that if we didn’t do this as a private medical community, Hawaii was going to be New York City.”
In the debate over who should be tested for the new coronavirus, Miscovich sides with experts who say the net should be cast wide to quickly identify infected people and isolate them and their close contacts.
His push for aggressive testing, however, is in conflict with the philosophy of the Hawaii Department of Health, which follows guidance from the federal Centers for Disease Control and Prevention to not test people who are asymptomatic or have only mild symptoms and can recover at home in isolation.
The guidance that calls for more limited testing has been informed in part by the global shortage of COVID-19 testing kits, the chemicals and lab equipment required to produce a test result and the personal protective equipment worn by health care workers who conduct testing and care for potentially infected patients in hospitals and medical clinics.
But Miscovich said his operation has been well-stocked all along. And he said he continues to buy bulk shipments of PPE without difficulty.
Miscovich said he suspects the executives of any hospitals or medical clinics who say they are in short supply are either unwilling or unable to pay for more of it.
“It’s out there,” Miscovich said. “I just bought more N95 masks — 10,000 of them.”
Miscovich said he has invested nearly a half million dollars of his own money to build his drive-thru testing project.
He said he’s spent about $100,000 to build a sprawling pandemic wardrobe, which includes N95 masks ordered in shipments of 10,000, surgical gloves and $8 hooded coverall suits. Worn by the health care workers who staff the drive-thru events, this impressive collection of protective gear, assembled in the midst of a global PPE shortage, is helping to keep his staff safe.
Miscovich’s investment also includes a 50% pay increase for his Premier Medical Group staff. He said he’s still paying his staff at their regular rate if they choose to stay home, either because they have a suppressed immune system, have children they need to supervise or just don’t feel comfortable working the events.
Some of the money has allowed the group to purchase pop-up tents and industrial fans that blow any airborne COVID-19 particles floating out of patients’ cars away from the staff. The group bought generators so that staff can create an electronic medical record for each patient, as well as coolers in which used testing swabs are delivered to private labs.
Miscovich said he has recouped about $35,000 of his investment in small payments from insurance companies, and nothing more.
“I’m doing this — we’re all doing this — because we care about Hawaii,” he said.
The drive-thru testing events are made possible through a deal Miscovich said he struck with the state’s two private labs — Clinical Labs of Hawaii and Diagnostic Laboratory Services — to supply him with swabs and test kits. In return, he and his testing troupe provide the labs with insurance information for the people who get tested so that the labs can seek reimbursement for furnishing the results.
The test is free for the person who is tested. There is no copay for people who do have insurance. And the labs have agreed to eat the cost for people without insurance, Miscovich said.
Miscovich said the labs typically provide results in one to three days. Volunteers deliver them to patients by phone.
For Oahu residents who test positive, the phone call comes from Miscovich himself.
“A lot of them are like, ‘I figured I had it,’” he said. “They were expecting to test positive because their Mom had it or their brother had it or they came back from New York and they’ve been coughing like crazy.”
“Then you get the other half that are just like, ‘What?’ They just can’t believe it because they don’t have a single sniffle. I can’t tell you how many people I’ve just told they have COVID and they’ve just come back from a run.”
The doctor said he has only encountered one infected person who can’t figure out how she may have been exposed.
It takes about 25 people to run a testing event. About half of them are unpaid volunteers — doctors, nurses, nurse practitioners and physician assistants, many of whom have been out of work since the health care system halted most non-emergency surgeries and procedures.
Volunteers are recruited by Melissa Fletcher, who co-founded the Hawaii Crisis Healthcare Alliance last month to develop a database of available practitioners who wish to donate their skills to the state’s COVID-19 response.
“I can’t stand by and do nothing,” said Chris Tomlinson, a hospital nurse who is working reduced hours.
Stephany Hall, a nurse practitioner student, said she’s volunteering because many of her hours have been cut, too, and she wants to feel like she’s doing her part to fight the pandemic.
While they aren’t making any money working the events, volunteers say they are well-paid in gratitude.
“People are scared but then they’re thankful,” Tomlinson said. “There have been aunties and uncles showing up with cold coconuts and fresh baked muffins. How awesome for us to get to take care of them.”
Occasionally, though, the staff faces pushback from residents who don’t want to host a testing site in their neighborhood. Last week a group of volunteers was accused of bringing COVID-19 to Wahiawa.
The group is constantly modifying its testing criteria. Right now it is targeting people with upper respiratory symptoms — congestion, sore throat, stuffy nose — in addition to the telltale signs of fever, cough and shortness of breath.
At the top of the list is anyone with a total loss of taste or smell.
The group tests people with no signs of illness if they have been in contact with an infected person.
They are also pursuing first responders, health care workers, restaurant and grocery store workers, Hawaiian Electric employees, public bus drivers and people who work at airports and harbors.
People who want to get tested are sometimes turned away if they have no signs of illness, no recent travel history and have been isolating at home, leaving little opportunity for infection to find them.
Some who do have symptoms are sent home to bring back the rest of their family members.
“There have been people who are flat out terrified.” Tomlinson said. “You wish you could give them a hug but, of course, you can’t.”
On Wednesday, a woman pulled up to a Wahiawa testing site, her face streaked with tears.
Karysma Cyr, a 25-year-old operating room nurse, tested the woman’s oxygen saturation. It was normal.
“Thank God!” the woman gushed.
Her pulse, however, was abnormally high.
“Are you nervous?” Cyr asked the woman.
“Very,” she said.
Some people are not as scared of the virus as they are of having a testing swab inserted several centimeters up their nose.
“If you get the test, you’re usually crying — because it literally makes you tear up,” Cyr said. “I’ve been tested twice and I cried.”
The testing swab can also create a burning sensation similar to the feeling of having salt water lodged in your nose.
But the test is generally considered uncomfortable, not painful. It takes 10 seconds to swab each nostril.
“Some people jump away from me when I go to swab them, and I’m like, ‘I need your face to stay here — and if you want it to be right, I’ve got to get up in there,’” Cyr said. “You kind of just have to encourage them that they can do it.”
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