Bolinas offers test to all in rare Covid-19 project

04/15/2020

Free Covid-19 testing for all Bolinas residents and West Marin first responders will roll out next week in an extraordinary project envisioned by two locals and led by a team of infectious disease specialists from the University of California, San Francisco. The program, among the first of its kind in the world, will offer the town a rare window into how its population has been affected by the novel coronavirus and provide valuable data on how the virus spreads in rural communities.

The drive-through test will include a mouth and throat swab to check for active infection and a finger prick to detect antibodies against the disease. A second round of testing will follow two weeks later, if enough money is raised. The project’s estimated cost of $400,000 has been funded entirely by donations.

The project was spearheaded by Bolinas residents Jyri Engestrom, a venture capitalist, and Cyrus Harmon, the chief executive of a pharmaceutical company, who were connected by a third local who heard them both talking independently about testing Bolinas.

They were inspired by the Italian town of Vò, where all 3,300 inhabitants were tested twice. Several asymptomatic people were identified and isolated. The work, along with a lockdown, helped bring the virus under control in the town. 

“The question that we asked was, how could we could get everyone in Bolinas tested?” Mr. Harmon said in a Zoom meeting on Monday. “Unfortunately, when we asked that question, the best answer we could find at the time was, basically: You can’t.”

Mr. Harmon blames testing shortages on strict regulations, a lack of urgency by the federal government and technical issues with the Centers for Disease Control and Prevention. The idea of testing the entire town resonated when he and Mr. Engestrom raised it with other residents, including Mark Pincus, an internet entrepreneur, who anchored the donations with a $100,000 contribution. They contacted the hospital, which assembled a team of infectious disease doctors.  

“It was really amazing, this idea to mobilize the Bolinas community and to have a partnership that could advance how we respond to this epidemic,” said Diane Havlir, the chief of U.C.S.F.’s Division of Human Immunodeficiency Viruses, Infectious Disease and Global Medicine, who has dedicated her life to HIV research. “In history, the most effective responses to epidemics have happened when the community is front and center, they’re partnered with scientists based on principles, and they’re working with policymakers. That is exactly what is happening here.”

Over 1,100 people were signed up as of Wednesday morning, so the website began placing essential workers and first responders on a waitlist until someone could make sure that they worked in town.

Bolinas will be one of the first communities in the world to collect information on who is actively infected and who has been infected with the coronavirus, Dr. Havlir said. The research will shine a light on transmission dynamics in rural communities, aiding in the regional and global response. But first and foremost, the information is meant to help participants. 

A researcher from U.C.S.F. will call each person who tests positive and the case will be reported to Marin County. Nurses from the county will reach out with guidance, and the Coastal Health Alliance will offer consultations.

Anyone over the age of 4 who lives or works in Bolinas is invited to register; West Marin health care workers and first responders may also participate. Each part of the test is voluntary, so participants can opt out of the finger prick, the nose swab or the throat swab. Households should arrive together by car and will stay in their car during the 15-minute test. Those without cars may walk to the testing site at the fire station, where operations will be modeled after U.C.S.F.’s own testing site.

Results for the polymerase chain reaction test, which detects the coronavirus’s genetic material, should be available within 72 hours, researcher Bryan Greenhouse said. Aggregate data will be provided to the town as soon as it is available. 

The antibody test will take longer because those tests are still being developed. The infectious disease team is evaluating nearly 100 different tests and will try to pick the best one.

If a surge of tests were to be needed in other places, those would take priority. But for now, the clinical lab at U.C.S.F. is under capacity, so the project will not detract from the testing of sick people, Dr. Greenhouse said.

The virus test has an up to 20 percent chance of giving a false negative, so researchers are stressing that social distancing should continue regardless of results. The chance of a false positive is very low.

“Even if your test result is negative, it makes it much less likely that you’re infected, but it doesn’t make it impossible,” Dr. Greenhouse said. 

The team will set up on Sunday evening and test from Monday through Thursday. Roughly 75 percent of the cost will be spent on testing, while the rest will go toward setting up the site, compensating medical workers and purchasing personal protective equipment, Mr. Engestrom said.

He has not yet put forward cash; he’s waiting with trepidation to see how much is needed to close the gap. He and some employees have been organizing, but Mr. Engestrom says the project has no real leader.

“It's very Bolinas—people notice something isn’t getting done and start doing something about it,” he said. “Like making sure the materials are in Spanish and English, painting signs, grading the dirt field, raising funds—that sort of stuff.”

The project has the support of the Bolinas Volunteer Fire Department, which lent its firehouse to the project, and the Bolinas Community Land Trust, which is acting as the umbrella organization so that donations are tax deductible.

Aenor Sawyer, a U.C.S.F. physician and Bolinas resident, is serving as a community liaison due to her unique position of having a foot in both doors. She is working with the school’s Office of Community & Government Relations to anticipate any media coverage.

“This is not being done for publicity. In fact, we are doing everything we can to protect the town, the community from that,” she said.

This is the second time in the last year that Bolinas has been the subject of an academic study. Researchers from the University of California, Berkeley, launched a yearlong study last July to develop the most efficient method of evacuation using traffic simulation models.

 

To schedule your Covid-19 test, visit bolinastesting.org