Universal Covid-19 testing wrapping up

David Briggs
Phlebotomists and medical students are testing around 1,400 residents, essential workers and first responders for Covid-19 in Bolinas this week. The overall infection results will be released next week, and the antibody test results will come a few weeks later.  
04/22/2020

The dirt lot at Mesa Park was transformed by wedding tents and dozens of geared-up medical workers and volunteers as drive-through Covid-19 testing rolled out in Bolinas this week. 

Over 1,400 people registered for the program, spearheaded by wealthy Bolinas homeowners who organized a wide range of community stakeholders and infectious disease experts from the University of California, San Francisco, to see the project through. 

The results will inform both regional and global responses to the pandemic.

“Bolinas can serve us as a model of a rural, relatively isolated community that would apply to other communities in West Marin in terms of community-wide prevalence,” said Dr. Matt Willis, Marin’s public health officer.

I was one of the first people tested on Monday morning. I wasn’t sure if I was considered an essential worker in Bolinas; I deliver the paper and conduct interviews in town, but my exposure is much higher in Point Reyes Station. I registered anyway.

The woman who checked me in asked me to use my own pen to sign a waiver, which acknowledged the tests had inherent and unknown risks. I held up the waiver while she took a picture, and she assigned me to the first of four lanes.

The test took about five minutes. First, a phlebotomist pricked my finger and massaged the blood into a vial. Then, she stuck a long cotton swab behind the left and right sides of my tongue for five seconds, and up my nose for 10. 

The nose swab was uncomfortable. It made my eyes water, and during the whole drive back to Inverness I felt the spot at the top of my nostril that had been prodded. Overall, it was a smooth and painless process.

Over the next few days, participants should begin receiving their results for the polymerase chain reaction, or P.C.R., tests, which detect active infection, and aggregate results are expected next week. Results from the antibody test will take a few weeks because the team is still deciding which test to use. 

Although other places have done either P.C.R. tests or antibody tests, doing both at the same time hasn’t happened on a large scale in the United States. The UCSF team will follow the testing with that of residents in the densely populated Mission District in San Francisco, creating samples from both a rural and an urban community. Depending on the results, a second round of testing could follow.

The value of the P.C.R. tests is clear: If participants test positive, they will be contacted by a nurse who will trace their exposure and instruct them in how to isolate. Marin County Health and Human Services has a team on standby to carry this out. Asymptomatic carriers would change their behavior.

The antibody testing has promising value for showing how close the community is to herd immunity—but first, the tests must be proven accurate, and they must demonstrate immunity. Neither of those criteria have been met yet.

For example, Dr. Willis took an antibody test along with a family member after they both recovered from Covid-19. While Dr. Willis tested positive, his family member had a negative result. By doing the P.C.R. and the antibody test concurrently, the study should help measure the accuracy of the antibody test. 

Health officials assume that antibodies offer some degree of protection, but for how long is unknown. It could vary from lifelong immunity to just a couple of weeks, Dr. Willis said. Until that information is known, the results shouldn’t influence a person or a region’s behavior.

Establishing herd immunity is the endgame for stopping the spread of Covid-19. That can be achieved through vaccination or the infection of enough people. With a vaccine far from ready, public health officials are looking to slowly relax the shelter-in-place order, leading to more infections.

“The challenge on the public health side is profound,” Dr. Willis said. “We’re facing a disease that can cause very serious illness, but we also know most of us will eventually become infected as we move toward herd immunity… If we have a reliable and accurate antibody test, that would be very valuable to us in terms of our public health response, once we know better what immunity represents.”

If the antibody tests show that not many people are immune, that would tell Dr. Willis that rural enclaves have been spared from Covid-19, meaning more people are vulnerable. He would approach the shelter order differently than if many people are immune. Before testing began, no Bolinas residents had tested positive for Covid-19.

Caterina Fake, project leader Jyri Engestrom’s partner, wrote in a blog post that she thinks Bolinas can serve as a model for community-run testing. 

“People keep asking about getting the tests, but the tests aren’t the problem—we actually had too many to choose from, and we’re going to run several tests on the samples we’ll collect,” she wrote. “We realized nobody has access to tests because nobody was assembling all the other pieces.”

The project was an impressive act of collaboration. Organizers bought protective suits from hardware stores, gloves from restaurant suppliers and masks from China. A volunteer team of Airbnb engineers built the registration platform in two weeks. Twelve hired phlebotomists performed testing, medical students assisted, and volunteers helped direct traffic. 

The Bolinas Fire Protection District, Mesa Park, the Bolinas Community Land Trust, and the Coastal Health Alliance were brought in as partners. Donors, translators and community outreach were key. Altogether, the project has cost about $200 per person, plus hundreds of volunteer hours.

“So far the reception in the community has been incredibly warm and supportive,” Mr. Engestrom said.

Although the millionaire status of the project initiators has garnered some skepticism on social media, organizers have managed to reach the working class of Bolinas. Outreach has focused on the unhoused, the homebound, and Guatemalan and Mexican residents.

“I don’t feel any apprehension about people with means pitching in to pay for this,” said David Kimball, who has volunteered his organizing skills. Other projects, like the construction of the Bolinas firehouse and the repair of Terrace Avenue, also relied on crowdfunding when the government wouldn’t take the lead, he said.

Mr. Engestrom, who spearheaded the project with pharmaceutical executive Cyrus Harmon, has founded and negotiated acquisitions for two companies: Jaiku, a mobile social network acquired by Google, and Ditto, a mobile local recommendations app acquired by Groupon. Ms. Fake co-founded Flickr in 2004, and today she invests in startups with Mr. Engestrom through a venture fund called Yes VC. 

Mark Pincus, the initial donor of $100,000, founded Zynga, a social gaming company that created Farmville and Words With Friends.

The vast majority of donors—93 percent of more than 150 individuals—contributed less than $5,000, Mr. Engestrom said.