COVID knows no boundaries- Testing equity deserves as much importance as vaccine equity
My wife and I entered the RT-PCR/COVID testing centre under the auspices of Brigham and Women’s Hospital (BWH), in Boston, MA. The appointment date/time was set a week in advance, the registration was duly completed.
Upon our arrival, the lady at the reception checked our names and the registration numbers. We were asked to replace our masks with fresh ones, which were offered. We stood anxiously in the queue maintaining social distance. Next, we were called by name as per our appointment times. We showed the personal identification number; in this case: our passports. A wad of soft tissue was handed over and we proceeded to a glass enclosure labelled: Personal Protection Enclosure. A face-mask donned nurse instructed us to blow our nose hard into the tissue to have a “clean” nose available for the upcoming collection of the sample from the nasal swab test. The entire process took a total of only 7 mins, with the efficiency of this operation evident through a clear division of labour. It should be duly noted, the entire process — the reception, collection of sample and delivery of the results within 72 hours was carried out without costing a penny to us. In other words, we got out travel-required RT-PCR tests done completely free of cost at BWH.
As international travellers, in the times of pandemic, we experienced the in-the-face dimension of the “new normal”, as we worked our way to get the RT-PCR tests done per protocol. We were on our return trip to Bangalore from Boston. This required that we get the mandatory and a time sensitive RT-PCR test done in the US prior to commencing this travel. The experience shared as described above was a pleasant one.
But the preparation to get to this pleasant experience was rife with confusion, un-professionalism, miscommunication and apathy rolled into one.
The plan for undertaking having the RT-PCR test results (72-hr prior to the international travel) occurred during the time we were on our last leg of our in-USA travel, in Lexington, KY.
A good one week prior to the date, inquiries were made across a few national pharmacies and local hospitals in Lexington, KY. The requirement spelled out during these inquiries was to get the RT-PCR tests done for international travellers, who are non-US citizens (and hence do not have US Social Security Numbers (SSN) or US health insurance). Finally, we zeroed in on a local Urgent Care Centre. On-line appointments were set. Post-confirmation of the appointment, the fact that the clients were non-US citizens/international travellers was clearly explained in-person to the employee at the service desk, and the type of test to be administered was deliberated with the active participation of the senior-most person of the Centre. We left with the clear understanding that the clients (international travellers without the SSN) will get their time-sensitive COVID-test (we chose the RT-PCR test), free of cost.
The day arrived. Hours before the flight we, the international travellers reached the said Urgent Care at the designated time. We were immediately asked if we had our SSNs. We mentioned that we have the universally accepted IDs (passport) but as non-US citizens, tourists, and we did not have SSN. Sullen silence followed. We pleaded that this particular matter was settled in-person a week ago. However, on the day of the testing, the person at the reception and the testing technician cited the lack of SSN disqualifies us from taking the free COVID tests. We asked for the Centre manager and were promptly told that he/she was unavailable. The test could be taken, but since we did not have our SSNs. we had to pay for the testing fees.
The lack of consistent communication rendered by the staff of the Centre (between the day of setting the appointment and the day of reporting to the appointment) was extremely disappointing. This caused additional stress and strain for someone bracing for a strenuous international travel. That this inept handling of COVID testing during a raging pandemic left a bad taste would clearly be an understatement. At the end, Urgent Care Centre was more interested in collecting revenue from vulnerable clients rather than keeping an eye on the big picture — how to contain the spread of the pandemic by executing the required testing. In fact, Urgent Care Centre in this case, did what would be normally termed as the classic “Bait and Switch”.
Thankfully, we had worked out our Plan B and got an appointment at BWH. Boston was our port of exit. We went through three rounds of phone calls with different set of people at BWH. One for explaining the context that international travellers need to be tested for RT-PCR, next for ensuring that it would be done free of cost (irrespective of citizenship status of the client) and then setting up of the appointment in advance so that the test results are duly received by the clients on time.
As stated earlier, the execution of our Plan B was a resounding success. Lesson Learned — Always have a Plan B.
The intent of this mandatory RT PCR testing is that the virus should not spread inadvertently or unknowingly (read: asymptomatically). Staying safe for oneself and others is the primary mantra for keeping reins on the pandemic. The unsaid corollary to this is that it should be given regardless of citizenship and health insurance status. A broad policy like this is to stem the spread of the virus. As often heard, the virus does not care about geographical boundaries. While this is what the policy makers are promoting, the purpose has not trickled down uniformly to the working level, where it ought to be rigorously and consistently implemented.
This brings to the fore why are we seeing inconsistent approaches across states and across centers identified to conduct the tests. BWH conducts the COVID testing free of cost, while Urgent Care Centre gets mired in the administrative minutiae and does not deliver on the public health message.
Localized and regional Urgent Care Centres are possibly not aware of the needs of the international travellers. The call centre or the help desks are manned by team that is adept at the task of reception, but not trained on other equally important and relevant tasks. Also, as seen above, there is inconsistent understanding of the day-shift and night shift staff in the administration of tests. The inability to see a larger picture coupled with the pressure to compulsively generate revenues even if it is counterproductive, is starkly clear from this experience.
In contrast, BWH is an internationally renowned hospital for patients with complex conditions. The International Patient Center provides a complete service to the patients visiting the hospital from countries outside of the United States. Their International Patient Center serves thousands of patients each year from more than 120 countries and they are well trained to handle international clients.
A shout-out to the BWH management that has done an exemplary job in trickling down the message to its client facing health-care providers that the pandemic we are dealing with, does not respect boundaries. Whoever needs to be tested has to be tested without questions or making them go through hurdles or seeking exorbitant financial compensation. The hospital has stood true to its vision of a healthier world, and has been conscious in delivering through its mission of providing “ … individual care…in all settings, from an exam room to a virtual visit or in an ICU receiving highly specialized, compassionate care; …that improve our understanding, prevention and treatment of diseases.”
Some lessons have to be learnt from this anecdote. Free and unhindered testing is a must for all residents of the USA, which includes the tourists visiting USA, the uninsured, in addition to its health insured citizens. We need to emulate the organizations (like BWH) that do this task of RT-PCR/COVID testing wholeheartedly, with seriousness, commitment and professionalism and who are laser-focused on the ultimate goal: BEAT THE VIRUS AND STOP THE SPREAD OF THE PANDEMIC!
Testing equity deserves as much importance as vaccine equity.
Somjit Amrit
#pandemicresponse #covid19response #rtpcr #vaccinepassports #covidtesting
#Internationaltravel #coronaviruspandemic
