Rural Texas has struggled to get testing compared with big cities, but mobile testing sites could help

A coastal community with no health department, hospital or urgent care clinics received a welcome visitor Thursday: a mobile testing site that rolled into Aransas County to help screen Texans for the new coronavirus.

With a population around 10,000, Rockport has done everything it can to limit the outbreak — from closing parks and beaches to barring short-term visitors. But testing was one tool out of reach for the south Texas enclave, still wounded from Hurricane Harvey, which destroyed the closest hospital nearly three years ago.

“Many people don't have insurance — who’s going to pay for that?” Rockport Mayor Patrick Rios said of purchasing commercial tests. “You’re talking about a million and a half dollars to test everybody in the area, and we just don’t have that kind of money.”

Urban centers have had free testing sites for weeks, operated by the government and other providers. Houston officials recently opened up testing to anyone who wants it, and Gov. Greg Abbott has promised a dramatic increase in testing statewide.

But for some living in more remote areas, help arrived this week as a wave of National Guard teams fanned out across Texas — which has had one of the lowest per-capita testing rates in the country.

Up the coast from Rockport, Bay City hosted a temporary test site Friday.

In Floresville, which had a mobile team in town Monday, Mayor Cecelia Gonzalez-Dippel said there’s now “30 more people that hadn’t been tested that were tested.”

“That’s good for us,” she said. She just wishes she’d known the team was coming before late Sunday so she could have put the word out.

And in Aransas County, which has had two confirmed cases, Rios was grateful to see a site Thursday.

“This will give us a good idea of if we have anything going on,” said Rios, who’s heard residents complain of pollen allergies but not coronavirus symptoms. Before, the area “had a very difficult time with our folks getting tested” at facilities in Nueces County, 40 minutes away, he said.

The deployments come as the governor prepares to reopen parts of the Texas economy and as Democrats and some medical experts say it’s premature to lift strict social distancing measures that have been in place for about a month. The state is “nowhere near where it needs to be in testing,” U.S. Rep. Sylvia Garcia, D-Houston, said this week.

A shortage of supplies

A shortage of supplies has hampered testing efforts across the country and in Texas — where, a few weeks ago, a public lab in Tyler ran out of chemical reagents and stopped accepting samples.

Smaller communities have also struggled to get tests because they were not prioritized by the government or are too cash-strapped to buy them from the private sector, which runs the majority of tests in Texas. Some tried and simply found the equipment out of stock.

That happened in suburban counties around Houston.

In a mid-April release titled “Why is it so difficult to get free COVID-19 testing in Montgomery County?” local officials said they asked the state for 1,000 test kits in March and received only six. They sought tests from major health care suppliers and found the equipment was backordered, the release said. Chambers County issued a similar document saying it got 105 of the 1,000 kits requested from the state.

“It was more geared at the residents of our county just because we were getting calls from them — ‘Where's the free testing in Montgomery County? Where's the drive-thru testing in Montgomery County that's free of charge?’” said Misti Willingham, spokesperson for the county public health district. “We just wanted to let them know that we are taking steps to remedy that situation and that we shared their frustration.”

A spokesperson for Chambers said the county has been in contact with state officials and expects to receive 500 test kits, which it will use to set up a testing site. Willingham said Montgomery hopes to receive a grant for swabs so it can offer free testing to symptomatic residents.

Chris Van Deusen, a spokesperson for the state health services department, said the agency gave Montgomery 64 kits and Chambers 135 kits by mid-April and has “since sent more to each.”

Before, the department was not able to completely fulfill requests because of a limited supply of test collection kits — which require swabs and solution-filled vials used to transport samples to labs for analysis, he said. The state lab in Austin had supplies on hand for flu testing and distributed those across the state “as fairly as possible” — looking at population and the number of cases in an area, and “trying to fill as many as possible, even if it was just a few” items, Van Deusen said.

The agency — which has gotten supplies from private sources and made requests to federal agencies — received new shipments last week and has begun sending them to local authorities.

Challenges in urban areas

Access to testing varies across the state. Several cities have free testing sites supplied by the federal government — including Houston, which can now test 1,000 people per day and is offering to screen anyone, and not just people with symptoms. Other providers, like Walgreens and medical facilities, are ramping up drive-thru testing.

Abbott has said he’s confident the state will get the supplies needed to dramatically increase its testing capacity this month and next. Texas has reported 242,547 tests administered, and has a population around 29 million.

Epidemiologists say tests are crucial to understanding the spread of the virus, including in rural and semi-urban areas with limited health care infrastructure that could be overwhelmed by a small cluster of cases. Testing will remain key as the state begins to loosen stay-at-home directives and officials conduct contact tracing — going back to find everyone a person with the virus may have infected and testing them, too, experts said.

“We actually have to expand testing if we hope to successfully avoid another significant wave of infections as we emerge from our restrictions on social distancing,” said Rebecca Fischer, an infectious disease epidemiologist at the Texas A&M School of Public Health. “That's probably the most important challenge at this critical juncture.”

But officials in urban areas — with far greater populations — say they also are dealing with testing challenges, stemming from a dearth of supplies.

Dallas County, for example, has had its plans to create super testing sites stymied because of a lack of two items: swabs and reagent.

Judge Clay Jenkins said the county submitted a request to the state for supplies weeks ago, in the hopes of increasing testing at Parkland Hospital and UT Southwestern Medical Center. He says the sites could analyze at least 4,000 test daily and turn around results in one day.

“We have invested the money on the people and the machines. We just need the reagent, the swabs. Unfortunately, despite the best efforts of the state and locals, the federal government has not provided us with swabs and reagents,” Jenkins said.

In Travis County, Judge Sarah Eckhardt said there’s been an “incredibly inefficient distribution” of testing resources nationwide — yielding a situation where it’s “every state for themselves, every hospital for themselves, every county for themselves.”

At one point, county officials drove to San Antonio to pick up a testing medium from the state — only to discover it was for bacteria and not viruses. It was an honest mistake, Eckhardt said, but demonstrative of the complicated supply chains.

Cost is a concern in Travis, too — which was testing at a rate of 6.6 out of 1,000 residents earlier this month, higher than other counties.

Although it receives some tests from the government, Eckhardt said the county fronts the price of administering them — scheduling patients, finding qualified staff to swab noses, and having epidemiologists reach out to people with whom a patient was in contact and could have infected.

Disclosure: Texas A&M University and UT Southwestern Medical Center have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.