A small town in northern California is working to become the first in the US to have every community member tested for coronavirus. Researchers hope the endeavor will help clarify how Covid-19 spreads through communities, and how immunity is built.
Bolinas, an unincorporated, rural enclave of 1,600, nestled right above San Francisco and bordered by the ocean on three sides, drew upon its residents’ personal resources to launch the effort.
The town raised $300,000 through GoFundMe to buy testing equipment and tents. Two residents – the venture capitalist Jyri Engeström and pharmaceutical executive Cyrus Harmon – used their connections to reach researchers at the University of California, San Francisco, and invited them to set up a study in their town. Local volunteers set up a website where people could register and helped source masks, face shields and other protective equipment for medical workers. Local not-for-profit organizations offered to help spread the word to homebound older residents and unhoused community members.
The results from the Bolinas study, in addition to a similar testing program in San Francisco’s economically and ethnically diverse Mission District, will help researchers understand how the virus spreads through rural and urban communities, said Dr Aenor Sawyer, a Bolinas resident and UCSF orthopedic surgeon who is coordinating testing in the small town, about the project.
What is the benefit of testing every single person?
Over and over, we see people saying that they’re ready to lift the distancing restrictions and open everything back up, but it’s actually reckless to begin lifting before we have any information – or enough information – about how the virus moves through a community. We can’t safely start returning to normal life until we learn more about the transmission of the virus, until we learn about the development of antibodies – the extent to which they give us immunity, and for how long. Community-wide testing is really what we need in order to answer some of those questions.
Why is it important to do two types of testing?
We’re trying to encourage everybody to get two types of tests – the PCR test, which will look for the presence of a viral infection, and the serological tests or blood tests, which will look for the presence of antibodies.
If someone has a positive result from the PCR test, we’ll call them right away, so they can take steps to keep themselves safe, and isolate themselves so they keep their loved ones safe. If someone isn’t able to isolate themselves, we’ll get them a room in a hotel.
The antibody testing is important because there’s a lot we don’t know about antibody tests. We don’t know which test is best in class, and beyond that we don’t know once you get the results, what that actually means. If you have the antibodies that your body produces in the early stages of the infection, you could actually still be infected and pass the virus along to others. Another type of antibody may indicate you’ve had the infection and fought it off, but that doesn’t necessarily mean you’re fully immune – we don’t know how long immunity lasts.
So we need a lot more information on antibody tests, and the way to get that information is to do a lot more antibody tests. Since these are blood tests, we can also run several types of antibody tests on the same blood sample to compare and validate the results of different tests.
How is it going so far?
We’ve set up a drive-thru testing site for most residents. For homebound elders with chronic conditions or people with limited mobility, we’ve partnered with a local non-profit to send medical staff to people’s residences to conduct the tests. We made sure to reach out to our homeless population and people living in their cars.It’s been extraordinary – we tested 487 people just on Tuesday.
The testing in Bolinas is not mandatory. We’re trying to take down any barriers to that end, making the testing free and accessible to everyone.
There was a delightful moment at the drive-thru testing site where I turned around and saw a car in the first slot, a man with his bicycle about 20ft back, and a young guy on his skateboard another 20ft back. Every mode of transportation is acceptable – everyone is welcome.
How will the project in Bolinas relate to the one in San Francisco’s Mission District, where a community organizer has similarly galvanized an effort to try to test everyone in the neighborhood?
What’s really different is that the Mission District is not as isolated geographically as Bolinas. There are no borders around the Mission, there’s no geographic separation across San Francisco’s main thoroughfares distinguishing one neighborhood from another. So it’ll be really interesting to see how different or similar the viral transmission is in the Mission versus in Bolinas.
The main thing is, we just need more community-wide testing across the board. We’re hoping we can demonstrate a model for widespread testing in the Mission and Bolinas to help other cities and communities do the same.
Some communities have complained that they’re unable to access the swabs, test kits and personal protective equipment, let alone the funding, they need to ramp up testing. How did you manage in Bolinas?
Well, first and foremost, we didn’t want to take away supplies from anyone else in order to conduct this research. We’re working really hard on making sure that we aren’t taking supplies from the frontlines of healthcare. So we’ve gotten creative.
We sourced our masks from paint shops and hardware stores. The most in-demand swabs they use at hospitals are medical centers are these long ones with a score – which are long enough so they allow medical personnel to take a sample without having to touch patients, but can easily be broken in half so they fit inside these test tubes. Those are hard to come by, so we developed a technique to use different types of swabs that we break and that can work just as well. UCSF also developed their own testing kits, which we are able to use in Bolinas.
In terms of processing the tests, that’s been a challenge in California as well. There’s been bottlenecks and delays. Luckily, UCSF has an enormous capacity, so they’re able to process all their tests in-house and they’re able to help other counties process tests – and we’re able to take advantage of that.
I do think it’s important to not rely on the community to always come up with the initiative and money. We need a state fund to help local leaders do this for every community up and down the state.
