Albany County is in eastern New York State, 136 miles north of New York City. Covering approximately 525 square miles, its urban center sits along the Hudson River surrounded by suburban municipalities and rural hilltowns.

As home of the state capital, much of Albany’s population is employed by the government, health, finance, education, and business sectors. Several colleges and universities offer undergraduate, graduate, and professional programs. Four hospitals, including a Veterans’ Administration Medical Center, provide services to residents of Albany County and the larger metropolitan region.

The county population is 305,506. Residents are predominantly white (75.8%), and the largest minority groups include Black (14.1%), Asian (6.8) and Hispanic/Latino (6.3%) persons. Minority populations are concentrated in urban areas.[i]

Albany County prioritized addressing COVID-19 response inequities by developing strategies for testing, care coordination, supportive resources, surveillance, case monitoring, contact tracing, and communications for historically underserved populations.

At the pandemic’s outset, it became evident that timely testing was critical to successful mitigation efforts and that lower income and minority communities faced significant challenges in accessing testing services. The County successfully advocated for New York State to establish a drive-through testing site in Albany County; however, this and other early sites were primariy located in suburban areas, limiting access for at-risk urban residents without personal transportation. Recognizing this access issue, the County Executive’s Office and the Albany County Department of Health (ACDOH) partnered with Whitney M. Young Jr. Health Services (Whitney Young), a federally qualified health center (FQHC), to implement multi-site mobile COVID-19 testing services targeting low income and minority communities. These sites were designed to be pedestrian focused and in areas readily accessible via public transportation.

Goals of the mobile COVID-19 testing program include: operating a free mobile COVID-19 testing unit; fostering community involvement in the decision-making process; providing culturally and linguistically sensitive COVID-19 health education; and identifying individuals at risk for COVID-19 in Albany County.

Initial results show that during the April 15, 2020 - November 30, 2020 period, the program conducted 5,085 tests at eight (8) sites (Attachment III).

One crucial factor contributing to the success of the program is the collaboration between Albany County, Whitney Young, the City of Albany, and numerous community-based organizations in recognizing the barriers to COVID-19 testing and designing a program to overcome them. Fiscal support from the County, philanthropies, health insurers, and the CARES Act, combined with Whitney Young’s operational experience providing mobile health care services makes the program successful.

To reduce health inequities, the mobile COVID-19 testing service is free of charge and located in communities characterized by lower income and/or minority demographics, removing barriers due to lack of fiscal or transportation resources.

The immediate public health impact of the mobile COVID-19 testing program is to expand COVID-19 testing to underserved populations in Albany County. This program may improve health outcomes among these populations by providing a model for comparable interventions that include expansion to other communities challenged by distance or fiscal obstacles accessing COVID-19 services, including COVID-19 vaccination.

COVID-19 has disproportionately affected socially disadvantaged groups. Specifically, COVID-19 has had a substantial impact on racial and ethnic minority populations and essential workers in the United States, including Albany County (County).

Disparity in the distribution of COVID-19 exists within Albany County. During the April 15, 2020 – November 30, 2020 period, the likelihood of SARS-CoV-2 infection in very high-deprivation areas of Albany County (the cities of Albany, Cohoes, Watervliet) were measurably higher than those in very low-deprivation areas (Attachment I). These communities are characterized by larger proportions of non-White residents, persons working in manual, essential, and public-facing sectors, more crowded housing, and food and health care insecurity.

While the City of Albany is home to 32% of the county population, 77% of the Black population and more than 53% of the Hispanic population reside within the City.[i] COVID-19 racial disparities are evident in hospitalization. Blacks represent 11.7% of the Albany County population; however, 22.2% of persons ever hospitalized for COVID-19 were Black and 23.0% of persons ever in intensive care were Black (Attachment II). These urban areas also tend to have higher poverty rates than the County as a whole. The percent of persons living below poverty level in the City of Albany is almost double the percent in Albany County (22.9% vs 11.7% respectively).[ii]

People with chronic diseases are far more likely to experience serious complications if they become ill with COVID-19. Significant disparities exist in the distribution of chronic disease within Albany County.Urban cities of Albany, Cohoes, and Watervliet and the village of Green Island have higher rates for asthma, cardiovascular disease, and diabetes compared to suburban and rural areas in Albany County.[i]

Social inequities put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19 including discrimination; health care access and utilization; occupation; education level; income; and housing.[i] ACDOH implemented enhanced mitigation strategies to increase the availability and accessibility of COVID-19 testing via mobile services in the most underserved areas.
 

In the pst, ACDOH has successfully integrated the efforts of public health, clinical providers, and payers through innovative clinic-to-community linkage models of care. This collective impact approach is exemplified by the Department’s use of community health workers to refer Whitney Young patients to the National Diabetes Prevention Programs. In the early weeks of the COVID-19 pandemic there was no local testing available. Early testing programs were in suburban locations creating an undue burden for disadvantaged individuals. After identifying this barrier, Albany County leveraged its historical partnership with Whitney Young to become the first county in New York State to provide COVID-19 testing in underserved neighborhoods via a mobile service model.

Albany County mobile COVID-19 testing represents an innovative use of an existing resource. In the past, Whitney Young has used the Whitney on Wheels (WOW) van, complete with requisite staff, equipment, and supplies to provide preventive services (e.g., routine physicals, vaccinations, health and nutrition counseling) directly to patients in schools and community settings, overcoming barriers to care. In response to community needs during the COVID-219 pandemic, the vehicle has been repurposed to provide COVID-19 testing services in neighborhoods not easily served by other testing resources.

The mobile COVID-19 testing initiative successful implementation continues through: structuring the mobile unit’s operations (staffing, scheduling, pre-registration, security, supplies and equipment) based on experience of the Whitney Young’s WOW mobile immunization van and supportive resources provided by Albany County;soliciting community engagement in program design, mobile service locations, and promotion; using quantitative and qualitative data to target neighborhoods with high incidence of COVID-19; and continuous review of operations to make ongoing adjustments such as a revised geographic footprint, amended hours, and varied testing approaches.

The mobile testing program was uniquely situated to address several challenges related to COVID-19 that created adversity within Albany County. The lack of sufficient and accessible COVID-19 testing options was the primary challenge addressed by the mobile testing program. While many of the early challenges faced by testing sites have since been resolved, in April and May 2020 access to test kits, lab resources, and personal protective equipment was a daily challenge that required constant communication to overcome.

Many County testing sites are drive-through sites, accessible only by vehicle, creating a barrier to testing for individuals without access to private transportation. The mobile testing program not only allows individuals to access testing without a vehicle, it also offers testing outside of normal business hours. Where applicable, Albany County also provides cost waivers for testing services.

Public communication is a challenge as community members may be unsure of expectations or eligibility requirements for testing. To address this, Albany County established a public webpage with testing information, descriptions and expectations of the mobile testing service, and if applicable, available appointment places, dates, and times. In addition, Whitney Young incorporated phone screenings to assess patient risk prior to testing. The County enlisted trusted voices in the community to amplify awareness of the program and overcome skepticism in historically underserved communities.

To address the challenges inherent in ensuring safety and maintaining infection control protocols, the mobile testing program utilizes appointments to manage the volume of individuals seeking testing; selects locations that can be secured and have a visible entrance and exit; uses a small number of security personnel for crowd control; and provides necessary personal protective equipment for staff. The program continues to adapt as winter arrived in Upstate New York, identifying large indoor facilities with adequate ventilation, like the County Civic Center, to continue providing testing in urban areas.  

Mobile COVID-19 testing is a creative adaptation of the WOW van mobile preventive care service offered by Whitney Young.  Use of mobile services to respond to underserved communities is an evidence-based practice described in public health literature, including:

Mobile immunization service staffed by nursing students operating in Philadelphia to deliver immunizations to young, at-risk, urban children - McNeal, G. J. (1996, May-June). Mobile health for those at risk. N & HC: Perspectives on Community, 17(3),134+. https://link.gale.com/apps/doc/A19029138/AONE?u=nysl_ca_nyempire&sid=AONE&xid=dbc7def2)

Albany County has been at the vanguard of establishing and participating in community coalitions to advance policy, systems, and environmental strategies for improving the health of its citizens with particular focus on disadvantaged communities.  

The goals of the mobile COVID-19 testing program are to operate an FQHC-managed, free mobile COVID-19 testing unit; foster community involvement in the location(s) of mobile COVID-19 testing and the referral process; provide culturally and linguistically sensitive health education specific to COVID-19; and identify individuals at risk for COVID-19.

To achieve these goals, the following steps were taken:

1.       To operate a federal qualified health center-managed, free mobile COVID-19 testing unit, Albany County collaborated with Whitney Young to use the WOW Van for provision of COVID-19 testing. Albany County covered expenses for persons without health insurance.

2.       To foster community involvement in the location(s) of mobile COVID-19 testing and the referral process, ACDOH consulted with community- and faith-based organizations, employers, healthcare systems and providers, policy makers, and others regarding the location(s) and design of mobile COVID-19 testing services.

3.       To provide culturally and linguistically sensitive health education specific to COVID-19, Whitney Young employs culturally diverse support staff and uses interpreters and a dedicated Language Line.

4.       To identify individuals at risk for COVID-19, pre-registration, including requisite screening questions, are used to schedule appointments for persons eligible for testing.

Community partners were involved in the planning process in multiple ways. Albany County (including ACDOH) identified mobile testing sites and planned COVID-19 testing publicity on the county webpage and other community facing locations. The City of Albany, including the Albany Housing Authority, promoted the importance of COVID-19 testing to control the spread of the virus. Whitney Young established pre-registration and screening protocols and identified resources required including staff, equipment, and select supplies. Additional community partners provided funding, personal protective equipment, testing locations, and community outreach.  

Community partners continue to collaborate in the implementation process. Albany County (including ACDOH) provides personal protective equipment for staff administering COVID-19 testing at the mobile testing sites; and coordinates COVID-19 testing publicity on the county webpage and via the County Executive’s regular press conferences. The City of Albany provides security at the mobile testing sites. Whitney Young operates the mobile COVID-19 testing site including providing staff, equipment, select supplies, and laboratory coordination.

ACDOH serves as a Chief Health Strategist by enhancing the use of information technology, implementing transformative partnerships, aligning resources, integrating evidence-based practices, advancing preventive aspects of clinical medicine to address the root causes of disease and disability and improve population health. ACDOH ensures compliance with Public Health Law and Sanitary Codes of New York State and Albany County and directly provides Family Health, Communicable Disease Control, Chronic Disease Prevention, Community Health Assessments and Community Health Improvement Plans, Environmental Health, and Public Health Emergency Preparedness services.

ACDOH is recognized as a local leader in establishing and sustaining cross-disciplinary partnerships to improve community health. ACDOH is a founding member of the Healthy Capital District Initiative (HCDI), a coalition of local health departments, hospitals, FQHCs, and insurers established to identify and address compelling health needs in the Capital Region. ACDOH was a recipient of the University of Wisconsin Population Health Institute’s Roadmaps to Health Coaching which assisted in ACDOH advancing community-based collaborations. ACDOH collaborates with unique partners at the neighborhood-level and in non-health sectors as exemplified in the Municipalities on the Move: Complete Streets Collaboration initiative (NACCHO 2018 Model Practice Program). ACDOH credibility and existing relationships with community stakeholders are instrumental in the success of the COVID-19 mobile testing initiative.

Several new partnerships have been cultivated throughout the process and directly contribute to the successful implementation of the mobile COVID testing program. Health insurers such as MVP Healthcare and philanthropies such as the Capital Region Community COVID-19 Response Fund provide financial support by underwriting mobile COVID-19 testing services. Private businesses, such as the South End Children’s Café, are providing meals for WOW staff during mobile testing site operations. The cities of Cohoes and Watervliet, and the town of Coeymans, are actively coordinating the expansion of mobile COVID-19 testing services to additional disadvantaged communities across Albany County.

Health equity was directly integrated into the COVID-19 mobile testing service through essential strategic partnerships. Several city and county coalitions, as well as academic partners, are engaged and provide insight in the following areas:

·         The Albany County Equity Agenda involves identifying and addressing the underlying causes of inequity related to service provision and workforce representation within the county.

·         The Albany County Strategic Alliance for Health is a coalition of stakeholders committed to chronic disease prevention and equity.

·         The City of Albany Equity Agenda focuses on achieving equity across all communities and ending the injustices caused by institutional and systemic racism and discrimination.

·         The State University of New York at Albany, Center for the Elimination of Minority Health Disparities, investigates policies and programs that reduce health disparities; trains researchers for health disparities work; improves communications with minority communities; and strengthens the cultural competence of health care providers.

The Collective Impact model provided a framework with demonstrated success for implementing the innovative mobile COVID-19 testing program while addressing health equity issues. ACDOH attributes success in this multi-strategic initiative to partnering with community organizations with shared values and goals; applying mutually reinforcing strategies that foster shared use of resources, skills and expertise; and maintaining ongoing open communication about challenges, successes and each organization’s role in the program.  

Regular conference calls facilitated communications about program challenges and successes; promoted a closer working relationship between ACDOH and Whitney Young; and contributed to shifting resources and efforts to improve mobile COVID-19 testing operations.

Resources were quickly reallocated in instances where few people pre-registered for select days and times to maintain and improve the value of the program by modifying the testing schedule and utilizing stakeholders to promote the program through various media outlets.

The County (and ACDOH) reviewed preliminary recommendations of the Final Report on the City of Albany’s COVID-19 Response Among Communities of Color (e.g., barriers to COVID-19 testing, enhanced outreach and education on the importance of testing) and used it as an opportunity to redouble their efforts by further expanding of mobile COVID-19 testing sites, dates, times, and focused media campaign on the importance of COVID-19 testing.[i]

The adaptability of the mobile COVID-19 testing program became ever more apparent following public demonstrations in support of racial justice in June 2020. The WOW van became a critical testing resource to persons potentially exposed to COVID-19 during these demonstrations, including first responders. For several days following the protests, the mobile testing sites expanded beyond their standard appointment based system and allowed anyone who attended the demonstrations to walk up and get tested at no charge.

To successfully implement new public health practices, such as mobile COVID-19 testing in disadvantaged neighborhoods, it is important to set realistic expectations and to be innovative, flexible, and diligent in meeting the evolving health needs of local communities. It is imperative to invest the time necessary to build relationships and understand each organization’s or community’s concerns, and to establish a process for adopting new approaches based on those concerns such as alternative locations or cost-sharing waivers for uninsured or underinsured individuals. Partners must identify multiple champions within coalitions and various levels of an organization, including chief elected officials, nurses, or public safety personnel, to create layers of support to meet the shared vision. Most importantly, clear communication with partners is critical to build support, generate ongoing intrinsic motivation, and facilitate sharing of successes and challenges.

Mobile COVID-19 testing demonstrates an innovative means of providing equitable services to disadvantaged communities. It is a model that is expected to be a key and meaningful tool in providing COVID-19 vaccination to underserved areas of Albany County.