Broome County is located in the Southern Tier Region of New York with a population of 190,488 as of July 2019. The county population is 82.7% non-Hispanic white, 6.4% black, 4.4% Asian, 4.4% Hispanic or Latino, 0.3% American Indian or Alaskan Native, and 0.1% Native Hawaiian or other Pacific Islander. In 2018, 17.3% of the population lived in poverty (1).

During the COVID-19 pandemic, the Broome County Department of Health (BCDOH) identified access to COVID-19 testing as a significant issue in their community. After receiving 10 Abbott Rapid Testing Machines from the New York State Department of Health (NYSDOH), which can produce results in 15 minutes, the BCDOH started a mobile testing site to expand COVID-19 testing to underserved areas and areas with high COVID-19 positivity. Increasing testing access not only reduces health disparities, but also improves the ability to control the spread of COVID-19 by identifying and isolating more cases of COVID-19 and tracing their contacts.

The mobile testing site started the week of October 5th, 2020 and is primarily staffed by Emergency Medical Service (EMS) personnel. When patients, who must be symptomatic, arrive at the site they register or check-in before receiving a nasopharyngeal swab by a staff person, after which patient samples are analyzed using the Abbott Machines in a bus, which has been retrofitted into a laboratory. After lab results are ready, patients are given a written print out of their results, and if a patient is positive they are also given an educational handout and the BCDOH follows up with them later to ensure they are isolating correctly and to contact trace. All testing is free at the site. The site uses a personal ID number for each patient and a lab “buddy” system to ensure that confidentiality is maintained and all results are given to the correct patient. Registration, lab orders, tests, and results are all recorded using a data system created in RedCap.

As of December 14th, 2020, 6,174 tests had been given at the mobile testing clinic, with an overall positivity rate of 11%. About half of patients so far have been walk-ins and half were pre-registered. Among patients served to date, 90.5% were white, 4.5% black, 0.3% American Indian or Alaskan Native, 2.4% Asian, 0.1% Hawaiian or Pacific Islander, and 2.2% were another or unknown race.

This project has been successful due to the knowledgeable team working with the BCDOH from all different areas of Broome County Government. Dr. Chris Ryan, BCDOH’s lab director and epidemiologist, acts as the senior advisor to the operation and is the ordering physician for all tests that are performed. The Office of Emergency Services provides oversight on the entire operation and has supplied staff, resources, generators, light towers, and management. Broome County Transit provided the bus that the lab is in and help clean and secure the site every night. Additionally, many churches and businesses throughout the county have allowed the testing site to be hosted on their property.

 1 https://www.census.gov/quickfacts/broomecountynewyork

The Broome County Department of Health’s (BCDOH) mobile testing site was conceived as a way to increase testing access in the county. In Broome County, the two hospitals who perform COVID-19 testing and the state sponsored specimen collection site are all located on a single mile stretch of road in the city of Binghamton, the county’s largest city, making them inaccessible to many due to travel and time constraints. Additionally, prior to the Broome County mobile testing site, much of the testing resources in the county required a vehicle for “drive-through” testing. This created a barrier to testing access for citizens who do not own a vehicle.

To make the mobile testing site a reality, newly developed Abbott Rapid Tests (both the Abbott ID Now and Abbott BinaxNOW tests) were used to quickly analyze patient samples and provide results. Rapid COVID-19 testing provides several advantages. One such advantage is reduced wait time for results. With the standard PCR test, which was the only COVID-19 diagnostic test widely available during the first months of the COVID-19 pandemic and is still considered the most reliable, results can sometimes take up to a week to receive due to laboratory backlog. With quick results, a positive case can be immediately put into isolation to stop them from spreading COVID-19 to friends, family, and other community members. Another advantage is quicker contact tracing. Quickly notifying close contacts of cases that they may have been infected with COVID-19 and to quarantine prevents further spread of disease. The longer it takes to contact trace, the less effective it is in preventing disease spread.

The mobile testing site was initially located in west Binghamton to identify more cases from a large COVID-19 cluster and to mitigate further spread. Since then, the site has moved to other parts of the county where high numbers of positive cases reside and where citizens do not have immediate access to other testing resources. Additionally, with the help of maps created by the Binghamton University Geography Department, the BCDOH prioritizes placing the site in census tracts where household vehicle ownership is low. To ensure that testing is accessible to everyone, regardless of insurance coverage, all testing done at the site is free. As of December 16th, 2.7% of all COVID-19 tests given in Broome County were positive, while the positivity rate of the BCDOH mobile testing site is about 11%. This shows that BCDOH has successfully targeted areas at higher risk for COVID-19 in their community.

To make the idea of a mobile testing site a reality, BCDOH had to redistribute some staff, skills, and technology. One of the key issues was developing a data management system that would allow BCDOH to easily and efficiently register patients, order tests, enter results and provide them to the correct patients, upload results easily and reliably into ECLRS (the New York State communicable disease reporting system that all COVID-19 test results are required to be reported to), and monitor site operations in real time. Dr. Chris Ryan of the BCDOH works as the Senior Advisor to the project and he helped develop this data system in RedCap. He also maintains the data for the site along with county IT staff. Without a knowledgeable data team, this project would not be as beneficial and seamlessly operated as it has been. Additionally, BCDOH staff were used early on in the establishment of the mobile testing site to swab patients and establish efficient protocols for the site; they taught these protocols to emergency medical service (EMS) staff later brought to work at the site to keep operations running smoothly.

The mobile testing site successfully utilized newly developed Abbott rapid tests to increase testing access in Broome County. While mobile health clinics are not a new invention, having been used in many cities, counties, and jurisdictions to increase access to healthcare services in underserved communities, BCDOH successfully combined the idea of a mobile testing clinic with new technology and a comprehensive, newly developed data system to create an innovate solution to a specific need in their community - testing access.

In October 2020, the Broome County Department of Health (BCDOH) created a mobile testing site to bring COVID-19 testing to underserved communities in their county. In order to establish this site and keep it running, the BCDOH has had assistance from community and State partners in planning and implementation.

To set up the testing site, BCDOH received assistance from the New York State Department of Health (NYSDOH), local churches and businesses, and Broome County Transit. The NYSDOH provided 10 Abbott Rapid Testing Machines to the BCDOH, who used these machines at the mobile testing site to provide quick test results to patients. Since operations began in October 2020, the testing site has worked with churches and businesses throughout Broome County to find spots where the testing site can park and set up. The site was initially parked at St. Patrick’s Church in Binghamton, who provided a tent where registration, check-in, swabbing, and result stations are set up. This tent allows the site to operate in rainy and snowy weather.

Throughout the actual implementation of the testing site, it has been primarily staffed by Broome County Emergency Medical Technicians (EMTs), and county IT staff help with data management. Site logistics are supported by Broome County’s Emergency Operations Center (EOC) Logistics Section. The Logistics Section Chief coordinates with the testing site manager to ensure site operations are running smoothly. The testing site is promoted to Broome County residents through BCDOH's partnerships with the Broome County Executive’s office and media contacts. The Broome County Public Information Officer informs the public of locations and times the testing site is available every week through traditional media and social media.

One of the most important partnerships that contributed to the success of this project is with Broome County Transit. They provided the bus used by BCDOH for the mobile testing site and retrofitted the bus into a laboratory by taking out seats; putting in temporary walls, internet, a phone connection, and power; and providing battery backups for an uninterrupted power supply. Broome County Transit also comes to the testing site every night to help clean the bus, take down light towers, and refuel the bus. BCDOH said that this new partnership with Broome County Transit is vital to the success of the operation.

This project also relies heavily on collaboration with community stakeholders – specifically churches and businesses in Broome County’s underserved communities who allow the mobile testing site to be set up on their property. Which businesses and churches to operate the testing site from are decided based on areas with high populations of positive cases, lack of other testing resources, and low vehicle ownership. Other logistical considerations include locations near a structure to have staff restroom facilities and an area for staff breaks, minimal weekday traffic for other businesses, adequate space, and access to major roadways. These partnerships allow BCDOH to bring COVID-19 testing to areas in Broome County with the greatest need.

Throughout the course of their mobile testing site’s operations, the Broome County Department of Health (BCDOH) has made several changes to improve the site’s workflow, meet their community’s changing needs, and ensure the site can operate safely and comfortably in the winter months. When the testing site was first set up, people could register for a testing slot by pre-booking an appointment or walking-in and registering with front desk staff. Since then, an additional registration source has been added. Now patients can scan a QR code with their phone to register for a testing slot. This reduces time spent in the registration line and makes social distancing easier to maintain at the testing site.

Staff from the BCDOH and other county agencies have been redeployed to help manage the testing site. BCDOH employees initially set up the site and established protocols. Emergency Medical Technicians (EMTs) were brought on and learned how to run the site from BCDOH employees, which they have been doing smoothly since. County IT staff help maintain the data from the site and upload test results into ECLRS, New York State’s communicable disease reporting system, nightly. 

Throughout the testing site's operation, BCDOH has moved the site to areas with high positivity rates and limited access to other COVID-19 testing resources. This allows the BCDOH to meet the needs of their community as COVID-19 surges occur in different areas of the county. In October, Governor Cuomo announced his new micro-cluster strategy, which designates certain areas of the state as yellow, orange, or red zones based on COVID-19 percent positivity and enacts certain restrictions in those areas including closing businesses, limiting gathering sizes, and in yellow zones, requiring schools to test 20% of their in-person school population weekly to remain open. When part of Broome County was designated as a yellow zone, in order to help a small private school in the county, who otherwise didn’t have the resources to complete testing remain open, the BCDOH mobile testing site was used to the test 20% of their in-person school population. This enabled the school to stay open and kept kids in school.

While the testing site initially used tents to protect patients and staff from inclement weather, those tents would not have been sufficient to withstand winter weather. However, moving the testing site indoors was not optimal given the increased risk of COVID-19 spread in indoor areas. In order to allow the testing site to continue to safely operate during the winter, the Broome County Office of Emergency Services (OES) purchased a large, enclosed tent with an air filtration and HVAC system so the testing site is now in a heated area with proper air filtration to keep staff and patients safe and comfortable. 

This project has had a significant public health impact on the most underserved communities in Broome County by bringing COVID-19 testing to residents who otherwise do not have easy access, either due to lack of a primary care provider or health insurance and/or limited time or ability to go to one of the county’s free testing sites in Binghamton. Due to the mobile testing site, BCDOH has been able to identify more cases of COVID-19 in their community, isolate those cases, trace and quarantine their contacts, and therefore mitigate community spread of COVID-19 in some of their most vulnerable populations.

From this practice, the BCDOH has learned more about the importance of emergency preparedness and flexibility of staff roles both at the department of health and other county agencies. In the future, this model could be used as a mobile vaccine administration site in underserved areas where residents might not have easy access to vaccine in other ways.