Located in Central Kentucky, Frankfort/Franklin County are home to the state Capitol; Franklin County Health Department (FCHD); and 207.75 square miles of mostly rural area and farmland. With a population of approximately 50,991, the majority of residents are white, non-Hispanic females, 84.4% and 51.7%, respectively. The other ethnic and racial breakdown of the population includes: African American (10.6%); Hispanic (3.6%); Two or More Races (2.5%); Asian (2.1%); and American Indian/Alaska Native (0.4%).

In December 2019, the novel coronavirus (COVID-19) was first discovered in Wuhan, China. Quickly, it spread and became a worldwide pandemic. In response to mitigation and response, mass community testing become a priority. The purpose of the COVID-19 Drive Thru Testing Sites was to test possible COVID-19 positive cases on a large scale all while ensuring the community’s and employee’s health and safety with minimal contact. In addition, it addressed convenience, cost, safety, and transportation barriers; as well as provided diagnostic testing opportunities for both asymptomatic and symptomatic community members.

The goals and objectives of this practice were to: (1) Test individuals for COVID-19 in a safe, reliable, and efficient manner; and (2) Help slow the spread of the disease through contract tracing, testing, and mitigation. Also, the drive thru events were held on-site at FCHD’s Public Health Center and off-site in various locations. This provided testing services for at risk/vulnerable populations to help reduce any inequities.

In the past, FCHD has utilized drive thru set-ups with the administration of the seasonal flu vaccine, H1N1 vaccine, and Hepatitis A vaccine with great success. Since April 2020, FCHD has adapted these set ups to address the specific needs of the COVID-19 pandemic. The initial testing drive thru was held Friday, April 17 off-site at Lakeview Park. This event tested 42 participants and helped guide subsequent events, including (1) Evaluating all testing locations (on and off site) for ability to handle large amounts of foot and vehicular traffic; (2) Increase time allotted for advertising, coordination, and registration; and (3) provide testing in areas with known health inequities.

The following factors have led to the success of the practice: • Use of previous experience/template • All hands-on deck approach with FCHD staff • Community Partner Collaboration • Continuous Quality Improvement • Technological Approaches with Registration and Scheduling; Data Input; and Test Result Notification • Mobile Drive Thru Events

These drive thru testing events helped to reduce health inequities by: • Online or Phone Registration • Interpreter present at all events • Mobile (off-site) testing events in vulnerable neighborhoods • Emergency Preparedness Coordinator placed flyers in key locations and had safe, socially distant conversations to promote mobile clinics • Local pastor of predominately Black congregation was tested at mobile clinic to help build trust with neighborhood members.

As we continue to improve our events, as a public health facility, FCHD has been able to test a mass number of people; practice for future mass vaccination distribution; help control the spread of COVID-19; and keep our community educated during a constantly changing situation.

2020 has become the year of COVID-19. Within weeks of discovery in Wuhan, China; the disease quickly became a worldwide pandemic. As a response to the increasingly alarming public health problem, testing became a priority. Beginning in April 2020, FCHD began to implement COVID-19 Testing Drive Thru Clinics to community members. Using an existing Emergency Preparedness Template (previously used for seasonal flu, H1N1, and Hepatitis A vaccinations); FCHD was able to provide free, safe, and efficient COVID-19 diagnostic testing for both asymptomatic and symptomatic residents. Over the past 8 months, FCHD has held a total of 23 clinics testing approximately 1774 participants. In order to target underserved populations, three mobile drive thru testing events were held in different locations previously identified as underserved. This met at risk individuals, particularly those facing disparities where they are. These free mobile clinics were offered as drive thru events, but also provided walk up options. The purpose of targeted events was not only to provide safe testing opportunities, but to also help reduce cost, scheduling, and transportation barriers experienced within these populations. In addition to the mobile clinics, FCHD established additional steps to ensure all residents were provided the same testing experience despite varying needs. For examples, interpreters were available on site at all clinics; English and Spanish education materials were provided; and large visual testing “how-to” signs were posted for those who were hearing impaired as well as though needing further assistance.

Although the purpose of the drive thru clinics was to provide mass COVID-19 testing opportunities, it was also used to address health equity issues. It is widely known that this pandemic has affected the health and stability of certain population more than others, but it has also exacerbated the inequities faced by these areas. FCHD worked diligently both internally and with community partners to reduce any barriers that may limit COVID-19 testing
accessibility. It was decided that the most limiting potential barriers that could arise throughout the process were: cost, language, registration, and transportation. In response to these challenges, FCHD initiated and implemented free testing; provided interpreter services at all events; provided both phone and online registration; and held mobile testing clinics.
The emergence of COVID-19 allowed for the adaptation of an existing drive thru event template that FCHD had previously used on multiple occasions. This template was adapted to meet the unique needs of mass COVID-19 testing. In addition, it provided the practice needed for future COVID-19 vaccination distribution. For example, the health and safety of all employees was even more of a priority. Since this disease has been shown to be both extremely contagious and dangerous, it was essential that staff had access to a large supply of personal protective equipment (PPE) stocked and available at all times. Furthermore, due to the changing weather conditions throughout the year; tents, heaters, hand warmers, etc. were available to staff. Due to the serious manner of the pandemic and how it has affected certain populations, the template had to be further adapted in order to provide mobile clinics. For these mobile type clinics to be successful and run efficiently, multiple trucks and trailers were needed to transport all equipment (tents, traffic cones, chairs, generators, heaters, PPE, computers, signs, etc.) were needed. All available staff were used to pack, unload, and set up for these events. Each location had different spacing available, therefore, staff worked together to help the clinics run smoothly from start to finish. Since COVID-19 testing would need to be available in large numbers, it was vital to make registration and scheduling as easy as possible. Initially, FCHD used Google Docs but then transferred registration to Acuity Scheduling to streamline the process. Due to the nature of COVID 19 testing, participants were to be notified of results within 48-72 hours of the test. This required the use of staff to make multiple phone calls, but as events progressed, a notification text system was implemented to alert those whose results were negative.

As with other local health departments (LHDs) nationwide, FCHD had to make COVID-19 the priority of all daily operations. These clinics became an essential practice. To adapt to the emergence of COVID-19, staff duties were shifted, various services halted, and COVID-19 became an all “hands-on” deck approach. Every department was affected and staff were forced to work outside comfort zones. For example, since schools were shut down to in-person learning in March, our School Health nurses became the backbone of our response operations. These nurses (along with clinic nurses) were the main testers at each event and lead contact tracers as the pandemic worsened. Additionally, our IT department took on an even larger role. It became a full-time job to monitor Facebook and www.fchd.org for questions and comments related to the pandemic; as well as regular postings to update the community on testing events. Throughout this process; scheduling, data input, and result follow up has undergone continuous quality improvement. To make the process more efficient, FCHD changed scheduling platforms. Acuity Scheduling allowed staff to keep track of patients through all steps of the testing event. A major IT change was making data input quicker and more efficient. All testing specimens were sent to Gravity Diagnostics in Northern Kentucky. For this process to
work, identifying information for each patient and specimen had to be entered manually into the data portal. Over the course of the drive thru events, this was adapted to help consolidate the process. All participants who reported no symptoms were entered via an Excel spreadsheet at the end of each event. Only patients who reported symptoms were entered manually by testing administration support staff.

Local at-risk and vulnerable populations have experienced increased adversity due to the pandemic. To respond to these issues, all clinics were provided free of charge. The mobile clinics helped reduce transportation barriers. Also, to promote hygiene practices, masks and hand sanitizer was provided to all participants. This practice also helped overcome the mask and hand sanitizer shortage experienced in our community.

The purpose of the COVID-19 Testing Drive Thru Events were to: (1) conduct a safe and functional testing event; (2) test possible patients; and (3) use tests to help determine the spread of COVID-19 within the community. To help ensure these goals were met, FCHD held 23 testing events for members of the community. Both individuals with symptoms and those with no symptoms were able to test safely through this practice. Patients were asked to remain inside their cars, only rolling down their windows halfway down in order to receive the test. This provided adequate space for nurses (in full PPE) to perform the test. Once testing was concluded, participants were asked to self-isolate until receiving their results within in the following 48-72 hours. FCHD’s strong partnerships with local organizations was essential during these clinics. Frankfort/Franklin County Emergency Management, Franklin County Sheriff’s Office, and Frankfort Police Department were vital in both the planning and implementation of this practice. Each of these entities, along with the Kentucky State Police and Frankfort Street Department were crucial partnerships in ensuring the safety of participants and staff. These partnerships helped develop safe and efficient traffic protocols.

Before the COVID-19 pandemic, FCHD was no stranger to strong community partnerships. In 2008, FCHD and other community organizations came together to form the local Mobilizing for Action through Planning and Partnership (MAPP) Coalition. MAPP was formed to assess the strengths and needs of Frankfort and Franklin County and then helped address all identified concerns. The vision of the MAPP coalition is to become a community that fosters a healthy lifestyle for all. Now in its third iteration, MAPP consists of over 85 partner organizations, many of which have helped ensure the success of the testing drive thru process. Whether it was through safety or traffic protocols; street closures; or helping provide equipment FCHD relied on partnerships to help provide the best available services to our community members. One of the positives to emerge from this pandemic, is the new unexpected and unconventional partnerships. These partnerships provided innovative support and resources that not only help benefit the success of each event, but also contributed to the essential process of keeping our community healthy and safe. Some of those partnerships included:

• Castle and Key, Buffalo Trace, Jim Beam, and other local Distilleries: These distilleries shifted from whisky and bourbon production to making and supplying hand sanitizer to first responders and health care professionals. These entities donated hand sanitizer to FCHD, which was then distributed to the community throughout the testing events. • State Representative Joe Graviss: Donated hand sanitizer from Jim Beam to FCHD to be distributed to the public. • Kiwanis Club of Frankfort; FCHD HANDS Program; Community Members: Made adult and child face masks that were then donated to FCHD to distribute to the community. • Lakeview Park; Dolly Graham Park; Thorn Hill Learning Center: Allowed FCHD to use premises for mobile COVID-19 drive thru testing events. • Frankfort Plant Board (Cable 10 Channel); State Journal Newspaper: Provided screen time and newspaper space to promote drive thru events, but to also allow FCHD to keep Frankfort residents updated on the everchanging pandemic. • Frankfort Mayor Bill May; Franklin County Judge Executive Houston Wells: Helped with Drive Thru event promotion • Franklin County Sheriff’s Office; Frankfort Police Department: Traffic and Safety Management • Frankfort Fire Department: Provided heaters for testing • Kroger: Involved during initial testing event. In addition, Kroger utilized the testing plan of FCHD to test their own testing capabilities for state-wide testing.

FCHD partnered with Dolly Graham Park, Lakeview Park, and Thorn Hill Learning Center to provide mobile testing clinics. These three locations are within neighborhoods identified as having health disparities and inequities. By providing these clinics, FCHD was able to provide free testing to individuals who may otherwise not have the opportunity.

As with any event or practice, there is always room for growth and improvement. Some key improvements that were made throughout all testing events included:

• Due to the need to communicate within the whole testing site from point 1 to point 3, hand held radios were supplied to FCHD staff on the day of event. • To aid in paperwork and specimen identification, labels with identifying information for each participant were printed from the schedule the day before the event • Initially, patient registration and scheduling were completed using Google Docs. However, in order to make the process more efficient and organized, the decision was made to switch to the Acuity Scheduling platform. • Increased number of lanes for better traffic flow but also for larger testing capacity • Increased or decreased FCHD event staffing depending on the testing event capacity limit. • Improved data input system to help make it quicker and more efficient. • Changed from alerting patients of results by phone after the events, to developing a texting system to alert all negative patients in one mass text. All positive patients continued to be alerted by phone calls. • Translators were on site at each drive thru event • Large visual signage of testing procedures and protocols were visible at all stages of the drive thru process for those who were either hearing impaired or needed further assistance. • Time studies were conducted at each drive thru testing event to evaluate efficiency of all processes.

To meet the needs of the growing pandemic, FCHD staff were split into two groups. One group was mainly responsible for the necessities of the testing events, contact tracing, and updates to the public. The other group of staff attempted to maintain the altered services of the health department. However, at some point during 2020, each staff member has worked in multiple areas and provided COVID-19 information. In addition, our IT/Marketing department not only monitored and updated our website and Facebook page for COVID-19 education and changes, but also took the lead in promoting testing events and registration. Through www.fchd.org and Acuity Scheduling, community members were able to register the Friday prior to each event to allow for equal and timely access to testing opportunities. The IT department was vital in making the registration and data input processes productive and successful.

Once the COVID-19 pandemic is over, this drive thru template will have been used for testing and mass vaccination purposes. These events can be further used for future flu vaccines and any additional pandemics. This pandemic has shown us how quickly FCHD can become the response center in time of emergency, as well as mobilize and utilize partnerships and resources. Even though there have been kinks and changes to work through, we have learned through these events what works, what is possible, and what is out of the scale of adaptability. On a public health impact scale, the COVID-19 testing drive thru events have shown that in case of a pandemic or widespread event, public health is more than just a local health department. With the utilization of FCHD staff and community partners, we have been able to complete the following:

• Perform safe COVID-19 testing on a large scale • Help control the spread of COVID-19 through diagnostic testing • Notify both positive and negative COVID-19 cases, as well as contact trace on a large community wide scale • Keep community updated on constantly changing conditions • Address health inequities within our community