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I’m about as far from a public health official as one can get; I have no medical, health, or policy education or training. However, I consider myself observant and always curious. After a six-hour wait at an urgent care clinic in metro Atlanta the day after Christmas, I’ve got some questions for public health officials, the current administration, and the politicians setting Covid policy and directives.
I arrived at the local urgent care 35 minutes before opening. Not exactly how I wanted to spend a morning (and afternoon) of our holiday trip back east to visit family, but I felt crummy enough to justify a visit and mostly wanted to rule out strep throat. The line wrapped around the building at this point, but I was moderately optimistic hoping to see it move quickly and half expecting a triaging of patients based on need.
Move quickly it did not.
Nearly three hours passed before I made it into the building to check in and this left plenty of time to eavesdrop on the conversations in front of and behind me. I was in no condition for small talk myself, as my cough and little-to-no-voice necessitated mostly silence. After a couple of hours, I gathered that essentially all the individuals near me in line were there for a Covid test. Most were asymptomatic and getting a test “to be safe” (their words) or in preparation for travel. The family of seven a few spaces ahead were driving to Chicago the following day and getting tested “just in case” (their words).
Still, I was hopeful. I figured once I checked in and asked for a strep test, I’d be placed in a different queue outside of the Covid testing.
I was told to come back an hour and a half later to be seen (a wait that ultimately doubled). I inquired as to whether they were triaging based on need and while the clinic worker was kind, the answer was “no.” She mentioned they were short-staffed and said they’re seeing patients as quickly as possible (I believed her on both accounts). She seemed to take pity on my sickly self, but rules are rules.
Post-visit and after a conversation with my working nurse sister, I learned this is standard for urgent care clinics — they do not triage, they simply see patients in the order they arrive. Perhaps this worked pre-Covid, but it clearly does not work post-Covid, or at least not right now.
And really, my frustration wasn’t so much with the wait itself but the reason for the wait. I’d venture to guess nearly 90% of those in line were asymptomatic and there for Covid testing. Some for exposure (two ladies behind me, both, admittedly asymptomatic), others for travel (multiple families ahead of me, at least three of which were traveling domestically), and finally, the “just to be safe” contingent. I should note, I counted one woman who coughed and sneezed occasionally and one man in the waiting room who was also coughing, but again, the vast majority of those in line appeared to be there for Covid testing only.
After an hour or so nap in the car later, I returned to the waiting room. As the line outside the clinic dwindled, I sat close to the front desk in a lone chair away from the rest of the waiting area. Not long after, the clinic staff began turning away walk-ins and informed patient after patient that they were booked for the rest of the day — for Covid testing or otherwise. They were welcome to come back and get in line at 7 a.m. the next day, or, to the few who asked questions because they were sick, they were told to go to the emergency room. At this point, it wasn’t even noon.
To be clear, this is not a critique of this specific urgent care or the staff. And more broadly, I realize and appreciate the effort of the hundreds of thousands of frontline healthcare workers across the country who have been slammed since the start of the pandemic. They’re doing the best they can with what they’re given and within the policies set by the powers that be.
But how is it, nearly two years into this thing, we are failing spectacularly in ways even I can see?
By definition, urgent care clinics are intended to provide care for illnesses or injuries requiring prompt attention but are typically not serious enough to require the services of an emergency room. So why are they allowing nearly all available times to be taken by people testing “just in case” or for travel? Why aren’t those people redirected to dedicated Covid testing sites? Or at a minimum, why aren’t urgent care clinics staffed appropriately to handle those in need of urgent care as well those wanting a Covid test?
Six hours in line was merely an inconvenience for me, but one can gather this poses a greater challenge to single parents with two kids working an hourly retail job with no available childcare.
Clinics aside, why aren’t affordable at-home Covid tests readily available and handed out like candy to anyone and everyone who wants one? Two at-home rapid tests from CVS will run you close to $25. This is cost-prohibitive for many, especially as Omicron makes its rounds resulting in increased exposures leading the cautious to test more frequently. Availability and testing programs likely vary by state, but it seems if you’re traveling and need a negative test to make it to your destination or want one because of believed exposure, this is a different type of need and testing and should be categorized as such.
In fact, back in October, a group of COVID-19 testing experts presented a strategy to the Biden administration for “overhauling America’s approach to testing.” The plan called for getting rapid at-home tests in the hands of Americans and a major ramp-up of manufacturing capacity to produce 732 million tests per month.
The plan went nowhere.
And yet, just last week, in an interview with David Muir of ABC News, Biden said that he wishes he had ordered 500 million free, at-home Covid tests two months ago.
Does he though? He had the opportunity back in October and instead did nothing.
And in November, White House press secretary Jen Psaki mocked the idea that the government should send Americans free Covid tests.
The administration did announce plans to order 500 million at-home test kits and better late than never, but to how many levels of incompetence and failure must we be subject?
It seems we’re losing sight of the forest through the trees with this end-all-be-all focus on vaccinations.
Finally, as more and more doctors publicly state the obvious, this last point cannot be stressed enough. Covid, as a virus, is here to stay. We’re approaching the end of the pandemic and entering an endemic as the virus mutates down and population immunity increases. This is good news.
Marty Makary, MD, in a piece for the New York Post asks, “Why are we closing society and destroying the economy for 300 million Americans who are at risk only of a mild common-cold illness?
It’s not a question of whether you’ll be exposed and infected, but a matter of when. Vaccines and boosters are readily available and at this point, the public discourse and acceptance around individual risk assessment and informed medical decisions need to shift.
At this point, the laboratory and epidemiological data show the Omicron strain results in a milder illness and the vast majority of Omicron-infected people get common-cold symptoms. Better yet, we’re seeing the inverse of what we saw with previous waves, a continuing decline in death rates, despite a rapid increase in the number of cases.
So why does it seem that such a large percentage of the population is genuinely terrified of what is now amounting to the common cold?
And all this being the case, wouldn’t it make sense to distinguish between the asymptomatic, mildly symptomatic, and very sick when treating? My educated guess is that urgent care clinics are among the first line of resources for the sick. Policy and directives focused on a tiered and targeted approach to handling the virus seem prudent. Asymptomatic? Test at home if you must. Mildly symptomatic? Stay home until you feel better. Immune compromised or have high-risk factors? Get yourself to a doctor, or at a minimum, monitor symptoms closely and keep your doctor in the loop.
Public health officials, the Biden administration, and politicians setting policy around masks, vaccinations, and Covid generally must be held accountable for answering these questions and for the overarching narrative surrounding the pandemic. And more importantly, it is time to face the unintended consequences of senseless Covid policies on an individual level and on our healthcare system generally.Published in