key: cord-0911853-5td1ds1d
authors: Romero, Lisa; Pao, Leah Zilversmit; Clark, Hollie; Riley, Catharine; Merali, Sharifa; Park, Michael; Eggers, Carrie; Campbell, Stephanie; Bui, Cuong; Bolton, Joshua; Le, Xuan; Fanfair, Robyn Neblett; Rose, Michelle; Hinckley, Alison; Siza, Charlene
title: Health Center Testing for SARS-CoV-2 During the COVID-19 Pandemic — United States, June 5–October 2, 2020
date: 2020-12-18
journal: MMWR Morb Mortal Wkly Rep
DOI: 10.15585/mmwr.mm6950a3
sha: 15a99cf7729e06259b72becc49c9f472aeec5664
doc_id: 911853
cord_uid: 5td1ds1d

Long-standing social inequities and health disparities have resulted in increased risk for coronavirus disease 2019 (COVID-19) infection, severe illness, and death among racial and ethnic minority populations. The Health Resources and Services Administration (HRSA) Health Center Program supports nearly 1,400 health centers that provide comprehensive primary health care* to approximately 30 million patients in 13,000 service sites across the United States.† In 2019, 63% of HRSA health center patients who reported race and ethnicity identified as members of racial ethnic minority populations (1). Historically underserved communities and populations served by health centers have a need for access to important information and resources for preventing exposure to SARS-CoV-2, the virus that causes COVID-19, to testing for those at risk, and to follow-up services for those with positive test results.§ During the COVID-19 public health emergency, health centers¶ have provided and continue to provide testing and follow-up care to medically underserved populations**; these centers are capable of reaching areas disproportionately affected by the pandemic.†† HRSA administers a weekly, voluntary Health Center COVID-19 Survey§§ to track health center COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and personnel. Potential respondents can include up to 1,382 HRSA-funded health centers.¶¶ To assess health centers' capacity to reach racial and ethnic minority groups at increased risk for COVID-19 and to provide access to testing, CDC and HRSA analyzed survey data for the weeks June 5-October 2, 2020*** to describe all patients tested (3,194,838) and those who received positive SARS-CoV-2 test results (308,780) by race/ethnicity and state of residence. Among persons with known race/ethnicity who received testing (2,506,935), 36% were Hispanic/Latino (Hispanic), 38% were non-Hispanic White (White), and 20% were non-Hispanic Black (Black); among those with known race/ethnicity with positive test results, 56% were Hispanic, 24% were White, and 15% were Black. Improving health centers' ability to reach groups at increased risk for COVID-19 might reduce transmission by identifying cases and supporting contact tracing and isolation. Efforts to improve coordination of COVID-19 response-related activities between state and local public health departments and HRSA-funded health centers can increase access to testing and follow-up care for populations at increased risk for COVID-19.

data for the weeks June 5-October 2, 2020*** to describe all patients tested (3, 194, 838) and those who received positive SARS-CoV-2 test results (308,780) by race/ethnicity and state of residence. Among persons with known race/ethnicity who received testing (2, 506, 935) , 36% were Hispanic/Latino (Hispanic), 38% were non-Hispanic White (White), and 20% were non-Hispanic Black (Black); among those with known race/ethnicity with positive test results, 56% were Hispanic, 24% were White, and 15% were Black. Improving health centers' ability to reach groups at increased risk for COVID-19 might reduce transmission by identifying cases and supporting contact tracing and isolation. Efforts to improve coordination of COVID-19 response-related activities between state and local public health departments and HRSA-funded health centers can increase access to testing and follow-up care for populations at increased risk for COVID-19.

HRSA administers a weekly voluntary Health Center COVID-19 Survey to track health center COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and staff members. The 1,382 health centers asked to complete the survey are located in all 50 states, the District of Columbia (DC), and five territories and freely associated states. † † † This analysis used survey data from the weeks ending June 5-October 2, 2020, to describe the patient population and, among all patients who received testing for SARS-CoV-2 with viral tests (i.e., polymerase chain reaction and antigen tests), the numbers and proportions of persons with tests and positive results by race/ethnicity and state of residence. State survey response rates ranged from 68% to 80% among health centers. Proportions of patients receiving SARS-CoV-2 tests and positive test results included unreported race/ethnicity as a separate category.

As reported in the HRSA Uniform Data System in 2019, HRSA-funded health centers reported that 35% of their national patient population was White, 35% Hispanic, § § § 18% Black, 4% Asian, 1% American Indian/Alaska Native (AI/AN), 1% Native Hawaiian/Other Pacific Islander, and 1.3% multiracial persons; race/ethnicity was not reported for 6% of the patient population (Figure) (1). By comparison, § § § Patients who reported Hispanic/Latino ethnicity were classified as Hispanic/ Latino, regardless of race. 

0 (-) 0 (-) 0 (-) 54 (27) 0 (-) 0 (-) 0 (-) 0 (-)40 (-) 40 (-) 7 (-) 43 (-) 1,189 (13) Marshall Islands 1 0-100 121 0 (-) 0 (-) 0 (-) 1 (1) 0 (-) 0 (-) 0 (-) 0 (-)

Health centers' efforts to increase testing for SARS-CoV-2 are an important mitigation strategy to reach racial and ethnic minority groups at increased risk for COVID-19. Published state and national data indicate that racial and ethnic health centers as the denominator. The response range represents the lowest response rate and the highest response rate nationally and by state during June 5-October 2, 2020. † † Data for the number of persons receiving testing or who had positive test results are aggregated by health center before submission and cannot be deduplicated, which might inflate or misrepresent the number of patients who received testing or who had positive test results.

minority groups might be more likely to become infected with SARS-CoV-2, experience more severe COVID-19-associated illness, and have higher risk for death from COVID-19 (2-7). This study contributes to understanding current health center testing patterns and areas for improvement. Long-standing social inequalities and health disparities among racial and ethnic minority groups likely result from a multitude of factors that lead to increased risk for getting ill and dying of COVID-19, including discrimination,**** limited health care access and utilization, occupation, housing, and educational and income gaps. † † † † Further, these factors might contribute **** Discrimination, which includes racism, can lead to chronic and toxic stress and shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for COVID-19. † † † † https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/ race-ethnicity.html.

to other risk factors for severe disease and death, including limited health care access, underlying medical conditions, and higher levels of environmental exposure. The factors contributing to disparities likely vary widely within and among groups, depending on geographic location and other contextual factors. Health centers have a long-standing commitment to meeting the primary care needs of their communities (8) . HRSA has awarded funding § § § § to support health centers to purchase, administer, and expand capacity for COVID-19 testing and § § § § To date, in 2020, HRSA has awarded approximately $2 billion through three rounds of funding to health centers: 1) March 24: $100 million (https://www.hhs.gov/about/news/2020/03/24/hhs-awards-100-millionto-health-centers-for-covid-19-response.html); 2) April 8:$1.3 billion (https://www.hhs.gov/about/news/2020/04/08/hhs-awards-billion-tohealth-centers-in-historic-covid19-response.html); and 3) May 7: $583 million (https://www.hhs.gov/about/news/2020/05/07/hhs-awardsmore-than-half-billion-across-the-nation-to-expand-covid19-testing.html).

response-related activities, which has enabled health centers to maintain or increase their staffing levels, conduct training, purchase personal protective equipment, and administer tests. Health center services, including testing, contact tracing, isolation, providing health care, and aiding recovery from the impact of unintended negative consequences ¶ ¶ ¶ ¶ of mitigation strategies, have increased the capacity of health centers to reach populations at increased risk for COVID-19 as well as access to testing and care.***** A recent analysis of SARS-CoV-2 testing in a multistate network of health centers during the first weeks of the COVID-19 pandemic reported small racial differences in testing and positivity rates; however, larger differences were identified by ethnicity, preferred language, and insurance status, underscoring ¶ ¶ ¶ ¶ Potential unintended negative consequences include loss of health insurance; food, housing, and income insecurity; mental health concerns; substance use; and violence resulting from social isolation, financial stress, and anxiety. ***** https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/ cdc-strategy.html. health centers' unique position for serving racial and ethnic minority groups and addressing the ongoing need for targeted, language-concordant testing strategies (9 

What is already known about this topic?

Long-standing social inequities and health disparities have resulted in increased risk for COVID-19 infection, severe illness, and death among racial and ethnic minority populations.

What is added by this report?

Health centers have provided racial and ethnic minority populations access to SARS-CoV-2 testing. Improving health centers' ability to reach groups at increased risk for COVID-19 might reduce transmission by identifying cases and supporting contact tracing and isolation.

What are the implications for public health practice?

Efforts to improve coordination of COVID-19 response-related activities between state and local public health departments and HRSA-funded health centers can increase access to testing and follow-up care for populations at increased risk for COVID-19.

The findings in this report are subject to at least five limitations. First, the data used in this analysis are based on responses from health centers that voluntarily reported data to the Health Center COVID-19 Survey and might not be representative of all health centers in the United States, its territories, and freely associated states. Second, data represent a date range of information provided by health centers specified by weekly reporting date. Summary information across report dates is not comparable because of differences in health center responses for a given report date. Third, race and ethnicity data were missing for approximately 22% of patients who received testing and 19% of patients who had positive test results. Fourth, the reported number of patients tested each week does not fully represent the same patients included in the reported number with positive test results that week because of a lag between the date the specimen is collected and the availability of test results. Therefore, positivity cannot be inferred by dividing the number of patients who received positive test results by the number receiving testing. Finally, data for the number of persons with testing or positive results are aggregated by health centers before submission and cannot be deduplicated, which might inflate or misrepresent the number of patients receiving testing or positive test results.

Health centers are an integral component of health systems designed to address structural inequities (10) . During the COVID-19 public health emergency, health centers have played an important role in providing access to testing in communities disproportionately affected by COVID-19. Health centers' ability to reach populations at higher risk for SARS-CoV-2 infection might reduce COVID-19 transmission by identifying cases and supporting public health contact tracing and isolation among populations they serve.

Uniform Data System-National Health Center data

CDC COVID-19 Response Clinical Team. Characteristics associated with hospitalization among patients with COVID-19-metropolitan

Coronavirus disease 2019 case surveillance-United States

Characteristics and clinical outcomes of adult patients hospitalized with COVID-19-Georgia

Characteristics of persons who died with COVID-19-United States

Multidisciplinary community-based investigation of a COVID-19 outbreak among Marshallese and Hispanic/Latino communities-Benton and Washington Counties

Disproportionate incidence of COVID-19 infection, hospitalizations, and deaths among persons identifying as Hispanic or Latino

Integrating social care into the delivery of health care: moving upstream to improve the nation's health

SARS-CoV-2 testing and changes in primary care services in a multistate network of community health centers during the COVID-19 pandemic

Sentinels of inequity: examining policy requirements for equity-oriented primary healthcare

All Health Resources and Services Administration-funded health centers that completed the weekly Health Center COVID-19 Survey.Corresponding author: Lisa Romero, eon1@cdc.gov.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.