Prior to the SARS-CoV-2 pandemic, large-scale collection of medical laboratory specimens from patients sitting in their cars was an untried concept. That is no longer true.

As of today, residents who meet certain criteria for exposure to SARS-CoV-2—the novel coronavirus that causes the COVID-19 illness—can now have their biological specimens collected at drive-through testing centers in New York and 29 other states.

Drive-through collection of medical laboratory specimens is just one more way that the COVID-19 pandemic has changed forever how healthcare in the United States is delivered. In actual practice, drive-through sites are proving that it is possible to collect samples from large numbers of patients without needlessly exposing phlebotomists and other healthcare professionals to this new infectious agent. Another benefit is reducing the number of infected people entering hospital emergency rooms to be tested and potentially infecting everyone there.

Using a drive-through collection site does minimize exposure for phlebotomists and other frontline healthcare workers while they collect samples for testing. That is an important benefit. Yet, experience shows that in operation these centers have had mixed results.

New York State’s First Drive-through Testing Location

New Rochelle, New York—one of the hotspots of the COVID-19 infection—opened the state’s first drive-through testing facility on March 13, 2020. At the time it opened, the center was one of only 10 in the country.

During the center’s first four days, 1,882 people were tested, reported the New York Times (NYT). Every one of those people met the following criteria to be tested at the drive-through center or at any other testing center in NY:

  • Patients must have qualifying symptoms, such as a fever and cough, or be a member of a high-risk population, such as the elderly or those with pre-existing conditions.
  • Patients must make an appointment either through a doctor’s referral addressed to the New York State Health Department, the entity that issues the appointment, or by calling the New York State Coronavirus hotline.

On the Coronavirus Frontlines

A CNBC article co-written by Vivian Velasquez-Caldera, a Northwell Health phlebotomist who volunteered to work at the New Rochelle drive-through testing center, titled, “I Work at a Coronavirus Drive-thru Testing Site in New York. Here’s What a 12-Hour Shift Looks Like,” described what it’s like for frontline healthcare workers during a two-week rotation at the testing center.

Velasquez-Caldera said that the site collects more than 1,000 specimens per day on average and that every three hours couriers from BioReference Laboratories pick up the samples. Testing and recording of the samples take place at a medical laboratory in Elmwood Park, N.J., and patients usually get their results in a few days.

When patients arrive at the site, they must remain in their car with the windows rolled up. New York State troopers direct cars using megaphones from a safe distance. When it is time for the nasopharyngeal swab samples to be collected, troopers direct the car into the testing zone and the passengers roll down the windows, but remain in their car. Healthcare workers in full hazmat suits approach the car and ask each passenger to tip his or her head back so that a series of nasal swabs can be taken.

“Prior to the pandemic, only nurses and doctors were allowed to do the swabbing, so I had to train for the procedure,” wrote Velasquez-Caldera. “It’s a delicate process and just one mistake could lead to test result errors.”

Pathologists and clinical laboratory professionals should note that the medical staff doing the specimen collection at the drive-through site in Long Island, NY, shown above are in full protective gear. This is not the case at typical patient service centers operated by clinical laboratories throughout the US. (Photo copyright: Andrew Seng/The New York Times.)

Protecting Healthcare’s Finest

Phlebotomists and other frontline healthcare workers collecting specimens at drive-through testing centers are putting themselves at great risk for contracting the coronavirus. In Velasquez-Caldera’s case, as in many others, these brave individuals are doing so voluntarily, so ensuring they have protective gear is critical.

Velasquez-Caldera praises Northwell Health for its efforts in supplying workers with personal protective equipment (PPE). “I wear gloves and a jumpsuit that protect my entire body, along with a powered air-purifying respirator—a special face shield equipped with a respirator that cleans contaminated air before circulating it inside the suit,” wrote Velasquez-Caldera in her CNBC article.

Vivian Velasquez-Caldera (above), a phlebotomist with Northwell Health Labs, is shown at the drive-through COVID-19 testing site at Glen Island Park in New Rochelle, New York. “Every day, I see all kinds of expressions on people’s faces. There’s a lot of fear, yes, but mostly gratitude. They all leave and say, ‘Thank you. Thank you so much for what you’re doing,’” she said in a CNBC story she co-wrote.  (Photo copyright: Northwell Health/CNBC.)

Lessons Learned at Drive-Through Centers

While the New Rochelle COVID-19 testing center has remained opened and continues to collect thousands of specimens each week, other drive-through testing centers haven’t fared as well. For example, Brooklyn opened a drive-through testing center on March 20, 2020. But just two days later, the site was closed. 

Another drive-through testing center is being operated by Katherine Shaw Bethea Hospital (KSB) in Dixon, Ill. In an article published by the American Hospital Association (AHA), titled, “Four Lessons for Hospitals Implementing COVID-19 Drive-Through Testing,” KSB describes some of the lessons the hospital has learned thus far:

  • Know the CDC guidelines thoroughly. The team at KSB used role-playing scenarios before opening the center. “Our staff was very intent on following CDC guidelines to best protect our patients and community,” said Linda Clemen, RN, VP/Chief Nursing Officer.
  • The goal is to help patients fast, not to be perfect. “We knew we were going to make mistakes—not at the cost of patient safety, but in operations—and we knew we’d figure things out as we went along,” said David Schreiner, President/CEO.
  • Find partners in the community who can help. In Dixon, KSB does the testing, but local health departments process the tests and follow up with patients.
  • Help other organizations. “We’re receiving calls from many of our colleagues around the area,” said Clemen. “We are sending each other our plans, algorithms, whatever could help them.”

Drive-through coronavirus testing is a unique approach to collecting clinical laboratory specimens from large numbers of patients without having them enter doctors’ offices or patient service centers operated by clinical laboratories. If it can help minimize the exposure of phlebotomists and other healthcare workers collecting the specimens it is worth pursuing.

—Dava Stewart

Related Information:

In Virus Hot Spot, Lining Up and Anxious at Drive-in Test Center

I Work at a Coronavirus Drive-Thru Testing Site in New York. Here’s What a 12-Hour Shift Looks Like

Staring Down the Coronavirus

Brooklyn’s First Drive-Through Coronavirus Testing Site Opens in Coney Island

Four Lessons from Hospitals Implementing COVID-19 Drive-Through Testing