At the outset of the pandemic, testing for SARS-CoV-2 was hard to come by. Ala Stanford, MD, a pediatric surgeon in Philadelphia, saw that the testing shortage disproportionately affected the city’s Black population. In response, she started the Black Doctors COVID-19 Consortium with the aim of increasing access to testing among African Americans in the city.
Throughout the COVID-19 pandemic, the AMA is carefully compiling critical health equity resources from across the web to shine a light on the structural issues that contribute to and could exacerbate already existing inequities.
To date, the Black Doctors COVID-19 Consortium, which started offering free tests door to door, has conducted more than 20,000 tests. Dr. Stanford recently discussed her work and inequities in access to SARS-CoV-2 testing
AMA: How did this project start for you?
Dr. Stanford: I saw this article come across my phone and it said African Americans are dying from COVID in Philadelphia at a rate higher than any other group. It was a flashback to medical school. How many times have I heard this?
I’m from Philly, so all the people I grew up with, all the people I go to church with, they know how to find me. They were all calling. I just kept hearing stories over and over again about many of them not being able to get tested
AMA: What types of barriers to testing were Black patients encountering?
Dr. Stanford: The reasons were things like they came with a script [for a test] but their doctor wasn’t on staff at that hospital so they couldn’t get tested, or they walked up and they were only testing drive-up people, or there would be a mother and a child and they would test the mother and not the child; or you needed a state-issued ID. There were all these barriers that, in my mind, weren’t necessary for you to test someone. There was this set of completely arbitrary rules.
The other part was you had to be a health care worker, you had to be over the age of 65, you had to have traveled, so many of those criteria excluded African Americans. We’ve analyzed almost 10,000 of the 20,000 people we have tested and the majority of them are age 45–54, not 65 and over, and only 22% of them have comorbid conditions.
Using those criteria, the whole notion that you had to wait until you were sick enough to go to the hospital was how a lot of people were losing their lives, because by the time they got there they were so far gone that not even supportive measures of oxygen, antivirals, antibiotics, none of that was working. They were too far gone at that point.
AMA: How did your organization respond to the need for testing?
Dr. Stanford: I designed a barrier-free, no-cost testing solution and did everything opposite of what the hospitals were doing. I decided to be the physician of record for every person we tested. I have been for almost 20,000 people.
We didn’t charge anyone. If you had health insurance, we took your insurance but didn’t charge you a copay. If you didn’t have insurance, I had LabCorp bill me for everyone. People thought that was crazy, but the test only cost $150 at the time and it was ridiculous that people were dying because they couldn’t get the test. When the CARES Act was passed, funds were put forth to pay for uninsured people. But prior to that, in order to get the tests, LabCorp billed me and I had $200,000 worth of bills to show for it. (After the CARES Act was passed. LabCorp agreed to remove those tests and the balance from Dr. Stanford’s account and bill the Health Resources and Services Administration directly.)
AMA: Testing on that scale at that cost is a significant endeavor. How did you get it going so quickly?
Dr. Stanford: Well as far as the cost, I had to convince LabCorp that I was good for it. I had an account with them as a private practice doctor doing pediatric surgery. I already had a health advocacy and consulting company called Real Concierge Medicine, so I was doing that, and I already had a nonprofit called It Takes Philly that I started years ago to expose underserved children to careers they might otherwise be unaware of.
Basically, with that infrastructure, I was in network with the providers, with my concierge and medical consulting practices, and the nonprofit allowed me to think outside the box.
AMA: What were some of the other challenges in getting your testing initiative off the ground?
Dr. Stanford: In the beginning, I didn’t have testing kits. I would drive to my colleagues in primary care offices and take their tests. At the beginning, we went door to door to test people. After that we started going to churches, labor unions, mosques, homeless shelters, street corners, parks. Wherever the people were with the highest positivity rates, that’s where we went.
AMA: Why did you name your effort the Black Doctors COVID-19 Consortium?
Dr. Stanford: Because Black people were the ones who were being diagnosed and dying at rates greater than everyone else. I wanted them to know that health care professionals that were taking care of them were Black.
We were in their communities because we wanted them to know their status to potentially decrease the spread and also get supportive care if they needed it. Not everyone on our team is Black, by any stretch, and we test people of all races or ethnicities. Still, with the mistrust that exists in the community of the health care system, I thought that name was one way to bridge it early on.
AMA: How have the realities on the ground changed in terms of COVID-19 in these communities?
Dr. Stanford: Testing had gotten better. In August, we could test 85 people per day. Now we’re doing 400 people on average per day. And incidence had gone down. Our positivity rate was less than 5%. We had days with no deaths in the city. People were doing what they were supposed to be doing. And then what happened, unfortunately, during that time is people shut down their testing sites as we started to go into the fall. They felt like the need wasn’t as great.
That, plus cold and flu season, plus more people being indoors for smaller gatherings has created a perfect storm. Now the positivity rates are worse than they were in April and our hospitalizations are up. Our ICU beds are nearing capacity in many hospitals, but it’s because much of the resources we had in the spring we don’t have now.
AMA: What would you encourage physicians to do to help address the COVID-19 inequities we’re still seeing?
Dr. Stanford: You can push your hospitals. There’s a lot that can be done before people ever reach the door of the hospital that I think hospitals and health systems can do more. Hospitals have so much more than I have. I went from a private practice of four to now I’m managing more than 60 health care and non-health care personnel.