Dr. Robert Record, chief executive officer of Christ Health Center in Birmingham, oversaw a mass drive-through testing site for the COVID-19 coronavirus that ran from March 17-22 at the Church of the Highlands in Jefferson County.

After the final tests on Saturday that brought the total for five days to more than 2,200 tests administered, Record spoke to AL.com and gave an overview of what he had learned over the past week. The test site was closed after Saturday’s testing, with UAB Medicine ready to start drive-through testing on Monday at University Boulevard and 22nd Street South.

“We’ll refer some people to UAB,” Record said. “We’ll do some testing ourselves.”

By Saturday afternoon results had come back on 930 people tested by Christ Health Center. Of those, 31 tested positive for COVID-19, Record said. On Sunday morning, he updated the totals to 1,410 test results completed and 38 positives.

“We had a 3.125 percent positive rate,” Record said. “That’s a very similar positive rate to what we saw in community testing in Italy. These are important numbers for us to get out.”

By Monday morning, 1,546 of the Christ Health Center tests had been processed, with 46 positives, making the positive rate 2.98 percent, Record said in an update today. The final tally was 70 positives in 2,216 tests, Record said on April 2. That’s a positive rate of about 3.15 percent.

Statewide, Alabama had 157 confirmed cases as of 4:30 p.m. Sunday, with 71 in Jefferson County. The state had gotten results from 1,602 tests taken statewide at that point. By Monday morning, it was up to 167 cases in 1,832 tests statewide, with 79 in Jefferson County. Record said he did not know how quickly the numbers being reported from Christ Health Center are being tabulated into the state’s total.

Christ Health Center was founded by the Church of the Highlands as a health ministry and clinic in 2009 based in Woodlawn. It is an independent non-profit corporation with board members from other churches as well, said Record, a family physician and member of Church of the Highlands.

Record said Christ Health Center, only half of whose 18,596 patients are insured, was overwhelmed with a need for tests earlier this month but had no tests available. “Last Friday (March 15), I could get no tests,” he said.

On March 16, Record and Dr. Ty Thomas, anesthesiologist, founder and lab director at Birmingham-based Assurance Scientific Laboratories, began working together on testing at the Assurance office on Acton Road.

The Church of the Highlands, which has experience moving thousands of vehicles onto its campus and can activate hundreds of its Dream Team volunteers on short notice, provided the necessary infrastructure for mass testing, Record said. Christ Health Center provided about 10 of its 100-member staff, with doctors, nurse practitioners and nurses, and Assurance Scientific Laboratories provided the tests and three of its staff, but the church mobilized hundreds of volunteers and staff.

“This would not have happened without that,” Record said. “Christ Health Center can’t do that.”

Here are some questions, with answers by Record:

When you started confirming a lot of coronavirus cases, what impact does that have?

One of the things we did in getting 31 (now 38) positives in just a couple of days, and we’ll get many more, is we stopped that comment, ‘There’s no disease in Alabama.’ A week ago, we were still saying, ‘We have no confirmed disease in Alabama.’ Well, because we hadn’t tested for it. Now we’ve tested massively, and I think you’ve seen people respond.

You mean people are taking it more seriously?

That’s important. Just that saves lives.

What was the key moment when you said, okay we can close our test site down?

When UAB made the announcement. We can always re-start this. I have a team of 100, which I think is incredible. At the end of the day, we’re a little primary care clinic. Let’s get back to the home office, make sure those patients who are family to us have everything they need from us. It really was burn the candle at both ends and see if you can’t put it over the flame too. I got here (Church of the Highlands on Grants Mill Road) at 5 a.m. and left Woodlawn at 9:30 last night (Friday night).

Can you give much personal attention in mass testing?

Every single person in line is getting a phone call. It’s not like we’re calling every person and saying you don’t have disease and they say, ‘Oh Good.’ It’s, ‘So, what do I do next? Could I still have it?’ They’re asking follow-up questions that require responsible clinical answers. We take that honor with great weight. One hundred percent of those calls we’ve got to get it right.

How many physicians do you have doing that?

In Woodlawn we have seven physicians and 5 nurse practitioners, in Live Oaks (a psychiatric clinic in Woodlawn), we have two psychiatrists, but they are continuing their work by telephone. In Clay-Chalkville, we have six physicians and 20 residents, who are all physicians too. That’s a pretty big clinical team.

Will any of the church volunteers be working at the UAB drive-through site?

I think UAB’s going to be more professional. I don’t think there’s going to be reliance on volunteers at all.

How did a church get involved in public health testing?

What Highlands did here was to sit in that room at 8 a.m. Sunday morning and throw out the idea of a test center, and to have one open on Tuesday that was ready to do great work. From first conversation Sunday morning at 8, to Tuesday morning it’s open, and majorly, with signage, and a feeling that made people know they’re important. That just doesn’t happen.

How do you balance faith and medicine?

There’s no balance between faith and medicine. Faith and medicine go completely hand in hand. They are 100 percent right together. We respond with hope. We respond with courage. There’s never been a plague that came to this country, there’s never been a disease that came this way, that we didn’t rise up to meet it. Is this one terrible? Absolutely. We’re going to dive in together like we did this week. If we can bring hope in the middle of testing, we’ll bring hope to the next phase. I think Birmingham’s the greatest city on earth, and we’ll come together, and we’ll rise up to the occasion, whatever occasion that is. I absolutely believe that, with all my faith. At the end of the day I’m a family doctor. We have some great public health leaders. I say listen to them. They’re making great comments. As much as you can, social distance is a great word. We’re practicing physical distancing, but we’re not socially distancing.

Are you being asked for advice on mass-testing?

We have churches and municipalities across the country calling us and saying, ‘How can we do this process?’ We’re still Church of the Highlands, which is a church, and Christ Health Center, which is a primary care clinic. We’ve only done this for a week, but we’ve learned some things. Whatever we know, we’re willing to share, and we hope they can use it to serve their community.

What worked well about a drive-through testing site?

The problem with this is how do you do testing well, without exposing your team to disease, and while saving personal protective equipment. The busiest day here we saw well over 700 people (798 on Thursday). That day we used 14 N-95 masks. For us to test in our clinic, and test five people through the day, uses up a massive amount of equipment that we want to save as a scarce resource in the city, and share with the hospitals if they really need it. We are working on a way for us to do in-person testing without significant exposure. I have a team working on it right now.

What about the poor people your clinic usually focuses on?

At the end of the day, we’re really a clinic dedicated to our neighbors most in need. A crisis lets us say everyone’s in need and to be big. I want to get back to Woodlawn. This process to save equipment, and protect people, requires a car. The car was our defense. It was a great one. We Forrest Gump-ed into that. That doesn’t solve it or give an answer for my homeless neighbor. That doesn’t work for the single mom who doesn’t have a car. For Christ Health Center, those two people are our VIP’s. Our whole system is designed around the most vulnerable being treated like a VIP. Now I need to get back to Woodlawn for a few days and make sure that’s happening at a level to fall in line with our values.

Has this taken a toll on you personally?

I haven’t slept all week. I wouldn’t quit for not sleeping. I was never tired until I knew this (Saturday) was the last day for a little bit. This team would work. This is not platitudes. I haven’t seen my little girls. If I haven’t seen my little girls, that means my team hasn’t seen their little girls. We’re going to see our little girls for a little bit, catch our breath. (He and his wife, Leland, have four children, including two daughters, Mimi and June, adopted from China.) I did see two of my kids. Every day, my 16- and 18-year-olds (daughter, Caley,16, and son, Tate, 18) were in the lines, and I’ve never been a more proud dad than to watch them check in patients.

Would you consider starting the mass-testing again?

If UAB calls and says, ‘We need you back at this,’ it can happen in as little as maybe 24 hours. Assurance will work with us. We’re asking, ‘Where is that resource best in our entire community?’ Do we need to help another community in Alabama get this done?

Did everyone in the mass testing lines see a doctor?

One hundred percent of the patients that went through that line saw a doctor - a few saw a nurse practitioner, but 100 percent were seen by a clinician. You’re looking at them through a window, talking to them through a phone, asking them key questions. There were some really sick people here. They’re calling their doctors. The doctors are saying, ‘I don’t have protective equipment.’ They’re trying to treat them by phone. Some of them were in heart failure. Cardiologists can’t see them if there’s a chance they have this.

Who pays for uninsured patients?

Christ Health Care. We may get something from insurance, we may not. Every uninsured patient, we told Ty (Dr. Ty Thomas, of Assurance Scientific), we will pay for the lab. The only time anybody knew if anybody was insured was when they checked in. The next people in line didn’t know. Everybody got the same experience. No uninsured person will be charged a penny for anything.

Did Assurance Scientific Laboratories profit from this mass testing?

For Assurance Scientific, those little swabs only make money if you run a bunch of tests on them. We’ve run one test on each swab, COVID-19, nothing else. Assurance Scientific lost money on every single sample they ran. They invested more money in running the sample than they will collect from the insurance company. What Ty and them did, to have an entrepreneur who has the only mouse trap in town, respond to a crisis like this, and say, I’m not only not going to make money on it, I’m not going to price-gouge, I’m not going to break even, I’m going to lose money. He could have sold those swabs, gone home and watched TV, and come out better financially. A lot better financially. Instead, I don’t think he slept in 12 days. He’s running tests right now. If you can make a hero in this story, I’d love for it to be my church members who served, and that guy. When you see somebody with a precious resource say, ‘I just want people tested,’ everybody in town needs to know that’s a hero neighbor, to me. They’ve been a virology lab for years. An ENT (ear, nose and throat) doctor might go in and they have a little swab they rub in your nose and he checks for 15 different viruses and says, you specifically have this one. It’s very reliable because it’s PCR (Polymerase Chain Reaction) testing. It’s not like free agents and looking at how colors change. It’s looking at sequences of nucleotides. So, they run that, and that’s a profitable business for them. They’ve done it forever. When COVID-19 was still the Wuhan virus, they found the sequences that they should program for and they invested a bunch of energy, money and time into programming for that virus in case it came our way. When everybody was saying it wouldn’t come our way, they invested time and got FDA approval. So, you’re seeing a lot of labs now coming online this week. They’ve been working for the last two weeks to get FDA approval.

Can state health departments meet testing demand?

If the FDA rapidly approved testing, there are providers out there. The Alabama Department of Public Health is fantastic. They are not a virology lab. At their best they’re going to be able to do 200. You can’t test Alabama with 200 tests a day. We had Mobile officials up here today (Saturday), monitoring our site. We’ve had some people from Atlanta. Atlanta doesn’t have as much testing as we did this week. South Korea has done mass testing. This (at Church of the Highlands) is as close as we could get our city to South Korea. With public health officials when you ask if we can get to South Korea’s level of testing, they say it’s scarce resources. Ty’s response is I have a virology lab, it’s not as scarce as you think it is. Let’s get our people tested. Christ Health Center being so small, we’re able to be nimble. I still haven’t gotten a test from ADPH. Remember, I had zero tests 8 days ago. I tried to get them from ADPH. I just couldn’t. Not because they didn’t want to, but because they didn’t have them. You can’t give what you don’t have. A week ago, there was zero testing. UAB now has some testing capacity. We’ve seen some other drive-ups, some urgent care, so they have testing capacity. We’ve seen LabCorp say they’re expanding testing capacity. Great. We were able to stand in the gap while others couldn’t.

How much did COVID-19 test kits cost?

I don’t know what one of those kits costs because I never paid a penny. Nobody had to pay a penny. If their insurance pays us something that’d be great. We have no clue if that’ll happen. We’re sending out a certain code, that is very low-level code. First of all, it doesn’t seem right in the middle of a crisis to tell somebody to hand me a credit card to pay their co-pay. That seems wrong. Second, the car was our protection. Even if I was going to ask for a co-pay, I couldn’t get it without risking exposing my team. Nobody touched anything here until the very end. At the very end, we had somebody in full gear, medical professional, people that were trained.

How do you take a sample?

Of everything we did, the swab’s the easiest thing to do. You have to go deep in the nasopharynx. Some people just barely swab the nose. You’ve got to get that swab to go around the back and into the nasopharynx. You’ve got to be trained. It’s not hard, but you’ve got to do it right. All that was monitored to make sure we did it right. In any testing there are controls, and a certain number kick out, and we had less kicking out than anyone’s ever seen. So, something was right. I’m going to say the favor of God, but something was right. We were aggressive in making sure we got an adequate sample. The (car) window was only open for 20 seconds.

How did you handle medical forms after you slide them in the window?

They show it up to their window. We capture it into my EMR (electronic medical records), which is all HIPPA compliant. It’s not an iPhone picture, it’s a picture that goes straight into the EMR, so that it’s securely transmitted. By the second day we figured out how to send out our electronic portal. So, while people were sitting in their car, they could build a chart in our health record. Then when we checked them in it was much easier. This allows us to communicate with them securely, digitally. We know every patient that was seen. We know their phone number. We know how to catch them and tell them, and if we have talked to them. We know if their report is missing. In any lab, there will be a certain number of samples that, something’s wrong with this one. We know how to find them all and say that. That’s 2,200 different people in five days. That’s a lot of people to say you’ve got to get 100 percent right. That’s what the team worked into the wee hours on. Jefferson County numbers have skyrocketed. That lets the people who make decisions have better information to make better decisions. A week ago, we did not have better information to make better decisions. Now we do. That might be one of the biggest blessings of this mass testing. There’s hope in the numbers.

What’s the hope?

The hope is we have a better clue where we are. Awareness is a major first step in winning. You’ve got to know how big your problem is. A week ago, we weren’t even testing, we couldn’t point to evidence to say we even had a problem. Now we have evidence. What is Christ Health Center’s role now? We’ve got to go find out.