Dr. Zeyad Baker thought he was pretty proactive and thorough in thinking through how his team of doctors, nurses, nurse practitioners, physician assistants and medical assistants could address the surging number of cases of COVID-19 cases in New York. The president and CEO of ProHEALTH, a group of 1,000 independent clinicians, took the doctors and nurses who were no longer seeing patients for non-essential visits, and reassigned them to evaluate people coming in with COVID-19 symptoms. He turned the driveways of a few of the ProHEALTH centers into drive-thru COVID-19 testing centers, and worked with doctors and nurses to adapt bedside manner into car-side manner.

He figured the five-person teams he trained could handle about 40 to 50 patients driving up a day. On the first day the drive thru opened, on March 19, 167 patients showed up. The next day, there were 212. “I should have thought it through better,” says Baker. “I didn’t fully anticipate the pent up demand.”

As drive-thru testing centers pop up across the U.S., in parking lots at hospitals, parks, colleges and stadiums, it’s not just the demand but concerns about supplies that are alarming health authorities. At Banner Health System’s four sites in Arizona, the limiting factor isn’t the staff, but the number of testing kits that are available. “We are testing as fast as the state and counties give us tests,” says Donna Furlong, a registered nurse and clinical services senior director at Banner. “We’re not holding back; we’re testing as fast as we can.” Each evening, Furlong lets her team know how many appointment slots to book and how many people she will need the next day to conduct the tests, depending on the supply of kits that arrive.

In Miami, where a drive-thru testing center was set up in the parking lot of Hard Rock Stadium (home of the Miami Dolphins football team), only first responders, health care workers and those over the age of 65 with symptoms of COVID-19 can get tested without an appointment. A Houston hospital warned patients to be wary of scams in which people were selling tickets for appointments at its own drive thru.

Because of the demand, ProHEALTH now has six drive thru facilities throughout New York, including walk through centers in Manhattan and Brooklyn. At the Manhattan sites, people don’t have to be ProHEALTH members to see a doctor and potentially get a COVID-19 test. “The first couple of days, you could literally palpate the anxiety radiating from within the car,” says Elizabeth Bigos, chief nursing officer at ProHEALTH. “People were incredibly nervous, and obviously concerned.”

What It’s like to work a shift in a drive thru testing center

At ProHEALTH’s sites, doctors are following guidelines from the U.S. Centers for Disease Control and Prevention to ensure that they aren’t “over testing,” according to Baker. Patients are carefully screened by doctors on the phone first to ensure they even need to come to the drive thru for possible testing. That means they usually have symptoms, including fever, cough or shortness of breath.

On average, every 3.5 calls to the ProHEALTH COVID-19 testing hotline ends up in a drive thru visit. Once there, patients are met by a greeter, who verifies their appointment and assigns them to a parking space. A five-person team—a nurse practitioner, physician assistant and doctor as well as two medical assistants—comes to the car fully gowned and covered in protective gear from head to toe. One of the assistants enters the visit on the electronic medical record, and fills out any physical forms needed, while the other performs the test, if needed. Physical paper is still required in some cases, and that means that the staff working inside the ProHealth urgent care centers are also fully covered in protective equipment.

They immediately learned one lesson after day one: although it’s challenging to gear up and remove protective equipment, it’s better to have more health care providers working shorter shifts.

“I’m an emergency room doctor, so I’m used to 12 hour shifts,” says Dr. Bonnie Simmons, medical director of urgent care at ProHEALTH, who worked a 15 hour shift on the first day the drive thru opened. “Those N95 [face masks] definitely make you feel tired and spacey, and make breathing difficult. People can’t hear you as well, so you speak louder. And after several hours of yelling through the mask for patients to hear—that’s exhausting.”

Another critical take-away was that health care workers can’t afford to dispose of their entire protective gear after each patient, as they’re technically supposed to, since they may run out of supplies. Technicians at ProHEALTH are changing gloves after each patient, but if the Haz-Mat suits aren’t damaged or compromised, the health care workers spray each other down with bleach solutions before taking off the suits for bathroom and food breaks. “We are reusing things that typically are one-time use only,” says Bigos. “Because of limitations in terms of supplies, we have to extend their use as long as we possibly can, as safely as we can.”

Why patients need drive-thru testing

For many of the people driving up, the visit is their lifeline for information about the disease, as well as some desperately needed reassurance. Since health authorities are asking people with COVID-19 symptoms not to come to emergency rooms, urgent care centers or doctors’ offices unless they are severely ill, these drive thrus provide their only connection to health care providers. “They are not looking for a cure; people are well informed that there is no magic pill. They just want someone to hear them, and tell them that it’s going to be okay, and have some control over the situation,” says Bigos.

Simmons says she hears out patients who believe they might have the virus, and who are worried they might have unknowingly spread it to others at birthday parties or other family gatherings. They’re also concerned about when they might be able to return to work if they are infected. “These are very real situations that people are starting to have to unravel and unpack,” she says.

Making it more challenging for doctors is the unfamiliar environment, providing care in a way that most of them have never experienced: through a car window, and encased in personal protective equipment. “They can’t see our facial expressions, so you have to use more body gestures to communicate,” says Dr. Daniel Griffin, chief of infectious disease at ProHEALTH. “They can’t see whether you’re smiling, since it’s hard for them to see your eyes so well. It’s a whole different way of interacting with patients that takes a lot of verbal and body language.”

It’s especially hard to not have physical contact because patients are so anxious, and doctors might normally extend a warm hand on the shoulder or hold a worried patient’s hand. “That kind of contact is almost more needed because it’s frightening when you see how much we’re protecting ourselves, and that sends a message that this is scary stuff,” says Griffin.

Even if he can’t provide that reassurance physically, it’s important to tell patients the truth, and provide as much objective information as possible, even if doctors don’t yet know everything about this virus and the disease it causes. “I’ve been doing emergency medicine my entire life for almost 30 years,” says Simmons. “In my career I didn’t think I’d have that many firsts. But this is new terrain. Every minute people are looking to me for all the answers. I go home just thinking I hope to continue to have enough answers. That’s what keeps me up at night—am I going to have enough answers to protect my staff and take the best care of our patients?”

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