Scale up of COVID-19 testing services in NYC, 2020-2021: Lessons Learned to Maximize Reach, Equity and Timeliness

During infectious disease epidemics, accurate diagnostic testing is key to rapidly identify and treat cases, and mitigate transmission. When a novel pathogen is involved, building testing capacity and scaling testing services at the local level can present major challenges to healthcare systems, public health agencies and laboratories. This mixed methods study examined lessons learned from the scale-up of SARS CoV-2 testing services in New York City (NYC), as a core part of NYC’s Test & Trace program. Using quantitative and geospatial analyses, the authors assessed program success at maximizing reach, equity and timeliness of SARS CoV-2 diagnostic testing services across NYC neighborhoods. Qualitative analysis of key informant interviews elucidated key decisions, facilitators and barriers involved in the scale-up of SARS-CoV-2 testing services. A major early facilitator was the ability to establish working relationships with private sector vendors and contractors to rapidly procure and manufacture necessary supplies locally. NYC residents were, on average, less than 25 minutes away from free SARS CoV-2 diagnostic testing services by public transport, and services were successfully directed to most neighborhoods with highest transmission rates, with only one notable exception. A key feature was to direct mobile testing vans and rapid antigen testing services to areas based on real-time neighborhood transmission data. Municipal leaders should prioritize fortifying supply chains, establish cross-sectoral partnerships to support and extend testing services, plan for continuous testing and validation of assays, ensure open communication feedback loops with CBO partners, and maintain infrastructure to support mobile services during infectious disease emergencies.