City Seizes Opportunity to Provide Testing to Residents

The City’s first COVID-19 cases were announced on March 13. All three cases were linked to the Biogen conference in Boston, one of several “superspreader” events that helped fuel the early spread of COVID-19 in the U.S.

As new cases in Cambridge ticked upward, public health and city officials were especially concerned about COVID-19 transmission in skilled nursing and long-term care facilities, given that older adults are at greater risk from disease and death due to COVID-19. The Cambridge Public Health Department (CPHD) seized an opportunity to provide early intervention and support.

Rapid Testing Pilot is Launched

On April 9, in partnership with the City, The Broad Institute of Harvard and MIT, and Pro EMS—and funded by the City—Cambridge became the first city in the state to provide onsite testing to every resident in all skilled nursing and assisted living facilities, regardless of symptoms. The first round of testing in Cambridge’s seven facilities revealed that 163 residents (29% of those tested) and 65 staff (13% of those tested) were infected. Residents who tested positive or were symptomatic were separated from those who were well. In total, the team conducted three rounds of testing in these facilities. In the third round of testing, 10% of residents tested positive, many of whom had been identified in prior rounds, and 5% of staff tested positive.

This strong partnership with the City, The Broad Institute, and Pro EMS has continued to provide testing throughout Cambridge to this very day.

Surveillance testing, which is what this pilot project undertook, is a different approach from how most COVID-19 testing is currently being conducted in the United States. Under the surveillance approach, everyone in a given population—in this case, those who live and work in skilled nursing facilities and assisted living facilities—is tested for COVID-19, regardless of whether they have symptoms or feel ill, or have an exposure to a confirmed case. It is equally important to test people who are asymptomatic in stemming the spread of the pandemic.

Surveillance testing provides a more accurate picture of the true infection rate at a given point in time. The goal of rapid identification of positive cases is to break the chain of transmission in these facilities and ultimately reduce the number of people who become infected.

Vulnerable Populations...and Testing Expands throughout Cambridge

CPHD cannot overstate the importance of testing as one of many evidence-based tools to effectively mitigate the spread of COVID-19. Testing allows us to identify who is infected (e.g., age, gender, race); where the infection is located (e.g., neighborhood); and how great the spread. In turn, we mitigate community spread by isolating those who test positive; quarantining those who come into contact with a positive case; and shutting down/restricting locales that are at greater risk for—or are already deemed—a cluster.

In late April, during the peak of the COVID-19 epidemic in Massachusetts, CPHD epidemiology and public health nursing team tracked and analyzed case data. Public health nurses and community health workers made calls to cases to support isolation and quarantine, as well as to fill in missing demographic information, and an epidemiologist created charts, tables, and maps that showed infections by age, gender, race, ethnicity, neighborhood, and zip code.

The data told a sobering story: When the state was in lockdown, people of color in Cambridge, particularly Black and multiracial residents, were being infected with the virus at a much higher rate than White residents. Certain neighborhoods had much higher rates of COVID-19 infection than others.

The data spurred City Manager Louis A. DePasquale to recommend an appropriation to the City Council to provide free, universal testing in the majority non-White neighborhoods. These City-funded mobile testing sites were open to all residents.

On May 19, mobile testing was launched in The Port neighborhood and in all Cambridge Housing Authority (CHA) senior buildings, expanding the City’s mobile testing capabilities among more vulnerable populations. Since that first day, mobile testing has expanded to additional neighborhoods.

It is hoped that expanded testing will help prevent further spread and provide an improved understanding of the prevalence of COVID-19 in Cambridge, especially in neighborhoods being disproportionately impacted.