The current Coronavirus Disease 2019 (COVID-19) pandemic has necessitated the testing of significant numbers of patients. Modeled after those used during a previous bioterrorism disaster and influenza pandemic, the authors present a descriptive report of their drive-through screening center and processes.
The authors recommend use of a large parking lot geographically removed from large population centers. Additionally, they recommend either a tent or temporary building to be used for work space and shelter from weather. They utilized a four-step process: Entrance → Registration → Examination → Specimen collection → Instructions → Exit. Patients do not leave their cars during this process. To minimize contact and preserve personal protective equipment (PPE), communication is performed either by mobile phone or electronic medical record whenever possible. Temperature is obtained with a contactless thermometer. If the physician strongly suspects COVID-19 during the examination step, the patient is transported to a designated hospital after specimen collection. Test specimens were collected with the car window opened the minimum amount necessary and car ventilation mode on internal circulation. Patients are provided with information about obtaining test results, home quarantine, and anticipatory guidance.
Healthcare workers (HCWs) who had direct contact with patients wore the following PPE: N95 respirator, eye shield/face shield/goggles, hooded coverall/gown, and inner and outer gloves. To decrease viral spread and minimize the possibility of specimen contamination, HCWs wore two gowns and two pairs of gloves for patients who required testing; the external gloves/gown were removed and hands disinfected after each patient contact. The authors reported that this process took approximately ten minutes per test, allowing them to screen 100 people per day with a staff of 4-8 HCWs. This is estimated to be 1/3 the amount of time that a typical screening process would take.
The authors recommended rotating staff every 1-2 hours if possible, and to ensure that no HCW wore an N95 respirator for longer than four consecutive hours. They also noted the need to be cognizant of relevant environmental issues, such as hot/cold weather, etc., and to adapt the working environment accordingly. Lastly, there must be adequate communication with the public regarding the limitations of the screening center to minimize the number of people who may attempt to use this resource inappropriately. They recommend considering a similar process for other uses such as medication distribution or vaccine administration.
Comment: While not a typical research manuscript we would select for Abstracts, this article describes a non-novel approach to a novel viral pandemic. The drive-through screening process has a number of advantages as outlined above, especially as centers begin seeing higher numbers of potential COVID-19 patients. It is important to consider and plan for the unintended consequences of such a program, including how HCWs will handle unexpectedly ill patients and patients arriving by alternative transportation (bike, walking, public transportation). Healthcare leaders considering a drive-through screening option should also consider the heightened emotions and fear that are present during epidemic/pandemic conditions and plan for security accordingly.
