Despite the resurgence of COVID-19 this spring, there are now fewer options for free PCR tests in New York City.
A Gothamist analysis of municipal data found that the number of NYC Health + Hospitals testing sites were cut in half citywide from mid-February to mid-April — from 270 sites to 144 locations — leading to fewer hours of testing availability. This shrunken landscape includes both brick-and-mortar clinics as well as mobile testing vans.
Practically speaking, these trends meant that New Yorkers had 15% fewer hours to get a free PCR test — given more than 10,000 hours were available the week of February 14th, when the omicron surge was waning, versus 8,500 hours the week of April 18th. By this part of the spring, the coronavirus was rebounding again, driven by newer versions of the omicron variant.
The revelation defies a pledge made by city health officials in the early spring, when they said changes in federal pandemic funding would not reduce city-run testing sites.
“There's going to be no change to our city-run sites in terms of our mobile sites, our fixed sites,” Dr. Ted Long, the executive director of the NYC Test and Trace Corps, told Gothamist in late March. “We're going to be continuing full force ahead and even expanding as we need to, to meet the demands of testing across New York City.”
In response to Gothamist’s findings, NYC Health + Hospitals didn’t explain why the testing sites were closed.
But Test and Trace spokesperson Adam Shrier pointed to the city’s expansion of free at-home test distribution sites, which number more than 200 across the five boroughs. Many of these home test hubs are located — given their placement at libraries and other public institutions —within 1 mile of closed brick-and-mortar sites.
The home test distribution ensures “fast, flexible, no-cost COVID-19 testing is available regardless of insurance status in the neighborhoods where testing is needed most,” Shrier said, adding that the city has distributed more than 35 million at-home tests.
PCR tests remain valuable for diagnosing cases and making sure people receive the health care they need, either immediately or if they develop the chronic symptoms of long COVID. The tests also provide data on the intensity of pandemic spread in New York City, as health officials here do not collect results from at-home tests.
But PCR tests are less convenient to use than the now-widely-available home tests, and overall interest in taking COVID-19 precautions is waning.
And even though the city has passed its latest peak, with a seven-day average of 4,500 cases in late-May, official COVID rates are still high. A plateau is forming, as the boroughs have recorded about 3,000 cases per day for the past two weeks.
Despite that, PCR testing locations remained halved as of June 27th. During this week, only 7,500 hours of free testing were available citywide. At the same time, a lack of federal coverage for testing people without health insurance has added new cost barriers for New Yorkers seeking testing at private sites.
NYC Health + Hospitals is planning to close seven additional brick-and-mortar sites on July 17th — but has launched three test-to-treat vans to provide testing and antiviral treatments at the same time, in collaboration with the health department. The city describes these changes as a strategic pivot to home testing.
At-home tests are more convenient to use and provide critical information about whether the test-taker is currently contagious, experts said.
NYC Health + Hospitals is planning to close seven additional brick-and-mortar sites on July 17th.
“People are getting tested less, probably because they do have more access to rapid testing,” said Dr. Uché Blackstock, a physician and founder of Advancing Health Equity.
But she also pointed to a narrative from politicians and other leaders, suggesting that, “we’re in a different phase of the pandemic” with less need for safety precautions. “People don’t feel the same immediacy or urgency to get tested,” Blackstock said.
Did declining access come from less demand for PCR tests?
Fewer people are going to COVID-19 testing sites now than at any time during the past year, according to data from the New York City health department. About 30,000 PCR tests were conducted each day in the week ending June 20, compared to over 100,000 tests per day during the peak of the omicron surge in early January.
A similar number of PCR tests were conducted daily at this time last year. But COVID-19 case rates were much lower then: under 300 new cases reported citywide each day, compared to about 10 times that amount now.
And those official case numbers are likely a significant undercount, said Dr. Denis Nash, an epidemiologist at the City University of New York who led a study estimating coronavirus infections in late April to early May, while the current surge was approaching its peak.
“We estimated about 1.5 million adults likely had COVID-19 during a two-week period, whereas the number in the official case counts was closer to 49,000 — of all New Yorkers, not just adults,” Nash said.
The May study, which has not yet been peer-reviewed, relied on a phone survey of about 1,000 New Yorkers and may be an overestimate, Nash said. Still, the large gap between their prediction and official case numbers suggests a potential need for more surveillance.
Test positivity rates point to the same trend. From mid-April through late June, the share of PCR tests returning positive results in New York has been between 5% and 10%. This means that a higher share of people getting tested have symptoms or recent exposures than at prior points in the pandemic, when test positivity was closer to 1%
Notably, testing site hours in Manhattan have remained relatively stable across these months, even while Health + Hospitals closed some locations. The outer boroughs closed a greater portion of testing sites or decreased their hours. Many of the sites that closed between February and April specifically offered saliva-based PCR tests.
Meanwhile, it’s now harder for New Yorkers without health insurance to get tested. In late March, the federal government ran out of funds to provide free testing and treatments to uninsured Americans. While Health + Hospitals sites offer tests regardless of insurance status, the federal change could still pose a problem for uninsured New Yorkers who go to private urgent care clinics or privately-run testing sites, Blackstock said.
Uninsured people and those with more limited healthcare access “are more likely to be chronically burdened with disease, so they’re already at risk,” she added. Testing challenges pose yet another barrier to care.
At one public middle school in Kensington, Brooklyn, the lack of federal coverage led private company LabQ to discontinue a testing van that had previously provided free services to students and people in the surrounding community, said JD Davids, a health advocate and co-president of the school’s PTA.
LabQ first told parents that it would require insurance information, then announced that the van’s prices had gone up to a new “group rate” of $75 to $100 per patient.
“Retaining testing went from a really formidable challenge to impossible,” Davids said. The testing van is no longer available. LabQ has not responded to a request for comment.
If PCR tests are less abundant, when should New Yorkers get one?
Taking a home test can be far more convenient than traveling to a public PCR hub — even if lines at these sites are far shorter than they were during last winter’s surge. Blackstock also pointed out that at-home tests can be more useful in some scenarios, such as if a COVID-positive person wants to avoid exposing others and is trying to determine whether they are still contagious.
She would recommend a PCR test “if someone was having symptoms and repeatedly testing negative on rapid tests,” she said. “But that person should still be isolating themselves if they’re having symptoms.”
The New York City health department similarly recommends that New Yorkers “concerned about the accuracy” of their at-home test result could get a PCR test to confirm whether they are infected, said agency spokesman Michael Lanza.
“Expanding our testing capacity with at-home tests gives more New Yorkers the critical information they need to quickly determine their status and take the appropriate precautions,” Lanza said. “The tradeoff is that we might not find out about each and every positive case, but that has been true the entire pandemic as those with asymptomatic COVID are less likely to seek testing.”
A PCR test result can additionally be important for accessing treatment, particularly if a coronavirus infection turns into a case of long COVID, Davids noted. Some long COVID clinics require a positive test result to accept patients, he said, even though studies have shown there may be little difference in symptoms between long COVID patients who have this confirmation of their infections and those who do not.
As fewer people seek out PCR tests, Blackstock and Nash would like to see new data sources provide more reliable information about COVID-19 spread in New York City. Nash suggested that surveys, in which “health department staff are actively going out and trying to ascertain how many cases there might be,” could be more valuable than results from testing labs and doctors’ offices.
Wastewater testing can also fill in data gaps left by declining PCR tests. New York City began work to screen sewage systems for COVID-19 in April 2020 — with routine sampling launching later that August. The city was publicly reporting this data to the Centers for Disease Control and Prevention up until it suddenly stopped in late April.
“We need to have our surveillance for the virus evolve a little bit, to meet the changing nature of the pandemic,” Nash said. Surveillance should be able to identify whether vulnerable New Yorkers are still disproportionately affected by COVID-19, he said, while also evaluating changing protection from vaccines.