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Biden’s free covid tests plan shortchanges Americans of color and hardest-hit communities, say health workers and activists

The administration’s move was largely lauded, but those who serve the nation’s most vulnerable say the tests should have been distributed more equitably

Stanley Cox near his Bronx apartment last month. He says without help, he might not have been able to get his free tests ordered. (Jeenah Moon for The Washington Post)
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When President Biden first announced plans to ship 500 million free coronavirus tests to Americans, the move was largely lauded. But some public health experts and community activists say the plan’s limit of four tests per household will force the tens of millions of Americans who live in multigenerational homes to make difficult — and risky — decisions about who gets to use them.

An estimated 64 million Americans live in multigenerational households, according to the most recent data available, a disproportionate number of them people of color and many of them working in essential jobs in cities and communities where the pandemic has hit hardest.

“There’s no consideration for those who are at higher risk. Every time we roll out a plan, why can’t we put them to the front?” said Myron Quon, executive director of Pacific Asian Counseling Services, which serves the immigrant community in Los Angeles. Four tests for families in vulnerable communities “is just not sufficient. Not even close. They’ll have to ration,” Quon said.

The Biden administration said it came up with four tests per household by looking at the number of tests — 500 million — first available for distribution and dividing that by the total number of U.S. households, which is around 122 million. Since then, the administration has announced plans to send an additional 500 million tests to households in coming months.

Cameron Webb, senior policy adviser for equity on the White House covid-19 response team said “I completely understand” why people would say the number per household is inadequate.

“The first point that I would make is whether it was four tests, six tests, eight tests, 10 tests, it might not ever meet the needs of any particular family over any length of time,” Webb said, emphasizing that the free tests are meant to serve as one of several ways for people to access testing.

But, how is it fair, for example, that a single person working from home is eligible for the same number of tests as a household of eight, especially when those eight family members are more likely to work front-line jobs that expose them to the virus, asked Riana Elyse Anderson, assistant professor of health behavior and education at the University of Michigan’s School of Public Health.

“It’s the full picture for me,” Anderson said. “How do we ensure that the folks that have already been hit the hardest, the families that have lost the patriarch, the matriarch, the grandma — all these people — that we’re not exposing them, the remaining folks, the communities that have been lamenting for almost 24 months now? … How can we almost make amends for our oversight in 2020? That’s what’s missing.”

Of the more than 900,000 people in the United States killed by covid-19 since the start of the pandemic, Black, Latino and Native Americans represent and oversize share, with death rates 60 to 90 percent higher than that of White Americans, according to a Washington Post analysis of covid-19 deaths.

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A policy in which every household is eligible for the same number of tests assumes that all Americans are living amid the pandemic on equal footing, Anderson said, which just isn’t the case.

Activists in communities hit hardest by the pandemic described how the scarcity of tests is leading to situations in which households are sharing one swab.

“That’s what people do in developing countries,” Quon said. “They bring the techniques with how to survive with … scarcity to the U.S.”

Activists also expressed concern about how information about the availability of the tests was shared with the public and the fact that they must be requested.

New York resident Stanley Cox said his home health-care attendant ordered the free tests sent to his Bronx apartment. “I’m not lazy, and I’m not stubborn, but to get certain things to people that’s in a minority position like we’re in, they make it difficult,” said Cox, 61. “If you go in the White neighborhood, you just snap your finger and boom, it’s there. … Here it’s a whole different scenario.”

Cox lives with his daughter, who was diagnosed with schizophrenia, and her two children who have special needs. His wife of 35 years died in 2016. He said he probably would not have figured out how to order the tests on his own.

The pandemic has been traumatic for Cox — isolated and with a steady barrage of bad news about his community being ravaged by the disease. When the coronavirus first hit the United States, New York City was an epicenter, and in December amid the surge of the omicron variant, the city had one of the highest rates of new cases in the country, though hospitalizations remained relatively low.

“It’s been hell,” Cox said. “My neighbor died, my neighbor under me died, my neighbor’s friend died, my daughter’s friend. … I mean it was like at least 30 people that I know right in my footsteps that passed away. It was very scary, because I was wondering, ‘Are we next?’”

Some health-care workers worry that language barriers create another obstacle. Immigrant parents with limited English skills often depend on their children to navigate life in the United States. Even those who manage to figure out how to order the tests may still be at a loss in figuring out how to administer them, they said.

“I am glad that screening resource is available for free, but just like everything else in this pandemic, that advantage will not be equitably experienced by people of color in this country,” said LJ Punch, executive director and founder of The T, a nonprofit trauma recovery and health organization that has been providing coronavirus services predominantly to Black residents in St. Louis. “That for me is always going to be a problem. And what I would like to see is the work being done filling in the gap.”

Prioritizing vulnerable communities for the free tests would benefit everyone, advocates said.

“Those who are most hardest hit … many of them are essential workers,” Quon said. “So this is why we don’t have enough beef. This is why we don’t have enough people working at McDonald’s. Because these high-risk people are the ones who keep the economy going. So we need them to show up for work.”

“The economy grinds slowly to a fake shutdown when our most at-risk folks are not able to work,” he said.

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Some public health officials and activists said it would have made more sense to send the tests to community organizations where workers could help make sure those who need the tests get them. They also would be able to show residents how to properly use them. Using community and faith-based organizations would help break down the barriers that are preventing people from getting tested, they said. These organizations are typically trusted by their communities and in many cases have already been working to educate residents about the virus. Their staffers often speak the residents’ language and share similar life experiences.

“In our community, there are those who feel safer, more comfortable doing something in a church setting than in a community center or hospital,” said the Rev. William Glynn, pastor of the 2,000-member Mount Olive Missionary Baptist Church in Fort Worth.

The church, in one of the hardest-hit Zip codes in Fort Worth, has been offering coronavirus testing to its predominantly Black and Latino neighbors daily. The church began with offering testing on Sundays but had so much success and demand that it recently expanded to seven days a week. “The church has always been the place of safe haven,” Glynn said.

Jaemi Tiongson, director of health education for CareSTL Health, a federally qualified health center that provides primary care for underserved populations in St. Louis, said an added benefit of relying on community organizations is that they can connect residents to other resources. She said many uninsured or underinsured residents who have come to CareSTL Health for vaccinations or testing also learned they have unaddressed illnesses such as asthma or high blood pressure during those visits.

The languages coronavirus test instructions are offered in depends on the brand, said Webb, the White House official. That too, has been an obstacle, some local health-care workers said.

“We’ve recently provided some services in a predominantly West African community that speaks a certain dialect from the nation of Gambia, so it definitely wouldn’t serve that community,” said David Collymore, chief medical officer for the Acacia Network, which serves people throughout New York state, including seven community clinics in New York City with mostly Black and Latino clients.

“There are a lot of challenges we have to be intentional about overcoming in terms of solely distributing the kits,” said Collymore, who noted that many of the network’s clients are essential workers with incomes below the poverty line.

Acacia and other organizations across the country are working to address language barriers and confusion about the kits by incorporating demonstrations on self-testing into their services.

Webb said the Biden administration tried to address those concerns, including reserving the first 20 percent of each day’s test kit shipments for households in vulnerable communities. He said they also took into consideration households without Internet access by setting up a telephone hotline, 1-800-232-0233, which offers assistance in more than 150 languages.

And according to the government’s FAQ page, households with multiple families can inquire about getting more tests by filing a service request or calling the Postal Service at 1-800-275-8777.

The administration said in late January that it had installed 32 new federal surge testing sites in 11 states, and of the 69,000 coronavirus tests administered at those locations, 73 percent were to people of color.

Webb said the government chose not to request information on the number of occupants in a household and their relationship because they didn’t want to make immigrant families with mixed legal status fearful.

“We were really intentional in the design of saying: ‘Hey, we’re not collecting a lot of your personal information. This isn’t going to immigration enforcement. This isn’t going all these different places. This is strictly to get you test kits.’”

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In eastern Nevada, the predominantly Latino town of West Wendover also has struggled with the four-tests-per-residence rule. There, the common practice in rural areas of using post office boxes instead of mailboxes has had an unintended consequence in the community of 4,500. To save money, multiple families sometimes share one P.O. box, even if they don’t live in the same household.

“While it I think it is well intentioned, by not properly thinking through all the different living situations that folks have, I think that places another barrier,” said West Wendover Mayor Daniel Corona.

Corona said he, his mother and his sister’s family were unable to get separate kits, because they share the same P.O. box.

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Van Nguyen, 69, a Vietnamese refugee who came to the United States 35 years ago, considers himself lucky to live within walking distance of Asian Resources Inc., a Sacramento nonprofit organization that has been helping residents order the tests and administer them.

“I can’t write in English, and I can’t read English,” Nguyen said through an interpreter. “I just don’t understand the process, so I just have to rely on somebody else to order it for me.”

Stephanie Nguyen, the organization’s executive director, said the organization has been hearing from a lot of people like Van Nguyen.

Van Nguyen, who lives with his wife and four other relatives, said it has been difficult to find testing. He has waited in two-hour-long lines to be tested.

“Four was not enough,” he said of the free tests. “We just decided that whoever wasn’t feeling well … go ahead and use it.”

Dan Keating contributed to this report.