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How the automated coronavirus testing process works in Silicon Valley

A nurse dressed in personal protective equipment prepares to give a coronavirus swab test Monday at a drive-through station at Cummings Park in Stamford, Conn. (John Moore/Getty Images)

Ten days ago, President Trump stood in the Rose Garden outside the White House and promised a new innovation in the effort to expand testing for the novel coronavirus driving the current pandemic.

“I want to thank Google,” Trump said. “Google is helping to develop a website. It’s going to be very quickly done, unlike websites of the past, to determine whether a test is warranted and to facilitate testing at a nearby convenient location."

The company, he said, had “1,700 engineers working on this right now” and had “made tremendous progress.”

That wasn’t true. The website and the process that would point people to testing sites wasn’t a project of Google but of Verily, a company associated with Google’s parent company. Nor was the process close to a broad rollout. In fact, when Trump announced it, it wasn’t available at all. In short order, it launched a pilot program in San Mateo and Santa Clara counties in California, two places seeing a surge in new cases (and where Google’s parent, Alphabet, is headquartered).

Last week, a friend of mine who works in the area, Michael Elliott, got a call from “Project Baseline” informing him he could be tested for the virus. I spoke with him by phone Monday to learn how this pilot program works, on the off chance Trump’s promise of national availability might come true. The conversation has been edited for length and clarity.

First of all, tell me what you do, what your actual job is.

Well, six days ago, I was chief operating officer for something called the Valley Medical Center Foundation, which is a nonprofit fundraising arm for the county public health system in Santa Clara County. My job was essentially to support the fundraising efforts benefiting the public health system here.

And then six days ago, our jobs, for all of us, turned into: What can we do to help our health system prepare for this crisis? And more specifically, what can we do to make sure our health-care workforce is safe?

All we care about right now are trying to protect our friends and colleagues who are going to be exposing themselves to significant risk. To make sure we can care for the folks who need help. So we stopped everything we were doing and we turned ourselves into what feels like a relief organization. But really what we’re doing is we’re raising money and we’re collecting supplies so we can supplement what our hospital leadership is already doing to be prepared for this.

So you yourself weren’t on the front lines, but you were in proximity to people who were on the front lines in terms of dealing with patients. And at some point, you used this Verily tool to determine whether you need the test. Why did you decide you should do that?

It was purely curiosity. When this came out, and that it was being piloted in San Mateo and Santa Clara counties, I was just curious as a person.

I clicked on the link and went through the very simple survey. I was immediately informed that I did not qualify for testing. I don’t recall the questions they asked, to be honest, but I don’t think there was anything that particularly stood out about me.

The testing is being ramped up, so my guess is when I filled out the survey, capacity was much less. And then sort of out of the blue, on Friday, I got a call from a Mountain View number. [Alphabet’s corporate headquarters are in Mountain View.] And honestly, my first thought was that the call was about waiting to donate in some way. And then I quickly realized, oh! You’re here to talk to me about this.

Was it a person or was it a robot?

No, it was an actual person. She identified herself as a volunteer.

Honestly, it took me about 30 seconds to decide if this was a scam or not, because, obviously — “I just need your date of birth, and I need your address!” I was like, is this real?

And I assume it was real unless they faked the entire continuum of the phone call all the way through the test. It would be a very elaborate way to steal my identity. I would almost, at that point — I think they deserve my identity if they went to those efforts. “Yes, please take out a home loan in my name. Bravo to you guys.”

No, she was a volunteer. I was surprised, and I actually asked, do you have any idea why I’m being selected? She said, no, I don’t know.

In the phone call, it was a very — it took about 11 to 12 minutes. She had a very well-organized script. They were very specific in saying, do not give me any health information at any point. This is not a call to help you with health information. If you need any assistance, obviously, call your doctor or go to an emergency department. It was mostly to verify my identity and then to give me instructions on what to do — to make an appointment, first of all, and then to give me instructions on what to present when I showed up for my appointment, which was at the Santa Clara County Fairgrounds.

I got an email from PWN Health, based in New York City. PWN Health was where the order came from. On March 20, I got an email saying my lab test order was approved by a physician who is a member of the medical staff of PWN Health, whatever PWN Health is, obviously they’re affiliated with Project Baseline. Lab tests typically are ordered by physicians, so this must be that component of it.

Let me take a step back. When you first took the online questionnaire, at the time, you weren’t presenting any symptoms or anything. You were basically just filling out questions.

I wasn’t taking the survey really out of any specific concern beyond the concern that all of us perhaps have somewhere inside every waking hour at this point.

I don’t remember the specific questions, other than, at the end of it, it didn’t feel necessarily reassuring, not knowing anything about this at all. Having no expertise in this, I wasn’t necessarily feeling like an assessment on a website was going to help sort of organize how we do testing.

So then you get this call from this person from Mountain View, and she helps you set up the actual appointment at the fairgrounds.

Yeah. They tell you when appointments are available and schedule one. They say, you will receive an email with a code on it, and you will need to bring your photo ID. And if there’s any discrepancy between the address and your name and what you’re showing on your photo ID or you don’t have the email, you will not be allowed to test. I think they’re obviously trying to prevent people just showing up.

On Sunday morning, you drive out to the fairgrounds.

Sunday morning at about 8:45.

I have to say, as someone who has experience in how you marshal crowds through spaces in efficient ways, it was a pretty exceptional job on their part. I don’t know if the fact that I deliberately took an early-morning Sunday appointment helped.

They’ve thought this through in a very precise way. They obviously have people who have really good experience, probably particularly for public-health-related crises in how to do this testing, because the signage was very simple and very clear. “Keep your windows up” was made clear right away. “Don’t take photos or videos.” Clear right away. I don’t know, but they are likely operating under the same HIPAA restraints as any other venue for providing care.

You would drive in and you would immediately see people holding signs. First thing you see, “Keep your windows up.” And then they have a little stop sign. You stop. They hold a sign outside your car, and it says, “Do you have an appointment?” and you would nod. Then you would move and they will show you another sign, just an 11-by-17 laminated sign that you can read, “Do you have your ID and confirmation email?”

Did they ask what language you spoke?

I did not observe that. I don’t know. That’s fascinating, in a town where 40 percent of the people are foreign-born [The Verily process, it turns out, requires the ability to read and speak English.]

Anyway, you go to that stop. They have caution tape, and they are rotating you around in your car. You move pretty quickly. And so the next step is after that initial, do you have an appointment and your ID, then you have someone who actually asks to see it. They hold the sign up. You never speak. You literally put your license on the window, and they verify. You put your phone on the window for your appointment number, and they verify it.

I will note that the initial volunteers were just outside wearing normal clothes, no mask, no anything. They weren’t near anyone else. As you got to the final stop where they verify your identity for the second time, it’s people who are now starting to wear protective gear. They affix the labeled bag that the test will go into somewhere on your car. They put the sticker on it, verifying your identity. That was sort of the final check-in station.

At that point, you drove inside one of the buildings, these gigantic sort of warehouse buildings where they have livestock shows and things like that. You drove inside there and there were eight or 10 testing stations, maybe more. You drive up into one of the testing places.

At that point, the workers are completely dressed in a significant amount of personal protective equipment. It was not the kind of full-suit hazmat things. You know, face shields, masks, gowns, gloves, covering their hair, feet. You definitely noticed that was the most significantly protected staff. Two people per station.

At that point, they ask you to roll down your window. They take the swab, the cotton swabs and tell you to put your head back.

They do alert you that it’s going to go quite a bit up there. I’m old enough now to know that probing tests in various orifices of your body are going to go farther than you imagine they would. So I was expecting it to be uncomfortable. And it was! At the end of the test, which was only about 15 seconds, I immediately thought, thank God we don’t have to test a lot of kids, because you probably — I don’t know how you would do it. I don’t know how you would do it. Kids would lose their minds.

At the end, she removed the swab, put it in the bag that was affixed to my car, immediately said, “Roll up your window,” and I was on my way. Maybe took 15 minutes.

How long was the line when you got there?

We’re all in our cars. So how many cars were in front of me? Maybe 20. 25. But they moved it through really efficiently. I thought it was a very efficient process.

It did go through my mind: I went to work after that. We’re taking protective measures at our offices. We have reduced head count, we do have access to masks and gloves, basic masking gloves and sanitizer. We’re taking precautions.

But I guess the question for experts is, okay, I get that test result, which I don’t have yet — that will tell me how I was up until Sunday morning. But no one told me to quarantine after the test. That was never something I was instructed to do. I thought, what’s the value? What do we learn? We learn a little bit, probably. How do we do this on a mass scale? I have no idea.

This certainly demonstrated that it can be executed very efficiently. But you know, my guess is if a massive testing regimen were something we wanted to implement, I think that would be hard to do.

In general, as someone who has better-than-average knowledge of health systems and how we deliver health care, I certainly didn’t leave the experience understanding how this fit in with anything else. But I was definitely impressed by the throughput, and I was impressed by the procedures they put in place that seemed like that they were protecting their workforce. And, you know, I left — other than having a swab jammed very far up my nasal cavity, it was it was a really well-organized experience.

It gave me some reassurance. Folks are anxious about the testing piece, and this is certainly a good resource. We’re fortunate to have it, and hopefully there will be more resources like this around the country.

Update: A spokesperson for Verily provided a statement about the English-only requirement.

“Verily removed that requirement and are actively working on translating materials into Spanish to launch in the coming weeks," it read. "We are focused on equity and are working on other languages to follow Spanish.”