Tuesday is the last day of operations for Carilion Clinic’s drive-through COVID-19 testing facilities on Postal Drive in Roanoke County and Barn Road in Montgomery County.
As numbers decline and the pandemic becomes endemic, one local health care leader says the dedicated test centers are no longer necessary, especially with home testing available. Another celebrated the teamwork of employees who worked often grueling hours to see the community through the worst days of the pandemic.
The closures “represent that transition to endemic COVID,” said Dr. Cynthia Morrow, health director of the Roanoke City and Alleghany Health Districts. COVID is “going to continue to ebb and flow. But the important thing is, we have so many tools now, three years later. We have tools now to get tested at home, we have tools to help decrease the severity of it. And so I think it’s appropriate that these extraordinary plans to respond to COVID, like opening up special testing sites, I think it’s appropriate for testing to be incorporated into routine medical practice.”
Testing began in March 2020 at Postal Testing Center (also called Carilion Clinic Testing Center – Roanoke), a building that formerly housed an orthopedics practice, in the Cave Spring area of Roanoke County, and at the Barn Road Testing Center (also called Carilion Clinic Testing Center – Christiansburg) near Carilion New River Valley Medical Center. (Disclosure: Carilion is one of our approximately 2,500 donors but donors have no say in news decisions; see our policy.)
“The testing centers were really necessary because we had such a surge in patients,” said Kim Roe, vice president of family and community medicine for Carilion. “The average testing volume that we have now at Postal ranges anywhere from about 25 to 40 people a day.” At the height of the pandemic, during the delta and omicron surges, the centers were seeing 500 to 600 patients a day.
“We served as sort of that overflow for the physician offices, because they certainly couldn’t handle that large volume of sick patients,” Roe said.
Roe credited teamwork by various Carilion departments, including technology and property management, for helping get the centers up and running.
“Everybody pulled together amazingly to put these together in about a week,” said Matt Lowery, director of the testing centers. “Even the Cox cable guy just happened to get a requisition and he was parked around the block. He said, ‘I’ll just come over and do it.'”
In the first week of operations, patients “were pulling in the parking spaces and then we were going out there and swabbing them from their cars,” said Lindsey Dobbins, clinical practice director at Postal Testing Center. “And then we figured out, with the volume, we need to figure out another plan. So that’s when we decided to do the drive-through. It may have been the second week.”
Employees collected nasal swabs from patients through car windows. Rapid (antigen) tests were processed on-site, while PCR (polymerase chain reaction) tests were sent to Quest Diagnostics for processing, Dobbins said.
At times it was hard to get enough staff. In addition to nurses and medical office technologists, Dobbins said she thought X-ray technicians, EMTs, paramedics and respiratory therapists had all pitched in.
“There were very stressful days. If you’re here closing at 6 o’clock, you’re not getting out till 9 or 10 o’clock and then you got to come back in the next morning to do it all over again. It was stressful, but trying to keep in the back of our minds of the reason we are here to help support the community.”
Between the two sites, some 340,000 tests were processed, Carilion spokeswoman Hannah Curtis said. The centers supported Virginia Department of Health and local health department testing efforts.
During the peak of the pandemic, the centers operated seven days a week beginning at 5 a.m., and on some days, final tests were processed by 11 p.m., according to information provided by Curtis.
Staff worked in rain, in the dark with flashlights, and sometimes in the snow. The centers also offered flu and strep testing. In addition to testing patients referred by their doctors, the centers tested Carilion employees, enabling them to get back to work quickly. For about a year, the Postal Center also offered monoclonal antibody treatments in rooms with negative pressure, Dobbins said.
Karen Harris of Roanoke went to Postal Drive for testing in summer 2020 and again in summer 2021. “Both times that I went, the people were so professional there,” she said. “And all I could think of was the long lines and how draining it must be” for the workers because of the gear they had to wear.
Personal protective equipment consisted of gown, gloves and an N95 mask or a powered air purifying respirator.
The longest wait time, at the peak of the pandemic, was about two hours, Lowery said. Postal served up to 550 cars per day, Barn Road 250.
The Virginia Hospital and Healthcare Association’s online COVID-19 dashboard reports a seven-day moving average of confirmed COVID hospitalizations. For the organization’s Near Southwest Virginia region, it shows a peak of 462 hospitalizations on Jan. 14, 2021, and another peak of 549 a year later, on Jan. 24, 2022. The pattern of January peaks continued in 2023, with 204 hospitalizations on Jan. 9, 2023. As of Feb. 28, there were 74 hospitalizations.
Dr. Anthony Baffoe-Bonnie is Carilion’s section chief for infectious diseases and the medical director for infection prevention and control. “The numbers in our ICUs, the numbers in other critical areas, are markedly down, significantly down compared to what we saw at the height of COVID,” he said.
“That COVID that we knew in 2020, the beginning, March, April, where there was a high death rate, is not necessarily the same thing we are seeing now, because of the immunity that has been provided us by vaccines, as well as individuals who are already infected.
“And that’s very reassuring and good to know. Having said that, again, that does not mean COVID is gone. And this represents really a new normal, or trying to have a new normal for what we do.”
The closures are an admission that COVID is here to stay, he said. “However, we now, unlike before, have more tools in the toolkit to sort of normalize this as much as possible.
“Now there is capacity for testing in doctor offices that was not available before, both PCR and antigen testing. And then there is also the availability of testing even in a person’s home. And with that, we feel it’s time to roll back on our testing, since this [home testing] is now widespread, and then direct our resources in other areas to help with this ongoing condition.
“So first thing that we would encourage anybody to do when they’re symptomatic, is to do a home antigen test,” he said. “Home antigen tests are very sensitive, but they are not 100% sensitive. So if you’re positive you’ve got it, call your doctor immediately. If they’re negative and strongly suspect it, still call your doctor. And the different physician offices will have different work flows that allow to bring in patients safely to get tested.”
Asked if patients should be more concerned now about encountering a COVID testing patient at their doctor’s office, Morrow said, “I think a lot of people don’t need to go to their doctor’s office to get tested, they can just get their at-home tests and stay home for those five days.” Someone who is not confident about their home test result and really needs a laboratory test should talk to their doctor about testing arrangements, she said.
“I do think that over the last three years, we’ve learned so much, and so infection control practices, how we can control or eliminate transmission within the health care setting, has certainly improved,” Morrow said. “And so, I think that a lot of health care provider offices, particularly primary care, know now how they can manage individuals who need to get tested.”
“We have a number of mitigation strategies that we have in place, where if you’re very symptomatic and sick, you can have a virtual visit with your physician,” Roe said. “And then we can bring you in for testing at some of the physician offices. We’ve equipped all of our offices with negative pressure spaces so that we can bring in people with respiratory illnesses specifically into those places.”
Roe said the closures represent “a celebration that we’ve come through the pandemic together,” citing the staffers who worked the centers and collaborated with the Virginia Department of Health to serve patients, employees and physicians. “So that’s the celebration part. That’s what I think is most important.”
The Postal center employed about 15 people on a typical day during the peak of the pandemic, Dobbins said. On Feb. 27, there were only a handful in the mostly empty building.
“We are cautiously optimistic that we won’t have to bring anything like this up again,” said Lowery. “But for its time it served a great purpose for public health.”