To stem COVID, this small Indiana city decided to test all public-facing employees

Reviewed by Emily Henderson, B.Sc.May 19 2020

Behind a nondescript strip mall in Carmel, Indiana, a short line of cars gathers mid-afternoon next to a large tent. Medical professionals stand out front, dressed head to toe in blue medical coveralls. People in the cars — many of them first responders — drive up to be tested for COVID-19.

The test involves a really long swab placed deep into the nose, toward the back of the throat.

"No, it's not fun, but it’s quick. I would say painless, but it is a little painful," Carmel firefighter Tim Griffin said. "It’s 5-10 seconds and then it’s all done and the burning goes away and you move on."

While there were shortages of COVID-19 tests across the country in March and April, this affluent Indianapolis suburb took an unusual step to keep residents safe. All city employees who deal directly with the public — such as police officers and emergency medical services personnel and sanitation workers — were tested weekly even if they showed no symptoms. Their families could also be tested.

Carmel is among a growing number of communities that have opened the door to wider COVID-19 testing. For now, the team in Carmel is testing workers weekly, and leaders said they are reevaluating the program frequently to determine its necessity.

"I think that, as we’ve seen from the World Health Organization and others, 'test test test' is very much the message that is going out there," said Claire Standley, an assistant research professor with the Center for Global Health Science and Security at Georgetown University.

While public health experts call for more testing, the gold standard for slowing the spread of the new coronavirus is to pair testing with a strong contact tracing program. During contact tracing, public health staffers help patients recall all the people with whom they have had recent close contact, and then staffers inform those people they may have been exposed to the virus.

Carmel, a city of more than 90,000, does not have a contact tracing program. But Mayor Jim Brainard said Carmel works to contain the virus when an employee tests positive. He said the worker is asked to self-quarantine. Then the city tests family members and other close contacts.

The state of Indiana recently announced plans for its own contact tracing program.

Carmel is home to NFL athletes and CEOs and has a large arts district and top-rated schools. The median household income is over $100,000 a year — about double the national figure.

In Carmel, the lab is at the same site as the test collection, a setup that Standley said helps speed the supply chain, because test results are back in days.

"It’s not that helpful if you get a test [and] you can’t get the result out to that person until four or five days later," Standley said.

The tests are taken just a few steps from the line of cars and the large tent to a private lab called Aria Diagnostics. Lab owner Zak Khan said Aria had to quickly pivot in the coronavirus crisis. The lab switched from doing toxicology tests from doctors' offices to processing hundreds of COVID-19 tests each day. Khan's lab turns the COVID-19 tests around in 24 to 48 hours.

Aria now works with a number of municipalities in central Indiana that want first responders tested for the virus. The lab also processes the tests of people with doctors' orders or those who pay $175 out-of-pocket.

"I think it’s a really cool study in how a municipality can utilize and leverage the power it wields to great positive effect in a very short period of time," Khan said. "I don’t know how else we would do that."

The Indianapolis Star reported that Khan donated $3,000 to Brainard's mayoral reelection campaigns, sparking concerns over ethics.

Stopping the asymptomatic spread of coronavirus is the idea behind Carmel's testing initiative. Brainard, and health experts, looked to Iceland and South Korea, countries where testing was quickly expanded to include people who work in jobs where they have a high chance of spreading the coronavirus to many others.

Carmel officials said the testing isn't about protecting just first responders; it also helps protect city residents.

"We do go into homes, and not just on patients that have COVID, but we’re going into homes with people that are sick, very sick, you know, whether it be cancer, heart issues, diabetic problems, you name it," said Griffin, the firefighter. "So this way we know if one of us is asymptomatic and we could possibly spread it to one of those patients."

Griffin is one of 350 city workers being tested each week. The city had administered about 2,000 tests as of early May.

"The goal is to slow it down, so our hospitals aren’t overwhelmed," Brainard said. "If we do that, we know we can save lives."

Brainard said area hospitals did not have a shortage of tests, so he decided to check city employees regularly.

Carmel has seen a positive rate of 2.5%. The city said the majority of these cases weren't yet symptomatic or were asymptomatic.

"We’ve had several first responders test positive. We’ve had several home sick," Brainard said soon after testing began. "We have one in the hospital right now, and we’re hopeful that he recovers soon."

This program is costly — Carmel expects to spend $500,000 to $600,000 from its health insurance fund for a month of testing. The fund, which usually pays for doctor visits or surgeries, now has fewer elective procedures to pay for, so the city said it can handle the costs.