'We're underprepared:' Urgent care centers find themselves on the front lines of a pandemic, but few have tests to treat the crowds coming in

t
• Urgent care centers are finding themselves on the front lines of the response to the novel coronavirus, whether they're ready or not.
t
• Over the past few years, these centers have pitched themselves as an alternative to the emergency room. Now that claim is being put to the test.
t
• When faced with the coronavirus pandemic, many don't have access to tests for COVID-19. And they've been grappling with how to handle the influx of patients worried they might have the virus.
t
• Visit Business Insider's homepage for more stories.

Dr. J.D. Zipkin, the associate medical director for a chain of urgent care centers, noticed a big difference on Thursday.

That day, as Broadway went dark and sports games got canceled, the clinics he oversees in New York went from treating one or two patients with suspected cases of the novel coronavirus to seeing entire families worried they might have come in contact with the disease. The cases, he said, are escalating.

As of Friday, New Yok had reported more than 400 cases.

As the virus spreads, the urgent care centers he works with have had to figure out how to handle potential cases of the novel coronavirus, which is highly contagious.

For years, urgent care centers have pitched themselves as a cheaper and more convenient alternative to the emergency room, for everything from a sore throat to a deep cut or minor fracture. Now, the highly contagious coronavirus pandemic is putting them to the test, and they're not all ready.

"It's the first pandemic that urgent care has been stably around for," Zipkin said.

Zipkin's clinics are better prepared, because they're affiliated with the giant Northwell Health hospital system. Other clinics don't have tests, or are trying to limit patient visits to conserve supplies of crucial protective gear.

Zipkin, who works for Northwell Health - GoHealth Urgent Care, said his centers are sending in more than 100 samples a day to be tested for the coronavirus.

To prevent patients from infection others, the centers text patients ahead of time to ask if they have symptoms like a fever, shortness of breath, or dry cough. Those patients are greeted with a mask outside the door.

"Urgent care centers are the frontline of healthcare, period," Heather Fernandez, CEO of Solv, a healthcare startup that connects people to urgent care appointments, told Business Insider. "It is where they have been going, it is where they are going first. Every urgent care in the country needs to recognize that that's the reality and have the appropriate protocols."

Urgent care has cemented itself in the US health system

Over the past two decades, urgent care centers have been catching on as Americans increasingly seek convenient ways to get healthcare. As of 2018, there were more than 8,700 urgent care locations around the US.

But the services offered by the centers typically don't extend to highly infections conditions like tuberculosis and measles that require higher levels of protective gear and rooms to handle infections.

The Centers for Disease Control and Prevention says that doctors should use a higher level of protection for coronavirus than they'd use for a patient with the flu.

"When we had a novel flu like swine flu, we were the place to go," Dr. Sean McNeeley, the former president of the the College of Urgent Care Medicine who's heading up the organization's COVID-19 task force told Business Insider.

In those cases, the medical providers at urgent care centers could wear protective masks, while for coronavirus, CDC says respirators and other protective gear are appropriate.

If the coronavirus requires that level of special equipment, McNeeley said, "we may not be the place to do it."

Urgent care centers, he said, are following the guidelines set by the CDC. And the role urgent care centers might be able to play is variable, based on whether each center is a part of a larger health system and included in emergency preparedness planning - like at Northwell - or if they're standalone.

Treating potential coronavirus patients

Already, however, people with concerns they have the novel coronavirus are showing up to urgent care centers.

Meira B, a 29-year-old librarian in Suffolk County, New York, went to a nearby urgent care center on Friday at the urging of family members who were worried her cold might be more than a cold. Business Insider isn't using her last name at her request to protect her privacy.

She called ahead and was told to fill out a form asking if she had certain symptoms, had recently traveled, or had been in contact with people who had been to one of the countries where the virus was widespread.

At the clinic, patients were asked to wait in their cars to avoid infecting others.

After about an hour, she got a call telling her to come in. Inside, a medical professional covered in protective gear gave her a flu test, which came back negative. She wasn't tested for the coronavirus and was sent home with a prescription for cold medicines.

The choice to visit the urgent care was driven by the coronavirus pandemic.

"If this weren't the current state of our world I wouldn't have gone to the doctor," Meira said.

An urgent care doctor based in Los Angeles who spoke under the condition of anonymity because he hadn't been given permission to speak with the press, told Business Insider that his clinic isn't equipped to test patients for the coronavirus.

Instead, doctors are talking to patients, figuring out if they're likely to have then disease, and then sending them to an emergency room or testing center. All the urgent care site can do is rule out flu, he said.

"That's the general frustration from urgent care is we don't have an ability to test patients that we have a high clinical suspicion might have it," he said. "In that way we're underprepared."

New York-based urgent care operator CityMD on Friday told patients experiencing mild cold/flu symptoms not to come in for a coronavirus test.

"Currently, widespread testing is unavailable and may even be counterproductive, because the demand for testing will overwhelm our ability to care for the sickest, most vulnerable patients," the company said on its website.

At the same time, patients are being directed to avoid the emergency room and seek care elsewhere.

"People are scared. They're hearing not to go to the emergency room, so they're turning to urgent care," Erik Vanderlip, the chief medical officer of Portland, Oregon-based Zoom+Care, which operates convenient care clinics.

Vanderlip said that to keep his clinics from running low on protective gear, the company has been directing patients to get care either through video chats or text-based visits. The clinics can't test for coronavirus yet, but plan to next week, he said.

On Thursday, the Urgent Care Association, the industry's trade group, partnered with Solv to provide free video telemedicine services and a COVID-19 assessment bot with the hopes of helping urgent care providers offer more care virtually, reducing the number of patients going to clinics.

Hospitals could be overwhelmed by the pandemic

Zipkin, with Northwell Health - GoHealth Urgent Care in New York, is confident his centers can take on the patients.

The ultimate goal is to keep hospitals from getting overwhelmed by patients who don't need a higher level of care.

By some estimates, millions of Americans sickened by coronavirus might need a hospital stay. That could put a strain on staff, tax supplies of equipment, and even put facilities at risk of running out of room.

"We have to protect our ERs. We have to protect our hospitals," Zipkin said.