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Scenes from a Broken Public Health System
How administrative apathy undermines pandemic protections
It was a dreary September morning, but my spirits were bright as I pulled up to the Rite Aid for my vaccine appointment. In the absence of any remaining public health guidelines of substance, and perhaps even without that caveat, getting the bivalent booster has been the best way to protect yourself from severe COVID-19 illness this winter. So I reserved a timeslot through the online portal as soon as they were made available to the general public. (If you are among the 84 percent of Americans who have not availed yourself of this miraculous technological development, I strongly urge you to get yours as soon as you can.)
I was heading towards the waiting area after checking in for my appointment when the pharmacist called me back to the counter. Oh, by the way, she said, they didn’t have any COVID boosters — the store was not expecting a shipment of the bivalent vaccines for several more days. The pharmacists had no idea why the Rite Aid corporate website indicated otherwise, and they did not have access to override the system and stop people from booking appointments for shots that did not exist.
For me, this incident was a minor inconvenience. I found another pharmacy that had an opening after a last-minute cancelation (and confirmed that they actually had the boosters in-store). I had no other pressing plans for the day, so I had time to make another stop. I have a car, which meant traveling a couple extra miles on short notice was not an issue. The DNA-morphing Bill Gates 5G receptors were coursing through my veins within the hour.
Yet my flexibility in that moment was an undeniable privilege. I had no work or caregiving commitments to rush back to. It was no trouble for me to get transport to another location. The ability to find another same-day appointment was a stroke of luck — I did not burn any unnecessary time off, nor did I have to block off any future dates to go for and recover from the vaccine. And perhaps most importantly given that the CDC’s own research shows that the U.S.’ dismal participation rate is primarily due to people not knowing that they could or should get the new booster, I am married to a frontline healthcare worker who would have eagerly corrected me had I wavered on whether the newest shot was really necessary.1
I don’t know how many customers at how many Rite Aids over how long a time were affected by this glitch, but the real-life consequence is that it delayed some number of people from getting the medical protection they sought in the midst of a very-much-still-ongoing pandemic. Given what we have known for nearly two years about how ease-of-access impacts COVID vaccination rates, how many of them decided it wasn’t worth the trouble to try again?
One pandemic-related benefit that thankfully remains active — at least for the moment — is the federal mandate entitling Americans to eight no-cost at-home COVID tests a month through their health insurance. Although I am about to spend the next several paragraphs complaining about the system’s flaws, I want to be clear in strongly recommending that you take advantage of it while you can. Having regular access to tests means you can use them as a precaution: Before visiting immunocompromised people, when you have the sniffles, prior to traveling. And of course you will be glad to already have them if you get sick! You can buy rapid tests anywhere and submit a claim through your insurance, but the easiest way to get them is to place an order online with no up-front cost at CVS, Rite Aid, Walgreens, or whatever the chain pharmacy nearest you is.
Without diminishing the legitimate usefulness of this program for those who have access to it, it was very much a compromise solution — recall that the ostensibly pro-science Biden administration had to be dragged kicking and screaming into providing even a limited number of tests directly to the American people — and its implementation reflects that. It is targeted towards people who have health insurance. Its scope is limited to a certain number of tests over a certain period of time. The customer is left to keep track of their own waiting periods between requests, as there is no reminder when your cycle restarts nor an option to order tests automatically when you are eligible. And like any non-universal opt-in system, you have to know about it to benefit from it, which many people do not.
Then there is the ordering process itself. We typically use CVS for our prescription needs, so we get our tests there as well. Their request form is laggy, slow, and often broken. It’s spread over multiple webpages, and even after going through the process at least a dozen times, I still have to double-check which of the confusingly labeled textboxes don’t apply to me, and which of the byzantine input fields correspond to things that are on my insurance card but under different names.
Especially since, if your request is denied, the site does not offer any explanation of why. Seriously, here’s the message the CVS website displays if your order is declined:
Maybe you made a typo. Maybe you misunderstood which numbers to put into which boxes. Maybe you’re not eligible to get tests now, or ever. Maybe the site is just glitching out again! The only thing you know for certain is that such a system was not designed with the first principle of encouraging people to use it.
For us personally, the quirks of this system were minor annoyances. We are fortunate enough that having to resubmit the form a few minutes or even a day later does not hinder us from going about our lives. Or at least it hadn’t.
A couple weeks ago, I realized that our 30-day request window had just reset. I logged onto the CVS website that night and ordered two sets of eight tests for my wife and me, as we do every month. I got an email that my order was ready for pickup a few hours later, and I walked to the store the next day. A big bag with my name on it awaited me behind the counter. The process had worked very smoothly. Except for one thing: There was only one batch of tests. The online form had thanked me for the order I placed under my wife’s name, and our online insurance dashboard showed a paid and authorized claim for antigen tests, but there was no record of the second order in CVS’ system.
I pulled out my phone to place a new order, but each time I tried my request was denied, presumably because we had already reached the monthly quota from our insurance. A very patient clerk combed through every shelf behind the counter and triple-checked the store’s digital records before directing me to the pharmacy window. The pharmacists promptly sent me back to the front desk. The cashier took me aside while she called the corporation’s internal employee hotline. Several rounds of back-and-forths confirmed that, despite being owned by the same conglomerate, the order number we were provided by Aetna was no help in CVS’ systems. All the while, my eyes kept wandering towards the shelves behind the register, which were chock-full of more different brands of COVID tests than I knew existed.
Maybe 45 minutes after I had walked through CVS' distinctive automatic doors, I was given a special number for a team who helps with complex online orders. If they could push the authorization through, the voice from the cashier’s phone assured me, they could pack up my tests on the spot. I stepped outside and was connected to an incredibly kind customer-service agent who was confident that she could help me. We talked about football while she clicked through the corporate system and I paced around a cobblestone alley behind the pharmacy.2 But after close to hour, she apologized and told me that it was our insurance’s problem to solve. I walked home defeated.
The next day we called Aetna in hopes of at least getting an alternative order-identification number that might be compatible with the pharmacy’s systems. After confirming several times that we had tried calling CVS, the agent said there was no way to reapprove an authorization that had already gone through. Her creative solution was to simply deauthorize the ghost order, resetting our 30-day clock so that we could request another set of tests.
It took a few hours for the phantom claim to clear the system, and by the time I put in a new order, our normal CVS was not accepting test requests. The closest store I could choose was a mile away from our apartment, and I decided to brave the rain and walk over that evening to get this prolonged saga over with. It was just past six o’clock when I arrived to find the store closed. I stopped under an awning and confirmed on both the website and the CVS phone system that they were open until eight o’clock, but the listed hours were cold comfort as I trudged home wet and empty-handed.
By the time my wife picked up the tests the next day, we had cumulatively spent at least four or five hours on the supposedly straightforward task of procuring our allotted pandemic-diagnosis tools. It wasn’t that supplies were limited, as there were plenty of tests available to purchase. It wasn’t that our insurance was refusing the expenditure. The issue certainly was not the at-least-seven people on CVS Health Corporation’s payroll who got roped into helping us. The problem was that no one in a position of power had ensured that the test-ordering and -authorization process — one of the few programs left for helping the American people navigate the COVID-19 pandemic — was actually working.
I am under no illusions that our personal experience is interesting or important. We are fortunate to have access to at-home COVID tests at all. We had both the time and the understanding of the healthcare industry to deal with the bureaucratic morass instead of deciding it wasn’t worth the effort. The mere fact that we were ordering tests out of an abundance of caution rather than an acute need meant the only consequence of the delay was the time we wasted. (It could have been a problem for the staff and other customers with whom I spent nearly an hour in the poorly ventilated store had I been actually sick!) But what would have happened — what, given the extreme improbability of a glitch like this affecting only one order across the whole country, must be happening — to people without such privileges?
Three months from now, this will all be moot: The Biden administration announced this week that they will lift the COVID-related federal emergency declarations on May 11. This will spell the end of subsidized access to many precautionary and treatment measures, presumably including this no-cost antigen test program. (You may notice the juxtaposition between the assertion that COVID is benign enough that the general public no longer needs easy access to such things, and the safety measures that thousands of international political and corporate bigwigs undertook for themselves at the exclusive World Economic Forum conference a couple weeks ago.) Not that Biden would likely be empathetic to these issues regardless. Over 50,000 Americans have died of COVID (to say nothing of the rest of the world) in the four months since his false, Trump-esque declaration that the pandemic was “over”, yet as of last month he had “stopped thinking about” the death toll. And that’s coming from the leader of the party that ostensibly cares about compassionate public health.
This essay isn’t about lockdowns or school closures. I have no interest in arguing about whether you should go out to dinner or spend time with your friends. We are over 2,000 words in and this sentence is the first time I’ve typed the word “mask.”3 All I’m asking is that you give a shit about the people around you who are trying to keep themselves and their loved ones safe from the pandemic, and that you recognize how our political and public health leaders continue to fail us through their disinterest. Our culture is becoming increasingly immune to caring when our institutions let the people who rely on them down. We owe it to our communities not to let the contagion of apathy spread.
Amidst the difficult conversations about the unequal benefits and burdens of a socially distanced economy, remember that it is also a privilege to remain insulated from what life is like in the hospitals, where they bear the brunt of the lack of spread-mitigation measures.
Though now that I’ve broken the seal, I would suggest that covering your face in crowded spaces is both the smart and the kind thing to do when transmission is high.
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