Families stood in line wearing masks. White pop-up tents sheltered health care workers while they drew patients' blood.
It wasn't the scene at a medical clinic, but the parking of a black church in South Dallas in late May. Friendship-West Baptist Church was the first of several black churches in the area to host a free weekly coronavirus testing event.
"Knowing what I know, that this disease is hitting us disproportionately and killing us disproportionately, it would be irresponsible and reckless for us not to step up and take this into our own hands," says Frederick Haynes, senior pastor at Friendship-West, who organized the event as part of the Together We Test initiative.
Neighborhoods in South Dallas, where there are more people of color, have fewer sites offering coronavirus testing than whiter North Dallas, just a few miles away. They also have less health care access more broadly.
These disparities mean the experiences people have when seeking a test can be quite different, depending on where they live, as well as their income or fluency in navigating the health care system.
South Dallas churches take on testing
Arthur Gillum attends Friendship-West and had long wanted to get tested for coronavirus. He said when the disease started its spread in the spring, he heard testing had been limited to certain people, like health care workers.
"I was ready to do it as soon as I could," he said. "And when this opportunity came, we were glad."
His wife Alice is in her 70s and is the driver in the family. She was happy to avoid driving on the highway to testing sites in North Dallas. "You'll notice that we are here because it is accessible. And you'll probably get a lot of people each time they're doing this test because it's close by," she said.
Public health experts say increased access to testing, and not just for the symptomatic, is key to finding and tamping down any emerging clusters of infection before they grow. And since the coronavirus has hit people of color especially hard, it's vital in their communities.
"We've got to shift that paradigm to where we are willing to test anybody who presents who wants a test," says Angela Clendenin, an instructional assistant professor of epidemiology at the Texas A&M School of Public Health. "How can we deliver this all the way down to that neighborhood level?"
She adds that access to testing can mean any number of things beyond location. "Access is about time, the ability to leave work, the ability to take time off," she says.
In major cities across Texas, there are disparities in access to COVID-19 testing, including fewer testing sites in neighborhoods where more people of color live than there are in whiter neighborhoods. Nationally, black people have suffered an outsized share of deaths from coronavirus compared to their share of the population. Latinos are seeing a higher proportion of case numbers.
In Dallas, these inequities are made worse by the fact that the private health care system places more services in whiter areas.
Haynes says he appreciates what local officials are doing to bring tests to South Dallas, like having two large federally-funded drive-thru sites, one in South Dallas and one downtown, and new temporary testing sites there as well. The City of Dallas also has a mobile service.
But Haynes says many black people don't necessarily trust official channels, due to past abuses by the medical industry.
"Let's use our trusted institutions," Haynes says. "The most trusted institution in the black community is the black church."
Getting tested in North Dallas
For some in North Dallas, a predominantly white area, not having symptoms of COVID-19 still made it difficult to get a test. The difference there, however, is that money and health care services are often more accessible.
Lindsay Pope lives in the Lakewood neighborhood of North Dallas and had an elective surgery planned in April. As the date approached, her doctor suggested she get tested for COVID-19.
"He didn't require the test but he recommended it if we could get one," she says. "And for my own piece of mind, I was like, 'ok, yeah, I'll do that.' But then I couldn't figure out even where to go."
Her surgeon didn't know where to point her, nor did her husband's primary care doctor who she asked next. Pope found it hard to figure out where a healthy, non-symptomatic person who isn't an essential worker could get a coronavirus test. (Dallas County recently published a comprehensive list of testing sites).
Then a friend suggested Pope use a service that comes to your home to do the test but charges the patient directly rather than the insurance company.
"They came out within 45 minutes of when I booked my appointment," she says.
Pope and her husband got three tests in all — the diagnostic test her surgeon had recommended, and two antibody tests, which can indicate if you've been infected with the coronavirus in the past. Add in an appointment fee, and the total bill was almost $700 — $200 for the diagnostic test alone — which Pope paid using a flexible savings account set up for health care expenses. She says she might try submitting the bill to her insurance company.
Pope says it's certainly not attainable for most people, and she wouldn't have done it without having a surgery scheduled.
"If you don't have a network that knows the medical industry or anything like that, I think it would be difficult to even know where to begin," she says.
And that's even without a language barrier or difficulty getting on the internet to find information. The city is now offering an on-demand service like this for free to people who have symptoms or had recent contact with an infected person.
State says it will tackle disparities
Texas Governor Greg Abbott announced June 8 the state will expand testing in underserved communities. It's a promise to bring equity to the two sides of Dallas and other cities.
Texas' case numbers have been increasing in the last two weeks, something the state partially attributes to increased testing in high-risk places like prisons. Still, the state is among the lowest in per capita testing, and its seven-day testing average is still slightly below Abbott's declared goal of 25,000 tests a day.
Some experts have said Texas needed to be conducting over 27,000 tests a day before reopening, which it started to do on May 1.
This raises the question of whether the state is missing flare-ups. Clendenin says as many people as possible need to be tested in order to know the extent of the outbreak.
Audrey Carlsen contributed to this report.
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