When Philip Hart woke up with a sore throat at about 9 a.m. Thursday, he knew he needed a coronavirus test. So the UPS worker booked an 11:30 a.m. appointment at Seattle’s test site on Aurora Avenue North, which accepts drive-thru and walk-up patients. By 11:45 a.m., he was done.

“That was like snorting a long piece of spaghetti,” the 52-year-old said, blinking teary eyes after a firefighter shoved a 6-inch test swab up his nose. “Honestly, though, this was really quick and really easy.”

Quick and easy is how most people would describe the free coronavirus tests provided at four sites run by the city, which helps explain why the sites welcome so many visitors, and why Seattle may try to adapt them for vaccinations.

As of Friday, the city’s sites had completed more than 463,000 tests since June, with about 1 in 4 Seattle residents visiting the sites at least once, according to data requested from the city by The Seattle Times. The sites can test more than 6,000 people per day.

Doctors, hospitals and clinics also do coronavirus testing. But it’s possible that the city’s sites have conducted close to half of all tests on Seattle residents, based on Public Health – Seattle & King County data from November, according to Michael Sayre, medical director for the Fire Department.

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The sites are a bright spot in a rough year for Mayor Jenny Durkan’s administration that has included pandemic shutdowns and the West Seattle Bridge’s closure. Durkan has drawn criticism for issues like police violence against Black Lives Matter protesters, an activist occupation on Capitol Hill and her objections to the City Council’s new tax on big businesses. The city is using the tax to bolster its 2021 budget amid COVID-19 revenue woes.

In a recorded video Monday announcing she wouldn’t seek reelection in 2021, Durkan called Seattle a national leader on testing. She said “beating COVID-19” would be her priority next year, with the city’s test sites likely to play a crucial role. They didn’t exist seven months ago but, like masks and Zoom calls, the sites have become essential during the pandemic — almost normal.

“Everybody is here. You see how many cars are here,” said Abby Myshrall, a registration technician at the Aurora site, which is located in an old vehicle-emissions check station. “I talk to about 300 people a day. It’s kind of hard because I’m an extrovert and I’m chatty. But I have to keep the line moving.”

The launch

Seattle’s testing sites didn’t open up immediately when COVID-19 hit. Instead, the city’s program took shape as the crisis evolved.

Durkan and fire Chief Harold Scoggins initially assigned firefighters to test first responders, then workers at nursing homes where outbreaks were the worst, Sayre said. Mass-scale testing came next.

“Once we learned how to test, it wasn’t a big step to decide to test others,” Sayre said.

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Serendipitously, the state had terminated its vehicle-emissions check program on Jan. 1, shuttering stations on Aurora and in Sodo. The stations were ideal places for the city to provide drive-thru coronavirus testing, because they had space for vehicles to wait in line and booths for service.

There were models in countries like South Korea, and in cities like Los Angeles, which began testing in April. Seattle partnered with University of Washington Medicine’s Virology Lab to process the samples, which gave the city a boost.

There also were challenges, said firefighter Mike McCaslin, who helped launch the Aurora site in June. The city had to hire temporary registration techs to handle the clerical work, many with no experience in health care. The firefighters taught them how to use protective equipment.

Right away, the Aurora drive-thru was swamped with vehicles, so McCaslin improvised a walk-up option. “We had traffic backed up, so I grabbed a table and started swabbing,” he said. “It worked really well.”

The Aurora site now does drive-thru and walk-up tests. In July and August, the city added walk-up sites in Rainier Beach and West Seattle. This month, the test company Curative opened no-cost kiosks in Northgate and the Central District.

What works

As residents jammed Seattle’s sites, Mark Del Beccaro took notice. The coronavirus test director for Public Health – Seattle & King County knew the agency needed to reach more people in South King County, where the virus was raging.

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South King County residents tend to have less money, less health care access and less remote-work options, increasing their vulnerability to COVID-19, Del Beccaro said. Doctors and community clinics were testing, but the logistics were less than clear; some people were being charged and the results were slow.

That’s why Public Health adopted a version of the Seattle model, opening sites with nonprofit partners in September and October in Renton, Auburn, Tukwila and Federal Way. An Enumclaw site opened last week, and a Bellevue site will open this week.

The mass-testing sites are popular for several reasons, Del Beccaro said: They’re designed to move quickly, patients can register online or “just show up,” they’re open to everyone and they’re free. The tests are provided by the city and the county with federal dollars, while patient insurance policies cover lab fees. People without insurance have their expenses covered.

Lowering barriers allows the sites to attract more patients, and testing more patients allows officials to better track the virus, said Del Beccaro. The results usually arrive in 48 to 72 hours.

“The only way we’re going to keep the virus from spreading and get the economy open again is to break the chain,” by identifying who needs to quarantine, isolate and receive support, Del Beccaro said.

The data

As of Friday, an estimated 183,000 Seattle residents had received coronavirus tests at least once at the city’s sites. An additional 81,000 King County residents from outside Seattle and 42,000 non-King County residents had been tested at the city’s sites. More than 116,000 people had been tested at Public Health’s sites.

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“I have a sore throat. I don’t think it’s serious but I wanted to be sure,” Jordan Garcia, 27, said after a nasal swab at the city’s Aurora site.

Some people visit repeatedly.

“I had one guy tell me it was his 23rd time,” McCaslin said. “They say it’s the best medical experience they’ve ever had.”

The positive-test rate at the city’s sites over the past two months has been 4.6%, while the rate at Public Health’s sites has been 12.2%. Together, the Seattle and Public Health sites had as of Friday conducted about 600,000 tests.

Back in June, “I had no idea this was going to fill such a gap,” Sayre said.

Measuring how the Seattle area’s public testing stacks up against testing in other major U.S. cities isn’t simple, because each metropolis has its own strategy.

Los Angeles city and county have conducted about 5 million tests, spokespeople said, while Washington, D.C., has conducted about 290,000. Portland has conducted none and Multnomah County only 3,000, though Oregon Health and Science University does low-barrier testing, a Multnomah County spokesperson said.

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What’s next

Testing is more important than ever at the moment, with coronavirus case numbers surging. King County’s positive-test rate reached 14.5% in mid-November and Seattle’s hit 10% as residents rushed to be tested.

The Washington state Department of Health reported 4,181 new COVID-19 diagnoses Saturday. The state has tallied 199,735 total cases and 2,879 deaths, with 53,282 cases and 912 deaths in King County.

Leading up to Thanksgiving, the line of vehicles waiting to enter Seattle’s Aurora site stretched several blocks. This month, the city is asking residents to visit the sites only when they have symptoms or have been exposed to the virus, rather than to prepare for ill-advised holiday trips.

Firefighters initially handled all the tests at Seattle’s sites, working overtime. Emergency medical technicians from American Medical Response, a contractor, now conduct about half of the tests. Fire Department supervisors manage the sites.

The program isn’t cheap. Leasing the emissions-check stations, buying the swabs, paying the workers and equipping them totaled more than $4.6 million through October, including about $1.4 million in firefighter overtime, according to the city.

The city is using Federal Emergency Management Agency funds to cover about 75% of its costs and federal CARES Act dollars to cover the remaining 25%, Durkan’s office said.

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Del Beccaro is worried about how Public Health’s sites will remain open without additional assistance, he said. They cost more than $1 million a month. “Unless the other Washington comes to an agreement, we technically run out of money on Dec. 31,” he said. “We’re trying to scramble to put money together. Shutting down would be catastrophic.”

Seattle has budgeted $5 million for its test sites next year, not knowing what Congress may do. With other big-city mayors, Durkan wrote a letter Thursday asking President-elect Joe Biden to send COVID-19 aid as soon as possible, including money for testing. Durkan was not available to be interviewed for this story, a spokesperson said.

Looking ahead, Seattle may try to help with coronavirus vaccinations, said Sayre, who “can imagine” adapting the city’s test sites for that purpose but isn’t sure yet. “We’re still working through” what that would entail, he said.

Doctors, clinics and drug stores have more experience with mass vaccinations than mass testing because they handle influenza shots, Del Beccaro noted.

Still, the Fire Department “is a problem-solving organization,” Sayre said. “We’re contemplating how we can contribute.”