How the wealthy and politically connected are all getting coronavirus tests

On March 31, CNN anchor Chris Cuomo revealed he tested positive for COVID-19 in a statement shared on Twitter. “I have been exposed to people in recent days who have subsequently tested positive and I had fever, chills and shortness of breath,” he wrote.

Thousands responded to Cuomo’s tweet and wished him a speedy recovery. Even his older brother, Gov. Andrew Cuomo, took to Twitter to tell him to “stay strong.”

We are all vulnerable to this virus.

I couldn’t protect my little brother. He couldn’t protect himself. And it's scary.

I'm worried about him just as we are all worried about the people we love.

I love you, little brother. Stay strong.

— Andrew Cuomo (@NYGovCuomo) April 1, 2020

The governor has since used his younger brother’s diagnosis to suggest that COVID-19 is a “great equalizer” and a sign that no one is immune to the virus. Ironically, Chris Cuomo’s case actually illuminates the state’s class divide when it comes to medical care. While many less affluent remain unable to get a test – even when hospitalized – the state’s wealthy elite seem to have no problem getting tested at the first sign of any symptoms.

On March 24, the Centers for Disease Control and Prevention stated that hospitalized individuals and symptomatic health workers should receive top priority when it comes to receiving a COVID-19 test. In New York City, most patients will not be given a COVID-19 test unless they’ve been hospitalized.

So how did Cuomo, who continued reporting from his finished basement, manage to get tested? The answer is unclear.

Meanwhile, research suggests that those in “lower economic strata are likelier to catch the disease,” according to The New York Times. In New York City, those most affected by COVID-19 reside in Queens’ Jackson Heights, Corona and Elmhurst neighborhoods, where many are essential workers like janitors, food service and child care workers. Those families also tend to live in tighter quarters, due to financial constraints, making them more susceptible to catching the virus.

“We know that in Queens, many families – because of poverty – live together in very close quarters,” New York City Health + Hospitals President and CEO Mitchell Katz told The City. “So that while we are practicing as a city, social distancing, you may have multiple families living in a very small apartment. And so it’s easy to understand why there’s a lot of transmission of COVID occurring.”

Residents of the Bronx, New York City’s poorest borough, are also twice as likely to die of COVID-19 than anywhere else in the city, due in part to jampacked living quarters and a greater prevalence of preexisting conditions like asthma and diabetes. The Bronx is home to the poorest congressional district in the country. “We need to recognize that there are these inequalities and then pump resources where they’re needed,” state Sen. Gustavo Rivera told City & State during its “Legislative Perspective On Coronavirus Pandemic” webinar on Tuesday. “I mean, we are asking the government to actually expand testing abilities in the Bronx and to think about a larger field hospital in the Bronx.”

New data from Michigan has shown that African Americans are also dying from COVID-19 at a disproportionately high rate, suggesting that those more likely to suffer from inequality and racism are hurting the most right now. “COVID is just unmasking the deep disinvestment in our communities, the historical injustices and the impact of residential segregation,” Dr. Camara Jones, a family doctor and epidemiologist who worked at the CDC for 13 years, told ProPublica, addressing racial bias in medicine. “This is the time to name racism as the cause of all of those things. The overrepresentation of people of color in poverty and white people in wealth is not just a happenstance. … It’s because we’re not valued.”

Chris Cuomo is hardly the first notable New Yorker with mild COVID-19 symptoms who was able to obtain a test. Rick Cotton, the head of the Port Authority of New York and New Jersey, also tested positive for the virus in early March after taking a test because he might have come into contact with an infected person at one of the transportation hubs he oversees. In mid-March, it was reported that four members of the Brooklyn Nets basketball team, including Kevin Durant, tested positive for COVID-19. Many, including New York City Mayor Bill de Blasio, were confused as to how the basketball team – as well as other NBA teams – were able to procure tests while others were not. The Nets obtained their tests from a private company. But many basketball teams that were able to quickly get tested for COVID-19 are sponsored by and have corporate deals with hospitals, which gives them much easier access to medical care, ESPN reported.

“People with connections and means have better access in medicine all the time. Should it be any different in a time of limited resources and crisis?” – Barron Lerner, New York University Langone professor of medicine and population health

The city’s more affluent residents similarly have more direct access to medical care by way of concierge medicine programs – which provide immediate access to health care for a premium – that offer an alternative to state-run testing centers or waiting in emergency rooms to receive a COVID-19 test. On March 20, Reuters reported that some elite New Yorkers were turning to Sollis Health, a medical concierge service, to get tested for COVID-19, despite other hospitals and clinics rationing their testing supplies. The annual cost to be a Sollis Health member? A cool $5,000.

Sollis Health confirmed to City & State over the phone on Monday that it is still conducting COVID-19 tests for its clientele.

“In a public health emergency, I agree that it shouldn’t be business as usual,” Barron Lerner, a professor of medicine and population health at the NYU Grossman School of Medicine, told City & State over the phone. “But what they’re (concierge medicine clinics) doing is business as usual. They’re like, ‘You pay a premium, then you get whatever you want and we make sure you get it.’ I think it’s a disservice to the larger public health effort to be doing unnecessary testing for people just because they want it.”

After Sollis Health received several requests for COVID-19 tests in late February, it contacted the New York Health Department for COVID-19 tests. The department provided the clinic with several tests but the availability of the tests was limited. On March 6, Enzo Biochem Inc., a private diagnostic testing company that works with Sollis Health, agreed to begin testing Sollis patients for the virus.

It may surprise some to learn that COVID-19 tests are not centrally controlled by the government to apportion them to the people who need them the most, as that would be the best way to track the virus’s spread. While the state government is trying to ensure that hospitals and labs have the materials required to test for the virus, private companies are still manufacturing tests of their own and selling them to the highest bidder, instead of giving them to the government to distribute.

Private hospitals also are often willing to expedite wait times or provide the wealthy with preferential treatment. “Many hospitals will fast-track a wealthy donor,” Dr. Arthur Caplan, a professor of medical ethics at the NYU Grossman School of Medicine, told The Atlantic. “They’re not going to sit in the ER waiting, or isolation room. You get to go quickly.”

The U.S. health care system has always catered to the more affluent, but that becomes even clearer in the midst of a public health crisis. During the 1918 influenza pandemic, data found that those living in Chicago’s underprivileged neighborhoods were much more likely to die from the virus than the wealthy.

Even middle-class New Yorkers who don’t enjoy any special treatment are still better positioned than lower-income households, whether they’re driving to another part of the state for a COVID-19 test, working from home – maybe even escaping to their summer house or an Airbnb in a less hard-hit region – and having access to decent employer-based health insurance.

“People with connections and means have better access in medicine all the time,” Lerner said. “So the ethical question then becomes should it be any different in a time of limited resources and crisis? And I would say yes. I think that we should be making particular efforts to use all available resources in as effective a way as possible. So that the testing should not be done, nor treatment by the way or anything else surrounding COVID-19, in a way that’s unfair, in a way that gives precedence to people of means and connection.”

The Medical Board of California is currently examining concierge doctors within the state who charged symptomless patients $250 for take-home COVID-19 tests. There is no public record of a similar effort currently underway to investigate those practices in New York.

Assemblyman Richard Gottfried, the chamber’s longtime Health Committee chairman, appears interested in potentially doing something to better regulate the state’s resources during a public health crisis. “Certainly for scarce and important resources like testing in an epidemic, that ought to be regulated in the public interest and not available just because you pay extra to be part of some particular clinic,” Gottfried told City & State during its webinar on Tuesday. “If a doctor is charging you extra for the privilege of being as patient and you want to pay it, that’s one thing. But if we’re talking about access to scarce, important resources, that’s an area where we need much more of a public role.”

Inequality in general is also linked to worsening the virus’s spread, as those unable to work from home continue to risk infection by commuting and working in jobs in which they come into contact with other people. And those with restricted access to adequate health care are unable to get the treatment they need to combat the illness. “I don’t know if we will ever achieve a society in which wealth and power doesn’t get you privilege,” Gottfried said. “What we do need to be able to do is to make sure that people who don’t have wealth and power are able to get, whether it’s health care or education or anything else, what they really need. And that goes for testing like a lot of other things.”