Behind the Struggle to Bring Covid-19 Tests to Key Biscayne

In letters to the local press, with petitions to their Village government, and with complaints on social media sites, Key Biscayne residents last month got into an uproar, demanding a testing plan for the Covid-19 virus. They wanted testing, and they wanted it now.

By the middle of March, the Village’s Public Works Department had started developing a plan for large-scale, drive-through testing to accommodate the local population of up to 13,000. It envisioned the Key Biscayne Fire Department playing a role in the screening.

In his initial meetings with Public Works and other Village officials, Fire Chief Eric Lang wanted to help but he warned of serious risk, according to an aide who participated in the discussions. He worried his small staff lacked the resources to handle the normal fire-rescue mission in addition to testing, which could expose his staff to infection, potentially affecting an entire shift.

Thus began a weeks-long vacillating effort by Key Biscayne’s government to create a testing program. Undecided about the importance of testing and with concerns about how to pay for tests, the Village administration’s efforts bogged down.

Then last week, the Key Biscayne Community Foundation, a private non-profit, stepped in and within days rolled out a program. Testing started Tuesday, April 14th, and 392 residents have already been processed. Five positive cases were newly identified by Wednesday, April 22nd.

Key Biscayne residents now could be tested, but getting there wasn’t easy.

With public demands for testing reaching a crescendo at the end of March, the Village administration and its seven-member elected Council got behind what was labeled a “pilot” test program. On April 1, Chief Lang sent a mobile team of firemen around to a small number of homes to test residents under established criteria, which covered individuals 65 or older who worried they had Covid-19 symptoms

The City of Miami had started at-home testing for seniors with symptoms on March 24, so Key Biscayne was playing catch-up.

To begin, Chief Lang’s crew obtained 10 testing kits from the City of Miami.

Back on March 21, the Florida Department of Health had reported that Key Biscayne had two cases of Covid-19. By the time Lang’s team started 10 days later, the state had recorded 21 cases on the island.

Then within a week of starting the pilot program, the Village informed the public in an April 8 statement on its website that the effort had been halted. A fire-rescue staffer reportedly had come down with a fever, which led to the staffer’s entire shift, one of three each day, to be quarantined, according to a source with close ties to the department. That left the two remaining shifts to cover all fire-rescue responsibilities, 24 hours a day, seven days a week.

At the same time, the Village government was struggling about how to get its messaging straight. An internal memo reviewed by Key News shows Village bureaucrats engaged in discussions about how to communicate with the island’s elected officials and the public to avoid mixed messages.

Despite earlier missteps, the Village government last week was still working out how to release information.

The Key Biscayne Village Manager Andrea Agha said Friday that as it became clear the island would not escape the health crisis, the administration realized it had a good deal to grapple with. “We’re not health authorities,” she said.

The leaders of the police, fire and many other departments, Agha said, spent two weeks in meetings working through the challenges facing Key Biscayne. They also relied on advice from the City of Miami’s Fire-Rescue Medical Director.

The Village government’s efforts were slow going.

“If things happened out of sequence, then that’s what happened,” Agha said. “We hadn’t faced a global pandemic before.”

The challenges went well beyond finding a certified laboratory and determining who could properly administer a Covid-19 test program under Village guidance. What steps to take became a bureaucratic hairball.

On April 14 , the Village Communications Director Gabriela Rodriguez sent an email around the administration. “The Village Manager, Andrea Agha, is the ONLY person within the Village Administration who can and should communicate with Elected Officials about anything and everything,” Rodriguez wrote. “Everything,” the note said, included “beach maintenance, underage golf cart drivers, Covid-19,” among other issues that council members might be interested in.

That opened a question about whether information was flowing in a timely way to the Village Council and the public about testing arrangements.

Councilman Ed London who had played a leading role in pressing for tests in early March, expressed frustration with the administration. He had worked with friends to identify a testing site and lab. His suggestion to use the streets around the Village Hall and Community Center were turned down. He said discussions dragged on for weeks and were “getting nowhere.”

“There were people in the Village who were against testing,” London said. “They only wanted a lockdown.” The Village was resisting having its employees, principally the Fire Department, get involved, he said.

With the initial pilot program stymied and the Village looking for a way forward, the Key Biscayne Community Foundation stepped in. Established in 2004, the organization is primarily funded by donations to benefit not only Key Biscayne but also other communities and groups in Miami-Dade County.

On April 9, Foundation Executive Director Melissa McCaughan White spoke with Agha to see what could be done about testing. It was decided that Chief Lang would work with White to set up a site. She and Lang had known each other since childhood.

Consulting with County health officials, the two identified a Miami laboratory, Biocollections Worldwide, Inc., as reliably equipped to handle the program. Now moving quickly on April 13 Village officials went along with a Foundation initiative to use a building on the campus of the St. Agnes Catholic Church.

Said London: ”If it wasn’t for Melissa we wouldn’t have gotten testing. She’s an angel.”

As for White, she said, ​“​I could say it was the textbook answer that nonprofits, or the independent sector, are supposed to bridge gaps between the government sector and the private sector. Honestly, it is a much less complicated analysis; it was the right thing to do for the community.”

Testing using nasal swabs began two days later. The Foundation receives the results anonymously usually within 24 hours, with tested residents notified at the same time

Curiously, the Village in its public statements did not acknowledge the testing program until two days had passed:

“After much work and a collaborative effort between the Village of Key Biscayne and the Key Biscayne Community Foundation, a COVID-19 pilot drive-thru testing site for Key Biscayne residents was established earlier this week.”

London said the Village held back announcing the Foundation-run program because officials wanted to be sure it would actually work.

Still, Village administrators acknowledged the public pressure when it did issue a statement. “The purpose of the pilot drive-thru testing site is fourfold: to meet expectations of our community, help residents as a public service, inform policy decisions and steer response efforts, including ways to mitigate and control the spread of the virus.”

Considering the time spent by the government and uneven communications, some residents were left to wonder how the Village could have foundered while the Foundation managed to act so quickly.

The Village says its mission is to “COMMUNICATE, PROTECT and take ACTION.” But according to a person close to the testing effort, the Village appeared more concerned about protecting its finances than acting. Officials overseeing the budget were worried about the cost of tests.

As part of the backdrop to the sluggish Village effort, Mayor Mike Davey last month found himself in a frustrating tangle with Agha. In what was supposed to be a private discussion, the mayor pressed the manager on why there seemed to be so much wheel-spinning over process at Village Hall and that not much was getting done. In other words the “action” part of the Village mission was compromised, according to Davey..

A fracas followed when the manager shared the mayor’s criticism with other council members.

Then the Covid-19 crisis broke and quickly turned attention away from the Davey-Agha squabble.

Budget worries aside, as the dimensions of the health crisis became clearer from late March into April, the Village bureaucracy struggled to identify who might reliably perform the tests the public was demanding.

As the Foundation then took the lead, White and Lang consulted experts across Miami- Dade and Broward counties in vetting laboratories that could do the tests. Testing nationwide has been slow to ramp up because of worries about test reliability. White acknowledged that to some extent Covid-19 test data may be flawed with false negatives and false positives.

The Foundation’s role started with a survey of Key Biscayne residents to gauge how many wanted a test. Based on 1,000 responses, White contracted with Biocollections for 500 test kits at a cost of $37,500 — or $75 a test. The foundation decided it could front money for the initial phase whether or not the Village would contribute funds along the way. The U.S. Government has declared the Covid-19 test would be cost-free to anyone who took one. Who will eventually pay remains unclear.

The Village was still worried about the cost. According to participant​s ​on several​ ​conference calls​ ​with local officials, the question of who was going to pay for the testing came up repeatedly. During one call, the administration expressed worry that emergency funds might have to be used, tapping reserves used for hurricane damage or similar events.

Mayor Davey in an interview Thursday said the Foundation would not be on the hook for the test program. “We’ll reimburse them,” he said. “The Village is committed to that.”

The Foundation, meanwhile, foresees an even broader test program. Some Village residents who want the test cannot leave their homes because of age and infirmities, White said. Now that the Fire Department has returned to full strength, Chief Lang is prepared to operate the mobile testing unit to visit the house-bound.

On Monday, the Florida Department of Health reported Key Biscayne has 63 confirmed Covid-19 cases, up from two a month ago. Biocollections has conducted 392 tests and reported results for 336. There were five positive cases. The Fire-Rescue pilot tests identified three positive cases.