On the front lines with StarMed’s CEO during the intense Omicron surge

On the front lines with StarMed’s CEO during the intense Omicron surge
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There’s a line again today, same as yesterday, same as New Year’s Day and Christmas. There’s always a line.

Mike Estramonte walks across Tuckaseegee Road to check on the crowds at StarMed, the medical clinic he started in 2018 that’s somehow become Charlotte’s COVID testing beehive.

He scans the minivans and Jeeps and sedans and pickups, hundreds of them, knowing the latest odds: nearly 1 in 3 will pop a positive COVID test.

“This is what it was like on Christmas,” he tells me. That day the line was so long Estramonte himself was out there directing traffic.

What’s happening: StarMed administered 65,000 tests last week statewide — 40,000 PCR and 25,000 rapid antigen tests. Two years ago, it was a relatively obscure clinic with few dozen employees; now they’re hiring 40 people a day to try to keep up with the Omicron surge.

  • As we walk through the parking lot, a National Guard soldier asks a driver of a silver sedan, “Are you prepared to wait 4 or 5 hours for a COVID test?”
  • The driver says yes, and the guardsman points her to the end of the line.

Why it matters: StarMed, a punchy startup in a city with two much larger healthcare giants, has become a vital part of the local COVID response. The lines at its sites act sort of like windsocks that tell us how Charlotte’s handling the pandemic.

The takeaway lately? Looking at these lines? We’re doing the best we can.

  • Omicron is everywhere! some people say. … But Omicron isn’t killing as many people as previous variants! others respond. … Close the schools! … Open the gyms! … If you’re vaxxed you’ll be OK! … Yeah, but what about my unvaxxed kids?!? … The CDC says …

All of the confusion, frustrations and jokes surrounding the Omicron variant funnel down and land at StarMed in a daily pileup.

For many people in the lines, there’s a job they’re not working that day, or grandchildren they’re worried they’ve infected, or some other form of life on pause.

  • Last week at StarMed’s south Charlotte location, neighbors grew frustrated at cars blocking driveways. One man approached staff with a shotgun. (Today, StarMed will move that location to the CATS light rail Archdale station’s park and ride, about a mile from the previous spot.)
  • On Jan. 10, Estramonte published an open letter explaining how 8,000 people encountered delays in their results: A company StarMed contracted with to process the overflow tests, Premier Medical, had an interface issue with StarMed’s results notification system.
  • At a Matthews testing center on Dec. 26, Estramonte approached a car that had cut in line. The young driver became irate and Estramonte called the Matthews police.
  • Over the holidays, CMPD shut down the west Charlotte site for 30 minutes because of traffic backups, prompting some folks on social media to joke that StarMed should just put a Chick-fil-a sign out front.

Estramonte and StarMed COO Tracey Hummell call it “organized chaos.”

“Mostly it’s because so few others are offering free tests. It really does feel like we’re in this ship alone,” Hummell says. “Our team is having to become more about traffic control and security than being medical professionals.”

But that’s sort of the story of StarMed — meet a problem, solve a problem, repeat.

And it’s certainly true of Estramonte, who in a decade has gone from a practicing chiropractor to executive of an operation that’s administered nearly 700,000 COVID tests and 400,000 vaccine doses — and one that has big plans to change healthcare here beyond the virus.

line at StarMed

Photo: Michael Graff/Axios

In the early days of the pandemic, StarMed was an outlier in COVID response. Atrium Health and Novant were running the show in concert with the county health department.

The first shipment of COVID tests Estramonte received in March 2020 had only 10 kits.

He wondered something he didn’t want to say out loud: Were the tests going to facilities in wealthier areas, where more patients are insured?

  • “Maybe I made it up in my head because I always felt like we were the underdog, and this is the area of town that’s always been neglected,” he says.

That underdog mentality is one reason he started StarMed in the first place: to fight for people in underserved areas of Charlotte.

Backstory: Growing up in upstate New York, Estramonte says he was the kid who had a lemonade stand not to make money, but simply to see if he could sell it.

  • When he was 12, he took a job working for a wealthy family down the road from his house. They hired him to vacuum floors in perfectly straight lines. “It would take me two hours to go back and forth to get it right,” he says.
  • When he was 15, he and a friend started a painting business. They first painted fences, then saved enough for a sprayer to help them do houses.
  • By the time Estramonte finished his undergrad degree, his painting business had eight employees and a truck.

    He went to chiropractic school, then moved to Charlotte to escape the New York winters. He found a job working for Dr. Fletcher Keith, who’d established his clinic near the intersection of Freedom and Tuckaseegee in 1959.

    • Estramonte quickly noticed that many patients didn’t have insurance, making it difficult to refer them to other providers for medical treatment.
    • He started to wonder how he could help bring quality care to low-income neighborhoods at all four points on the compass in Charlotte.

    Around 2010, Dr. Keith retired and turned over much of the business to Estramonte. Suddenly the 35-year-old was in charge of multiple facilities, and carrying around a load of financial burdens.

    He set a goal to pay off the debt by the time he was 40. He hired his neighbor, Hummell, a former Bank of America employee, to help him run the management business (Starmount) that oversaw the chiropractic offices.

    • In February 2015, a month before his 40th birthday, he made the last loan payments.
    starMed inside offices

    Some guidance for working at StarMed. Photo: Michael Graff/Axios

    Paying off debt didn’t bring the relief he expected. Instead he felt depressed and in search of a new goal.

    He met with his therapist/life coach. He flew to Austin, Texas, and spent three days journaling and reading.

    He bought the building that would become the Tuckaseegee clinic at an auction and started renovating; it had been a pawn shop and, before that, a Chinese restaurant.

    He remembers telling a contractor he wanted high-end floors and sinks.

    • “You do realize you’re building a clinic on the west side?” the contractor said.
    • “I took offense to that,” Estramonte says. “I was like, ‘Yes, I want to make it something special.'”

    After the first two lead doctors didn’t work out, Estramonte and Hummell hired Dr. Arin Piramzadian, who embraced the “controlled chaos” culture.

    In 2019, Estramonte says he finally was confident StarMed might break even. Still he wanted to make it profitable. He looked into setting up a certified laboratory, mostly to save the money they were losing by outsourcing tests.

    • They opened at the most basic grade of lab early in 2019.
    • In October that year, StarMed applied to boost its certification to high-complexity, the top grade, which would allow it to run all types of tests.
    • The first cases of COVID-19 started appearing in China a month later.
    • StarMed received its high-complexity lab certification in January 2020, which, as it happens, was just in time.

    Estramonte was watching reports of the spread overseas. He ordered an instrument, a Thermo Fisher, that could process of tests. The manufacturer scheduled it for delivery in May 2020.

    Had Estramonte waited one more month he probably wouldn’t have gotten the device, and the story of StarMed would be much different today.

    Guardsman StarMed

    Photo: Michael Graff/Axios

    Each year around his March birthday, Estramonte hosts a big party with friends called Reubenfest. It’s a tongue-in-cheek name, a nod to how he disliked corned beef and cabbage as a kid.

    The week after Reubenfest 2020, Estramonte met with his StarMed team and said, “I think we should prepare for the country to shut down.”

    • They went to hardware stores and auto parts stores rounding up masks. They drew up plans for a drive-thru testing site.

    While they waited on PCR tests, Estramonte was looking at other services when he noticed that other countries were using antibody tests. They were controversial here at the time — they only confirm previous COVID cases, not current ones.

    Estramonte had one of his many ideas: StarMed would save its limited PCR tests for the most high-risk patients, and it would offer antibody tests to healthy people who wanted to know whether that sickness they had the previous month was COVID.

    They set up the two lines, and Estramonte figured they’d keep doing it until the Thermo Fisher arrived. But one day in early April, Estramonte was watching county health director Gibbie Harris call out StarMed during a regular briefing:

    • “There is at least one non-FDA approved test being used in our community,” Harris said. “It has a very low sensitivity early in the illness which means a higher likelihood of a false-negative result. This could increase the risk that an infectious person would spread the disease.”

    Estramonte spent the night thinking he was sunk. But then he did what he usually does: He woke up to a new day and started over.

    StarMed survived the PR hit, and then some. Within a few months, the company was working closely with the county staff to increase testing.

    StarMed’s Thermo Fisher was operating by May 2020. That summer, the N.C. Department of Health an Human Services selected StarMed as its vendor to bring testing services marginalized communities in other parts of the state.

    • Estramonte and his team streamlined their training program to speed up the hiring process, and launched in counties around the state.

    Heading into the fall 2020, the state hinted that StarMed might be able to help with vaccine rollouts. Estramonte started investing back in the business.

    He bought four ultra-low-temperature freezers for $12,000 apiece. He kept adding staff and taking on more overhead.

    By the start of 2021, StarMed was in the red again and Estramonte was dipping into his personal money to keep people paid.

    But in early March 2021, the state contract came through. StarMed — along with its witty twitter feed — was off and delivering vaccinations.

    • By May 2021, the lines at StarMed facilities were mostly for people wanting a shot. The testing lines had dwindled to nearly nothing.
    • At one point, the county gave StarMed oversight of the Bojangles Coliseum vaccination events.

    By June, COVID appeared to be on its way out.

    Case counts and hospitalizations hit the floor, and StarMed’s team started brainstorming for the future.

    They looked into buying property in south Charlotte to open a primary care clinic. They planned to turn the Sugar Creek Road facility into a headquarters and a sliding-scale clinic where people pay based on their income and insurance rates.

    In less than two years, StarMed’s gone from about 100 employees to between 1,500 and 2,000. They include nurses, executives, doctors and traffic coordinators, and now Estramonte wanted to deploy them on something other than COVID.

    This past summer, Estramonte and Hummell beefed up the front office, adding top former public health officials and hospital leaders to help grow.

    Dorothy Mason is one of them. She was with Novant Health when it opened the Michael Jordan Family Medical Clinic in October 2019.

    • Early in the pandemic, the Jordan center was one of the busier testing locations in Charlotte. Mason remembers facing long lines of patients and looking over at the empty parking lot at StarMed.
    • “We would see StarMed and say, ‘What are these little StarMed folks doing over there?'” Mason tells me. “But then, after COVID came, people would get mad at us (at Novant) for lines and I said, ‘You know what? Go over there to StarMed.'”

    A year later, during summer 2021, Mason joined the team across the street.

    The Delta variant surge showed up almost as soon as she arrived, and Mason’s job quickly changed to director of recruitment.

    • “We need to hire 400 people,” Estramonte remembers telling her in her first or second week.
    • Mason wound up hiring about 700.
    • “She’s good at what she does,” Estramonte says while introducing her to me.
    • “Know anybody looking for a job?” Mason asks me.
      lines at StarMed January 2022

      People are waiting up to four hours for COVID tests. Photo: Michael Graff/Axios

      “If we hadn’t brought on all the people we brought on, I don’t know who’d be testing in Charlotte right now,” Estramonte says.

      One of the more exhausting debates lately is over which statistics matter, and whether we should be concerned at all with the total number of cases as they hit record highs.

      • After all, we don’t have a way to track the people are testing positive using at-home tests, as Axios’ Katie Peralta Soloff reported last week.
      • And besides, some folks say, hospitalizations is a far more important stat — and that’s not rising as fast as the case count.

      Still, a community should have some idea of how many people are sick, if for no other reason than to know how many people can’t go to work for at least five days.

      Behind each case count number is a person: a teacher or daycare workers bus driver or custodian, restaurant worker or delivery driver.

      The bottom line: Until the case numbers come down, we can still expect signs on doors noting unexpected closures, delays in public transportation, and all sorts of other hiccups.

      Estramonte, for one, dreams of life after Omicron.

      He’s started a nonprofit organization called the Blessing Foundation — “Blessing” is actually his mother’s maiden name — where he hopes to start a tutoring program and other services for kids.

      • He has more ideas than he knows what to do with. Most have something to do with bringing services to low-wealth areas.
      • Time and again during our conversations last week, he said of everything from MRIs to regenerative medicine to chiropractic needs: “It shouldn’t be that expensive. It just shouldn’t.”

      He wants to spend his time coming up with solutions. For now, though, at least until Omicron’s surge cools off, Estramonte and StarMed will continue to be a little bit of everything: medical professionals, traffic controllers, umbrella chasers, testers, mediators.

      For now those cars will keep lining up. And in a strange way, StarMed will continue being Charlotte’s community gathering space for the moment, at a time when there aren’t a lot of those.

      May it relinquish that title soon.

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