As the novel coronavirus threatens to catch hold in the United States, all eyes are on hospitals and public health officials.
But the nation’s health centers are often on the frontlines as well, keeping an eye out for potential cases, comforting fearful patients, and sometimes even going out into the community to evaluate individuals.
On Tuesday, the CDC announced that the spread of the coronavirus, now called COVID-19, in the United States is all but inevitable.
In addition, the discovery of a coronavirus patient who had not recently traveled to China and who had no known exposure to travelers was announced on Thursday. Because the patient did not fit the CDC’s criteria for testing, the announcement stoked fears that this might be an instance of “community spread” – the transmission of the disease through unknown sources.
Dr. Ron Yee is a health center physician and the chief medical officer for the National Association of Community Health Centers, an organization representing the nation’s more than 1,400 health centers. He said that the arrival of the coronavirus – and the CDC’s recent announcement – have had a significant impact on facilities around the country.
Dr. Yee sat down with Direct Relief to talk about how COVID-19 has affected American health centers and their patients, from supply shortages to social stigma.
Direct Relief: Let’s talk about this recent CDC announcement that coronavirus is likely going to spread in the United States, and we have to be prepared for it. How will health centers respond to that news?
Dr. Yee: NACHC has been in contact directly with the CDC’s coronavirus response team, probably multiple times a week. They don’t feel…like they’re seeing a “community spread” yet, meaning that we’re not seeing a bunch of person-to-person cases popping up all over the country.
So I think we want to find the balance of educating our folks but not causing a panic.
We are doing a webinar [for health centers] next week in conjunction with the CDC. That’s what we did with Ebola back in 2014.
How do you tie in your response efforts? How do you transport patients? What do you do about testing? How do you pay for testing? We will walk through all the operation aspects of what happens when someone calls up, or is possibly going to the hospital or isolation, if they’re a person under investigation or suspected of having a true exposure.
Direct Relief: How well stocked are health centers around the country with personal protective equipment (PPE)? What do they have? What do they need? Are there pockets where the supply level is higher or lower?
Dr. Yee: The Emergency Management Advisory Coalition is a coalition of community health centers that monitor this. They have seen geographically where there are some shortages. [The shortages] are not nationwide, they’re very specific, and I think most of those are around where they have [significant] Asian and Pacific Islander populations.
People are on high alert and so they’re going to use up their PPE a lot faster, even the surgical masks. They’re not truly following the CDC guidelines that you don’t need [PPE] unless you have a true exposure. There’s a lot of fear in the field.
There’s also a stigma that’s been going on. People of Asian descent – people are starting to ask them questions like, “Have you gone to China?” Or “How come you’re not wearing a mask?”
Direct Relief: How is the CDC’s new announcement [about coronavirus’s likely spread] helpful? In what ways does it create new challenges?
Dr. Yee: It’s a double-edged sword. It’s helpful in that it’s being publicized and people need to be aware of it. You can’t just sit back and go, “Oh, it’s no big deal, it’s not going to go anywhere.”
On the other side, you don’t want to cause mass hysteria, and we’re seeing that in certain geographic areas where all the PPE is being used up for no reason. The CDC has put out specific recommendations on how to selectively use personal protective equipment in the right way, so that you don’t wipe out supplies.
And they’re very specific about taking the right kind of history. First of all, keeping [potentially sick] people out of the healthcare facility, evaluating them even if it takes seeing them in their car so that they don’t expose other people.
If you don’t think about [the risk] objectively, then you get caught in this emotional thing and you go [to a health center] if…you haven’t been exposed. I think people are thinking, “Oh, maybe I stood next to somebody who had it. They came from China,” or something.
But if you read the CDC instructions, you have to be within six feet of the person and it has to be for a certain amount of time.
We’re trying to find the right balance of educating, but not causing a panic.
Direct Relief: So people are descending on health centers. Is that primarily a concern because they’re using up resources or because they’re making it more difficult to provide routine care? Why is it bad to have more people coming in?
Dr. Yee: I wouldn’t say it’s bad because that’s why we’re there.
Health centers are positioned perfectly because they have trusting relationships with folks already. I delivered kids that I followed for 20 years. So you have these relationships and they come to us and they trust us.
That’s when we say, “Look, you don’t have to get all panicked about this. Yes, this is happening in the U.S., but here’s how you protect yourself.”
We never want to say, “Don’t come to the center,” unless we’re telling them, “If you think you actually have it after you’ve walked through [the CDC’s screening questions] and thought about it, don’t come in because we want to take care of you outside [the facility].”
And we will arrange for that, whether that means coming to your car or whatever…if they meet the criteria of fever, cough, shortness of breath, exposure either directly from China or someone who’s been to China.
If somebody needs to be seen, and maybe they have a chronic disease and they’re older, and they’re really worried about this because those are the people that end up dying, we never want to miss a case like that.
Direct Relief: You mentioned that health centers are really well-positioned for this kind of response. What do health centers do well when it comes to dealing with this kind of thing? And what gives you concern or is less effective?
Dr. Yee: We’ve got, what, 1,400 health centers across the U.S., every territory, D.C. and Puerto Rico. And there’s a high trust level. Centers are where people go for their healthcare and the continuity of care is critical.
The other thing is that health centers are staffed by people who live in the community. A lot of times, my medical assistant might check in her aunt or uncle to see me. There’s a relationship, we understand the community culturally and linguistically. All of those elements are [present] in the staff that work in the health center.
On the negative side, the biggest challenge is, “How do you educate?” There’s what, 230,000 employees at health center. How do you educate 230,000 people on the best way to handle coronavirus or Ebola or whatever’s coming out.
[We also need to have] a very standardized approach to handling things, like the CDC, laying out guidelines and ways to handle [the outbreak].
How do we set up opportunities for people to hear the message, and then how do we nuance it for the health center: What does this look like specifically for you? What do you do when your patient calls up and says “Look, I don’t know if I was exposed or not. How do I handle this? Do I come into the clinic?” Those are the pieces that we’re working out right now.
This interview has been edited and condensed.