At the Charles B. Wang Community Health Center in New York City, COVID-19 is forcing staff members to learn on the fly.
While the federally qualified health center hasn’t seen any confirmed coronavirus cases, they have seen a few patients whose symptoms and travel history necessitated calls to the state’s Department of Health – and careful handling within health center walls.
“The few people we’ve evaluated, we’ve learned from that,” said Dr. Perry Pong, the organization’s chief medical officer. Staff members now limit the number of people going in and out of the room, and, if need be, call the patient’s room to ask follow-up questions rather than risking additional contact.
North East Medical Services in California’s Bay Area has had a similar experience. “We’ve had a few potential high-risk cases that came through, so we had a lot of learning from those,” said Dr. Kenneth Tai, North East’s chief health officer.
According to Dr. Tai, the stress of a high-risk patient sets off “a fight or flight kind of mode, where people can’t think as well or they tend to forget things.”
To adapt, North East has begun bagging personal protective equipment – goggles, face shields, gloves – into individual kits, so nothing is forgotten before a staff member walks into a room with a high-risk patient.
As coronavirus cases – and deaths – rise, health centers around the country are doing what they’ve always done: providing primary care and other essential health services. Now, however, they’re doing it with a limited supply of masks and gloves, and a significantly higher number of anxious patients.
COVID-19 “has really kind of struck a nerve with everyone, and people’s sense of fear has climbed up,” said Edward Liao, chief medical officer of QueensCare Health Centers in Los Angeles. Liao is “trying to respond to those concerns and also to be prepared for an outbreak in Los Angeles County.”
Healthy patients are less willing to come in for routine appointments, Dr. Tai said. When North East reminds patients that a yearly physical or well-child exam is due, “sometimes they feel like, ‘I’ll call you back in about a month,’” he said.
But other patients – with flu-like symptoms, a history of recent travel, or other coronavirus-related concerns – are filling the gap. “They are just wanting to be reassured,” Dr. Tai said.
Staff report feeling fear and concern about potential encounters with coronavirus patients, said Dr. John Hoh, medical director at Asian Pacific Health Care Venture (APHCV) in Los Angeles county.
“You don’t know whether tomorrow will be the first day that someone walks in who actually has the virus,” he explained. “I’m afraid there are a lot of communities and a lot of practices that have not been preparing as much as needed.”
APHCV has begun providing informational materials for staff; stockpiling personal protective equipment like masks and gloves, and teaching staff to process high-risk patients in under two minutes.
Because health centers are a trusted source of primary care and health information, they can play an important role in screening for the disease – and keeping patients out of overcrowded emergency rooms.
“We don’t want to tell patients to go to the emergency room, because emergency rooms are overwhelmed right now,” Dr. Tai said.
Instead, North East asks patients concerned about having the disease to call before coming in, so the health center can plan accordingly. “Our message is, ‘Please call us. We want to understand your situation,’” said Dr. Tai. “We want to streamline your visit, so we can get you in and get you out.”
It’s not without risk – for staff members in particular. “Are there people who have flu or bad colds in this community? Of course, there are many. Do they all have COVID-19? Of course not,” Dr. Hoh said. “The risk to healthcare workers of being exposed to a potential individual is much higher.”
COVID-19 has caused a widespread shortage of personal protective equipment – essentially, masks, gloves, face shields, gowns, and similar protective barriers. While the health centers interviewed for this article had enough to keep patients and staff safe, some felt the need to be cautious.
“Unfortunately, our vendors are all out, and…everyone’s been asking for” protective gear like masks, Dr. Liao said. “It’s going to be in short supply for most medical facilities.”
“So far, so good,” Dr. Pong said. “Of course, we’re not getting much supply, so we’re really telling our own staff not to wear masks unless it’s necessary.”
North East Medical Services had originally made masks available to patients in exam rooms. “We are finding out we couldn’t do that, because some patients will take the whole box,” Dr. Tai said.
Even as health centers continue to provide routine services and screen patients, they’re watching COVID-19 affect their communities and patients – many of whom are low-income.
“I’m afraid for people who work” at jobs like waiting tables, cooking, or offering guided tours, Dr. Pong said. “What’s going to happen to [their] livelihood?”
At one of North East’s clinic locations, in Chinatown, “you really don’t see tourists or anyone anymore,” Dr. Tai said.
It’s not the first time health centers have seen a major outbreak, he said. But there’s a key difference:
“We had gone through H1N1 [and] SARS before, but this one is a bit different because it’s happening in the community.”