When Covid-19 popped up in Brockton Neighborhood Health Center’s patient population, it happened quickly.
“We started seeing a case or two on a very small scale,” recalled Sue Joss, the health center’s CEO. “Then it just hit really suddenly.”
Every Saturday, Brockton Neighborhood Health Center held an urgent-care clinic. One Saturday morning in March, “suddenly we had a huge number coming in with the cough and cold symptoms, and it was a huge concern,” said Dr. Joseph Panerio-Langer, BNHC’s chief medical officer.
Quickly, BNHC’s staff got together to strategize, placing staff at the doors to screen incoming people, setting up a one-direction footpath through the clinic, and isolating a section of their main clinic for patients with respiratory symptoms.
They weren’t overreacting in the slightest, it turned out. Brockton, a town of about 100,000 near Boston, Massachusetts, quickly became one of the country’s coronavirus hotspots. Thus far, 227 people have died.
A Vulnerable Community
Under normal circumstances, BNHC is a fixture in Brockton, seeing about 35,000 patients a year, the vast majority of whom are low-income. People originally from Cape Verde form their largest patient group, speaking the unwritten language Cape Verdean Creole.
For the Cape Verdean community, public information officer Steve Damish converts infographics and health information into written Portuguese. A staff member at BNHC runs a local radio station that provides health information, along with other community news, in Cape Verdean Creole.
In addition, Dr. Panerio-Langer said, many of BNHC’s patients are essential workers.
“They might be first responders, but many of them also work in grocery stores or are home health aides or visiting nurses, where they’re constantly in contact with people who could be sick.”
Challenge After Challenge
As of May 21, more than 1,100 of BNHC’s patients had tested positive for Covid-19. “We have more cases just at heath center than at most towns in the state,” Joss said.
So had 36 members of the staff, including a physician who had to be placed on a ventilator. Dr. Panerio-Langer developed symptoms of the disease and self-quarantined for two weeks.
Some staff members lost family: a father, a grandfather, uncles. Health care workers were anxious about coming into work.
“We have a small number of staff who have chosen not to work, and they’re anxious,” Joss said. However, she pointed out, more than 90% of BNHC’s staff have elected to keep working, whether remotely or in the health center itself.
In the midst of it all, residents at a homeless shelter where BNHC runs a small clinic began showing signs of Covid-19. Concerned, the health center tested everyone, only to find out that nearly a third of the shelter’s residents had the virus.
The staff quickly set up a Covid-19 clinic outside the homeless shelter, and began moving patients to telehealth. But at first, only behavioral health visits were reimbursable, said Dr. Panerio-Langer, and revenue fell quickly.
Although the health center had quickly moved to Covid-19 testing and was providing treatment to positive patients, “we had to cancel almost all of our appointments for weeks in all of our departments except behavioral health,” he explained.
For a nonprofit health center operating on narrow margins, losing a significant percentage of appointments is a serious concern. “The loss of revenue has been pretty terrifying,” Joss said.
A Vital Role
But BNHC’s administrators never considered shutting their doors. “We figured out ways,” said Dr. Panerio-Langer. “We needed to see the patients. Patients were going to continue to get sick, and it didn’t make sense to divert everybody off to the emergency room…to shove the problem off to them was not the solution.”
As new measures came on board to make telehealth more of a possibility, staff members began transitioning to remote visits for most health issues. “That’s kind of the silver lining of all of this,” Joss said. A telehealth program rolled out under normal circumstances “might have taken two years. This took a couple of weeks.”
Especially for behavioral health, “the patients just love [televisits],” which are more convenient, Joss said.
And behavioral health interventions are badly needed. Patients have been profoundly affected by Covid-19’s presence in their community. “We’re trying to hire as fast as we can,” she said. “There’s an impending behavioral health pandemic.”
Patients are concerned about the threat that Covid-19 poses to their families, especially since many of them live with multiple generations of family members. “It’s great to get tested, but if you can’t isolate, if it’s impossible to stay away from those you love, then what do you do with that?” Dr. Panerio-Langer said.
And BNHC’s staff have been profoundly affected as well. “It hits people personally, because our staff is the community,” said Dr. Panerio-Langer. “Many of us know people who have been hospitalized, who are on a ventilator, and many of us know people who have passed.”
BNHC has a vital role to play in testing community members and following confirmed cases closely, especially during the period of about 10 days when patients are most in danger, Dr. Panerio-Langer explained. But keeping a line open to a community with pre-existing health conditions is also essential.
“It’s not like heart attacks have stopped occurring,” he said. “Our role…is also to help manage those chronic diseases and those acute issues so they’re not overwhelming the hospital.”