Testing. Staffing. Telehealth. Across the country, safety net providers are reporting similar concerns as they face the fallout from the Covid-19 pandemic.

To get a sense of what challenges health care providers around the nation are confronting, Direct Relief recently went right to the source. The organization held a series of calls with health care associations, serving a total of 11.9 million patients, in a number of states and Puerto Rico.

During these talks, consistent themes emerged from clinics set in vastly different locales. Notably, safety net health centers reported concerns with staffing, testing, PPE availability, and telehealth.

Most health centers who responded to a Direct Relief questionnaire, totaling 44 clinics, also reported an uptick in the number of patients they are currently seeing, and that they have seen marked increases in patients, both existing and new, who have lost their health insurance due to losing their jobs.

For free and charitable clinics, which do not receive federal funding, sources of revenue have become scarcer, since in-person fundraising events have been canceled during this pandemic.

Both Federally Qualified Health Centers and charitable clinics reported challenges related to staffing. Staff members have been infected by the pandemic, and many have had difficulties meeting childcare needs. Many clinics also reported pervasive fatigue amongst staff members as the pandemic drags on.

One clinic reported that their only pharmacist was forced to resign since she had to stay at home to watch her kids. Another clinic reported that 50% of its staff was out sick. Health facilities in Texas, North Carolina, and Florida were forced to close for two weeks after staff members tested positive for Covid-19.

Because so many free clinics depend on retired volunteers – many of whom are staying at home to avoid contracting Covid-19 – their staffing shortages are compounded.

Frustration with testing is a common theme, with clinics in Los Angeles County, the Mississippi Gulf Coast, southeast Kansas, southwest Florida, and elsewhere reporting up to week-long delays from labs — when testing supplies and kits are available.

There’s good news: PPE shortages no longer represent the acute crisis they once did.

However, many clinics are still unable to stock more than a few weeks’ worth of PPE at a time, due to a lack of inventory from their usual suppliers. N95 masks, gowns, disinfecting products, and gloves are still hard to source. One clinic reported having to pay almost $8 per N95 mask.

In New Jersey, many community health centers do not expect to resume normal supply levels until next year, and feel state agencies will move on to other matters, beyond medical supply chains. They are currently only able to source about a week’s worth of PPE at a time.

Most clinics were able to rapidly transition to treating patients via telehealth, which has allowed them to continue operating, even as social distancing protocols have been enacted. In LA, clinics said there have been fewer no-shows for behavioral health telehealth appointments compared to in-person appointments.

However, the transition for many has not been seamless. Many reported spotty Wi-Fi connections and a limited number of available laptops and cameras. Clinics are working through these issues, since they expect to continue offering a telehealth option.

This shift to remote visits has also created a need for more in-home diagnostic test kits.

While safety net clinics did not express concerns about the supply of this year’s flu vaccine, they did express concerns about the supplies needed to successfully vaccinate large numbers of people. Needles, tents, and alcohol swabs will all be in high demand once a Covid-19 vaccine is available

As is the case at large, many clinics expressed trepidation about how the flu could further complicate the pandemic.

While handling the existing pandemic and forthcoming flu season, safety net health care providers reported that they are preparing to withstand future natural disasters, such as hurricanes, tornadoes, and wildfires, that would place a further strain on their ability to continue operations.

As the foremost charitable provider of personal protection equipment during the Covid-19 pandemic, with a total of 20,079 shipments to 2,416 partners in the United States valued at $179.4 million, Direct Relief has been at the forefront of efforts to help safety net providers continue providing health care during the pandemic.

The organization will continue communicating with frontline health care providers in order to determine how to optimize support for their critical work, so they can continue to serve the nation’s most vulnerable people.

Additional reporting contributed by Alycia Clark, Leighton Jones, and Marisa Barnes.