Since December, California has been the epicenter of the Covid-19 pandemic in the United States, with Los Angeles County suffering the highest number of cases, both overall and per capita – one out of every nine Angelenos has tested positive.

Health centers – nonprofits that serve as the safety net of the U.S. health care system – have been on the frontlines of the pandemic. They serve residents, many of whom are uninsured, underinsured, and have low incomes, regardless of their ability to pay. Several studies, including from the CDC and American Medical Association, have shown that Covid-19 has disproportionately effected the Black and Latino communities as well as lower income communities. The AMA study showed that substantially non-white counties with a median income of about $60,000 had a Covid-19 rate nine times higher than substantially white counties with the same median income.

On Thursday, Direct Relief CEO and President Thomas Tighe hosted a video call with medical officers from three leading L.A. County community health centers as hundreds listened in on the call, an audience comprised of journalists, health care company representatives, health care providers and funders. Dr. Derrick Butler, chief medical officer of To Help Everyone (T.H.E) Health and Wellness Center, Dr. Robert Bolan, medical director of the Los Angeles LGBT Center, and Dr. Ilan Shapiro Strygler, medical director of health education and wellness at AltaMed Health Services, shared their experiences from the past year and why they believe they are uniquely positioned to help roll out the Covid-19 vaccine to diverse communities, which are often left behind in the U.S. health care system.

“Those of us in community health care are best able to communicate with our patients who may be suspicious or reluctant to believe that they should get a Covid vaccine,” said Bolan, noting that, many of his center’s 800 staff members come from the communities they serve, as is the case at many community health centers.

All three clinics are part of the Community Clinic Association of Los Angeles County, which represents clinics and health centers that serve 1.7 million patients per year, providing primary health care as well as dental, and mental health services, in addition to other services, which vary based on a given community’s needs.

“Coming into health centers in underserved communities of color, being able to show them that the system, when delivered with compassion, like we do at our centers, and having cultural competency, that we can be trusted because we have their best interests at heart. Patients know we aren’t trying to make money off this community. We’re here for health and wellness,” said Butler, who is Black. He also spoke about the specific origins of the mistrust of his community, which include the residue from historical scandals, such as the Tuskegee experiments, as well as ongoing “second class care due to systemic racism,” he said.

Butler said that while his clinic, and other Federally Qualified Health Centers are effective in combatting misinformation and building trust, he added that he would welcome additional help as well, calling on health care companies to deploy their marketing and sales staff to help build trust in the safety of the vaccine.

“We need help with marketing, we need help with educating people,” Butler said. “Get the movie stars and the athletes to publicly announce this. Sure, Dr. Fauci got vaccinated on television, but sometimes people want to see LeBron James get vaccinated,” he said, adding that such endorsements can help change minds.

Shapiro, who is originally from Mexico City, said his patients, most of whom are Latino, have struggled with mixed messaging from public officials and a kind of mixed reality that has made it difficult for them to stay safe during the pandemic.

“Stay home, but take care of yourself. Eat better, but don’t go to the supermarket. There is all this messaging that is very confusing to all of us,” Shapiro said. “Our communities, when we tell them to stay home, it’s about survival. They aren’t telecommuting, they need to go to one or two jobs and there’s less time to go to the doctor. They’re using public transportation and on the frontlines, they’re more exposed,” he said.

As the Covid-19 vaccines continue to be administered at scale, and indeed during the entire pandemic and flu season, community health centers have been able to rely on their local knowledge to best serve their communities. Some L.A. community health centers have started administering the vaccine, while most of the remainder are still waiting to receive doses.

“Community health centers shouldn’t be at the bottom of the list,” said Bolan. “We should be first in line to help with these vaccination efforts.”

‘We Cannot Afford To Lose A Grip’

As the vaccination process now takes center stage, Butler, Bolan, and Shapiro said they are continuing to work around Covid-19 in order to maintain continuity of care for their patients, especially those suffering from chronic conditions. Notable challenges have included ways to reduce the risk of transmission in clinics, staff members contracting Covid-19, technological limitations, and issues related to logistics.

One of the biggest ways clinics have tried to maintain the safety of staff and patients is to shift to telemedicine.

“We had a beautiful plan for two years that we had to implement in two weeks,” said Shapiro, in reference to his clinic’s shift to telemedicine. “We knew we had Covid-19 [to address], but we also knew diabetes wasn’t stopping.” AltaMed, which serves about 300,000 patients, maintained in-person visits when necessary, such as for screenings, but was able to move the majority of visits to telehealth. Some of the attendant challenges which were also present at T.H.E. and the L.A. LGBT Center, included patients without access to a suitable internet connection and smartphones, knowledge of how to use the phones and lack of ability to understand English.

“We tried to do things that we understood the community needed that were above the usual jobs of community health centers” Shapiro said. “It’s because we are here to serve the community… We cannot afford to lose a grip on preventative health care.”

“We were able to adjust the role of our staff in playing to meet those needs,” Butler said, referring to the specific medical needs required by his patients. “We know our patients.”

Though he stressed that the adjustment process has not been easy.

“It’s like building the ship while it’s in the middle of the ocean,” Butler said of how his clinic has had to adapt during the pandemic so as to reduce the risk of transmission within the clinic while still providing critical health care services.

Each of the doctors noted that the pandemic accelerated trends of preexisting health inequity based on social determinants like income and race, as well as environmental factors like clean air and water, that had been building for decades.

Despite the difficulties, the health care community leaders remain confident in their ability to continue being health care bedrocks in their communities.

“It’s really exciting in some way. The work in health centers is challenging and never boring. All of us have doubled down in our commitment to serving this population,” Butler said.

“This is a moment to say we are here and we are ready to help,” said Shapiro. “We have the secret sauce. We’re part of the community.”

A recording of the panel is available here. 

Since the Covid-19 pandemic started, Direct Relief has donated $50 million in cash and provided more than $240 million in medical aid to community health centers and clinics in the U.S. For more on Direct Relief’s Covid-19 response over the past year, please visit:
https://www.directrelief.org/2021/01/covid-19-relief-one-year-report-on-use-of-funds-and-response-activity/