As a Severe Flu Season Strains U.S. Health, Providers Hurry to Prevent the Worst

It’s been a tough year for flu in Baton Rouge, Dr. Rani Whitfield said.

“This is probably the heaviest respiratory season we’ve seen since Covid,” said. Dr. Whitfield, chief medical officer at Open Health Care Clinic, or OHCC, in Louisiana, referring to the 2020 pandemic.

Providers are seeing far more cases of RSV, influenza, and Covid-19 – along with severe secondary infections like pneumonia, he explained. Families living in crowded housing were quickly spreading infections that seemed more likely to turn severe – a particular concern at Open Health, a community health center that offers comprehensive care to patients with HIV and AIDS through its affiliated program, HIV AIDS Alliance for Region Two, or HAART.

Emergency departments were overwhelmed with severe respiratory infections, repeatedly forced to transfer patients to less-overwhelmed hospitals.

“It’s quieter now, but this was the season,” Dr. Whitfield said.

Clinicians at OHCC have focused on vaccinating patients – to prevent the worst symptoms – and on providing immediate testing for influenza and Covid-19, along with antivirals to prevent severe cases.

To make this possible, Dr. Whitfield explained, they’ve relied heavily on support from Direct Relief.

Direct Relief has provided vaccinations and other respiratory disease support to U.S. partners for years. This year, the organization inaugurated a new test-to-treat initiative designed to strengthen the care that safety-net clinics and health centers provide during each respiratory-illness season. More than 76,600 vaccinations for Covid-19 and influenza were distributed to inoculate patients – many of whom already have chronic respiratory diseases, HIV/AIDS, and other conditions that make them more vulnerable to severe illness.

In addition, Direct Relief provided 55,392 Covid-19 and influenza tests, and 754 units of antivirals to prevent the onset of severe symptoms in patients who tested positive. The support totaled above $7.2 million, and materials were distributed to 607 partners across the U.S.

“We launched the program to fill needed gaps in prevention, testing, and treatment,” explained Katie Lewis, Direct Relief’s regional director for U.S. programs. “A comprehensive test-to-treat program directly addresses gaps in respiratory care access and builds local capacity for response during seasonal surges.”

OHCC, for example, received more than $33,000 in Covid-19 and flu tests and vaccines.

Many patients at OHCC are trying to manage HIV or AIDS, or chronic conditions like diabetes, COPD, and hypertension. That already makes them more likely to experience the worst outcomes from a severe infection. Dr. Whitfield is also concerned that many patients already worry about missing a shift at work; if they can’t receive everything they need at a single appointment, they may not come back.

“These high-risk patients can get very sick…We want to make sure they’re tested and treated as quickly as possible,” he explained. “That’s why having supplies on hand…is so important.”

Dr. Whitfield even credits the test-to-treat program with helping to keep the local healthcare system functional.

“Direct Relief has helped us keep patients out of the ER. They’re treated in the clinic,” he said. “If we’re not resourced…the entire system is going to fail.”

Reducing the strain

“The emergency rooms are busy,” agreed LaCal Bates, senior director of clinical operations at Los Barrios Unidos Community Clinic.

In Dallas, where Los Barrios Unidos serves more than 5,400 patients at six locations each month, Dr. Eduardo Torres has noticed a “huge increase” in flulike symptoms among his pregnant patients.

“I would say [the case load is] probably double of what I’ve seen before,” the obstetrician told Direct Relief.

Despite misinformation, Dr. Torres reported that pregnant women generally want to receive a flu vaccine, because severe flu during pregnancy can be a medical emergency for both the mother and her baby.

“If someone is not vaccinated, they get really worse,” he said.

Los Barrios Unidos received more than $186,000 in Covid-19 tests, and Covid-19 and flu vaccines, from Direct Relief.

As at OHCC, Los Barrios Unidos’s providers work to prevent transmission, supplying patients with PPE and counseling isolation when a patient is sick – especially in the crowded, often multigenerational or shared households, Dr. Torres said, are common among the patient population.

Vaccines are “going to lessen your symptoms, so we can care for you in the clinic,” Bates noted.

In the loop

When nurse practitioner Cynthia Arceneaux spoke to Direct Relief, her young grandchild had tested positive for Influenza A that morning.

“From a health care standpoint, it has been overwhelming,” said Arceneaux, the medical director at Gulf Coast Health Center in southeast Texas, of the respiratory disease cases in her community.

Arceneaux said many patients are likely to delay treatment too long – they’re worried about money, or they try what billing manager Claudette Phillips described as “old-fashioned remedies” first – and their illness grows severe. A significant number of patients speak Spanish or Vietnamese as a primary language, and so need linguistically appropriate information and care. And many patients can’t afford to miss work, or take their kids out of school, for vaccines or testing.

Gulf Coast has responded by offering late-evening hours on Fridays and Saturday clinics. The community health center provides vaccinations at local schools, and information in multiple languages.

“All the parents always say thank you. They don’t have to pull their kid out of school to get their vaccines. They don’t have to miss work to get their vaccines,” Arceneaux said. “We’re trying to make sure we don’t leave anybody outside of the loop.”

Direct Relief provided Gulf Coast Health Center, a long-term partner, with over $53,000 in Covid-19 and influenza tests, as well as flu vaccines.

The ability to provide free testing has been precious to patients, Arceneaux and Philips told Direct Relief.

“It’s been so helpful,” Arceneaux said.

A patient who comes in with serious respiratory symptoms is often anxious about money they can’t afford to pay, Phillips explained. Having to pay for tests or even for over-the-counter flu and cold remedies may mean not being able to put food on the table. (Gulf Coast provides these items for free.)

Patients think, “‘I’ve got to get tested for this, I’ve got to get tested for that.’ And that’s money,” she said. “We say, ‘No, we have programs that can help us with the testing,’ and you can see the relief on patients’ faces.”

That relief frequently translates into word-of-mouth, which encourages new patients who might have thought they couldn’t afford respiratory care to come in. “Word of mouth in this community goes a long way,” Phillips explained. She gave an example: A mother home from work with a sick kid may talk to a fellow parent. She’ll then come in and say, “‘Hey, I hear y’all got testing for the flu.’”

“A little bit of compassion, a little bit of medication”

“It’s hitting a lot right now,” said Stephanie Brady, executive director of the Community Clinic in Southwest Missouri.

The clinic, which serves about 5,000 patients each year, keeps a few appointments open each day for walk-in patients.

This respiratory season, Brady said, those spots have filled quickly, often with patients with the flu or Covid-19.

She’s particularly concerned about the impacts on patients, many of whom are homeless or have significant pulmonary diseases, like emphysema, COPD, or asthma. (High-risk patients receive care at special pulmonary clinics – Brady recruited two pulmonologists to volunteer at the clinic about five years ago – and are vaccinated at the beginning of the season for flu, pneumonia, and other respiratory illnesses that pose a particular threat to their health.)

Many of the Community Clinic’s patients are what Brady calls “the working poor”: They make too much money to qualify for the state’s Medicaid program, but can’t afford private insurance. “They’re trying to make ends meet, and they just can’t get ahead,” she said.

For that reason, many of them go years without seeing a doctor before they discover there’s a clinic available.

Staff members work closely with local hospitals – for example, Brady estimates that the Community Clinic prevents about 1,300 emergency room or urgent care visits to a community hospital each year, all from patients who can’t afford to pay for healthcare. The hospitals provide support to the clinic in return.

This respiratory season, Direct Relief provided the Community Clinic of Southwest Missouri with more than $142,000 worth of Covid-19 vaccines and tests for Covid-19 and flu.

Pop-up clinics and vaccination visits to homeless shelters, domestic violence shelters, and local community organizations help volunteers reach the most vulnerable for both vaccination and testing.

These patients are eligible for free care at the clinic, Brady said, but they often don’t come of their own volition.

Clinic staffers are “seeing all these people who are sick, and it’s cold outside, and they’re trying to live on the streets,” Brady said. “A little bit of compassion, a little bit of medication, some cough drops, and it means the world to them.”