Community health centers are on the front lines amid COVID-19 outbreak

As the Seattle region continues to see more coronavirus cases, there’s concern about what this will mean for hospital systems, and whether they’re prepared.

But hospital systems aren’t alone in their response to the crisis.

As the number of cases continue to rise, community health centers are also on the front lines of the response to COVID-19.

“Our role in the community is to be the front line of care for patients with barriers to care, so those who are uninsured, underinsured, have transport barriers, language barriers, cultural barriers,” said Meena Mital, Chief Medical Officer for Neighborcare Health.

Neighborcare Health serves 75,000 patients each year at dozens of clinics in the Seattle area, according to their website.

Mital said community clinics throughout the region will play a big role in the response to the coronavirus, because many people who become ill will have mild symptoms.

“We are finding that people are turning to us for evaluation of more mild illness or moderate illness, the type that wouldn’t necessarily necessitate immediate hospitalization or going to the emergency room. And that’s really a large majority of the people impacted by this disease,” she said.

Already, many community clinics in the area are seeing impacts. They’re having to adapt in order to keep patients and staff safe.

Impacts so far

Community health centers are getting a surge in calls and visits from people who are concerned about COVID-19.

“We’re definitely seeing more people reaching out to us either by the phone or walk-in,” Mital said.

People are turning to community clinics because they’re concerned about symptoms. But they’re also turning to them for information.

This is one piece that can be challenging. Mital and other health care workers are getting a lot of information from public health officials, but things can change rapidly.

“When guidance is changing on a daily basis, to read it, interpret it for our system, disseminate it and make sure everybody knows about it is quite a challenge for us,” Mital said.

This can be frustrating for patients. Testing, for instance, is an area of great interest in the community, and also an area where a lot of questions remain.

Esther Lucero is CEO of the Seattle Indian Health Board (SIHB). SIHB serves about 6,000 patients annually at their clinics, most identify as American Indian or Alaska Native. They also house one of 12 tribal epidemiology centers in the country.

She said they’re hearing concern from patients as news about the virus spreads.

“What we’re hearing is a lot of fear because these symptoms are translatable to a lot of other illnesses,” Lucero said.

Concern around this virus has extended beyond their patients, according to Lucero.

She said the company that cleans their clinic stopped providing service due to fears about coronavirus exposure. So they’ve had to bring that responsibility in-house.

There are also practical issues to deal with, like a lack of appropriate quarantine space for vulnerable patients.

Native people are vastly over-represented in King County’s homeless population and Lucero said the outbreak presents challenges when it comes to their patients who don’t have housing.

She estimates about 40% of the people in their elders program are experiencing homelessness.

“So here we have a large portion of homeless population, incredibly vulnerable to this virus, all in one environment with very limited ability to create a quarantine space or an isolated space,” she said.

And it’s not just their patients who are vulnerable.

Lucero said they have staff who fall into the vulnerable populations outlined by county health officials – people over 60, people who are pregnant, and those with underlying health issues.

Lucero said they’ve already mandated that some providers work off-site to protect them.

“So we’re dealing with supplies that are running short, we’re dealing with staff that are running short,” Lucero said.

No one knows how long this will last, which is raising questions for community clinics about staffing levels in the long term, what it might mean financially, and how long stocks of protective gear will last.

SIHB has a stock of masks, but Lucero said it’s not an abundance.

The national Indian Health Services has said they’ll provide access to masks for organizations like Lucero’s, but she said they’ve yet to see any come in.

Other community health centers are also struggling with shortages.

That’s one area where Public Health – Seattle & King County is offering support.

“We have put together a joint request going into our emergency folks in order to get the appropriate personal protection equipment to the community health centers,” said Jerry DeGriek, Deputy Director and Regional Health Administrator for public health’s community health services division.

DeGrieck said they haven’t secured the equipment yet, but it’s in the works. He said community clinics provide a vital service.

In the midst of the outbreak, systems like SIHB and Neighborcare Health are facing challenges, but they’re adapting.

Changes are already underway

With staff shortages already a reality at SIHB, Lucero said they’re getting creative.

They’re doing things like having medical staff who need to be off-site do phone triage of patients from home.

Public health officials and clinics are urging all patients with potential COVID-19 symptoms to call before going to a clinic in order to reduce exposure.

Changes have also been made at Neighborcare Health clinics.

Peggy Evans is the chief transformation officer for Neighborcare Health, all safety issues report up to her.

She said they’re focused on minimizing risk for staff, while also being able to remain open.

“It’s really a balance between making sure that our staff are safe, while we can see patients. And that might mean any number of things,” she said.

They’re trying to screen more people on the phone and conduct tele-health visits when they can.

They’re also introducing a "greeter" position. The idea is if you come to a clinic with symptoms, you’ll be met by a greeter who may steer you to a phone appointment instead.

Chief medical officer Meena Mital said everything they’re doing is to ensure they can there for patients in the long run.

“Our goal is to make sure we stay open and staffed and available for our community because, you know, I think we’re not quite at the peak and the worst is yet to come.”