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Just When They’re Needed Most, Clinics for the Poor Face Drastic Cutbacks Just When They’re Needed Most, Clinics for the Poor Face Drastic Cutbacks
(3 days later)
SEATTLE — Providers of health care in the nation’s poorest neighborhoods are used to toiling below the radar, treating chronic diseases and other ravages of poverty in places many Americans never see.SEATTLE — Providers of health care in the nation’s poorest neighborhoods are used to toiling below the radar, treating chronic diseases and other ravages of poverty in places many Americans never see.
But the spillover effects of the coronavirus, in cutting off routine procedures and checkups that are the day-to-day rhythm of medical economics, are hitting this sector hard too, with layoffs, furloughs and fears that a system of government-supported clinics dating back to the War on Poverty could collapse.But the spillover effects of the coronavirus, in cutting off routine procedures and checkups that are the day-to-day rhythm of medical economics, are hitting this sector hard too, with layoffs, furloughs and fears that a system of government-supported clinics dating back to the War on Poverty could collapse.
“Our first official day of unemployment was the 23rd,” said Tracy Baker, 39, a dental auxiliary worker at a nonprofit medical clinic in a rural area of northeast Washington State where the jobless rate was already more than double the national average even before the recent blows to the economy. Her husband, Josh, 41, a machinist, lost his own job a week after she did.“Our first official day of unemployment was the 23rd,” said Tracy Baker, 39, a dental auxiliary worker at a nonprofit medical clinic in a rural area of northeast Washington State where the jobless rate was already more than double the national average even before the recent blows to the economy. Her husband, Josh, 41, a machinist, lost his own job a week after she did.
Ms. Baker’s employer, New Health Community Health Center, has laid off more than a third of its work force — 60 out of 175 — over the last two weeks, as revenues plummeted from fewer paid patient visits. “It’s heartbreaking for us,” said Desiree Sweeney, the executive director of New Health. “They’re good people.”Ms. Baker’s employer, New Health Community Health Center, has laid off more than a third of its work force — 60 out of 175 — over the last two weeks, as revenues plummeted from fewer paid patient visits. “It’s heartbreaking for us,” said Desiree Sweeney, the executive director of New Health. “They’re good people.”
The nation’s latticework of nonprofit community health centers was first established in the 1960s and now stretches across every state to provide about 29 million people with primary care, regardless of their ability to pay. Almost a quarter of the centers’ patients are uninsured, and almost 70 percent live in poverty. The centers are a crucial link in a fragmented American health care system that too often fails to reach into poor neighborhoods.The nation’s latticework of nonprofit community health centers was first established in the 1960s and now stretches across every state to provide about 29 million people with primary care, regardless of their ability to pay. Almost a quarter of the centers’ patients are uninsured, and almost 70 percent live in poverty. The centers are a crucial link in a fragmented American health care system that too often fails to reach into poor neighborhoods.
Recent years have been pretty good for these places. When most states expanded Medicaid under the Affordable Care Act to cover many previously uninsured low-income adults, many community health centers saw their revenues improve, sometimes dramatically. But now, the centers are being battered by ferocious crosswinds as routine medical care — including dental work, a primary source of revenue — has been put on hold to conserve resources and keep the coronavirus from spreading.Recent years have been pretty good for these places. When most states expanded Medicaid under the Affordable Care Act to cover many previously uninsured low-income adults, many community health centers saw their revenues improve, sometimes dramatically. But now, the centers are being battered by ferocious crosswinds as routine medical care — including dental work, a primary source of revenue — has been put on hold to conserve resources and keep the coronavirus from spreading.
At the same time, doctors and administrators in clinics from Massachusetts, Kentucky, Idaho, Iowa and Washington State said they are being put in a new role: working with hospitals to screen people for the virus, while bracing for a surge in patients if those hospitals become overwhelmed and people have nowhere else to go. Plus preparing for a time of greater economic pain in their already struggling patient populations.At the same time, doctors and administrators in clinics from Massachusetts, Kentucky, Idaho, Iowa and Washington State said they are being put in a new role: working with hospitals to screen people for the virus, while bracing for a surge in patients if those hospitals become overwhelmed and people have nowhere else to go. Plus preparing for a time of greater economic pain in their already struggling patient populations.
“We are expecting there will be more people seeking our services at the same time we’re not able to keep all our staff on hand,” said Chuck Jones, the chief executive at Harbor Health Services, which runs six community health centers from Boston to Cape Cod.“We are expecting there will be more people seeking our services at the same time we’re not able to keep all our staff on hand,” said Chuck Jones, the chief executive at Harbor Health Services, which runs six community health centers from Boston to Cape Cod.
Mr. Jones was forced to furlough 160 people over the last few weeks — a quarter of the work force. In consolidating care and staff, he also had to shut down in-person appointments at the nation’s first community health center, called Geiger Gibson, which opened in 1965 in the basement of a public-housing project in Boston’s Dorchester neighborhood.Mr. Jones was forced to furlough 160 people over the last few weeks — a quarter of the work force. In consolidating care and staff, he also had to shut down in-person appointments at the nation’s first community health center, called Geiger Gibson, which opened in 1965 in the basement of a public-housing project in Boston’s Dorchester neighborhood.
“It is nonsensical that in the biggest health care crisis our country has ever faced, organizations like ours are being forced to furlough people we will need,” Mr. Jones said. He said he fears for his patients, a group of Americans who, in isolation or poverty, “quietly pass off our radar.”“It is nonsensical that in the biggest health care crisis our country has ever faced, organizations like ours are being forced to furlough people we will need,” Mr. Jones said. He said he fears for his patients, a group of Americans who, in isolation or poverty, “quietly pass off our radar.”
“I worry a lot,” he added, “that if community health centers go away, we won’t as a society hear the struggles of these people.”“I worry a lot,” he added, “that if community health centers go away, we won’t as a society hear the struggles of these people.”
Community health centers are expecting a boost from the $2 trillion stimulus package recently passed by Congress and signed by President Trump; they will share $1.3 billion. But spread across 1,362 of the centers, the money will only keep the system afloat for about 37 days from the start of the first payments, according to estimates by the National Association of Community Health Centers.Community health centers are expecting a boost from the $2 trillion stimulus package recently passed by Congress and signed by President Trump; they will share $1.3 billion. But spread across 1,362 of the centers, the money will only keep the system afloat for about 37 days from the start of the first payments, according to estimates by the National Association of Community Health Centers.
Finding a meaningful role in the crisis is the challenge that consumes people like Bill Wagner, the longtime executive director of Family Health Centers, which has eight sites serving 42,000 patients in and around Louisville, Ky. His organization’s revenue dropped by 30 percent in March, after Gov. Andy Beshear signed an executive order requiring that all non-urgent care be put on hold; he expects an even bigger loss this month.Finding a meaningful role in the crisis is the challenge that consumes people like Bill Wagner, the longtime executive director of Family Health Centers, which has eight sites serving 42,000 patients in and around Louisville, Ky. His organization’s revenue dropped by 30 percent in March, after Gov. Andy Beshear signed an executive order requiring that all non-urgent care be put on hold; he expects an even bigger loss this month.
“What is the role of a community health center during a pandemic?” Mr. Wagner said. “The roles of the hospital I.C.U.s and E.R.s and the public health departments are clear. But we’re kind of in the middle here.”“What is the role of a community health center during a pandemic?” Mr. Wagner said. “The roles of the hospital I.C.U.s and E.R.s and the public health departments are clear. But we’re kind of in the middle here.”
Family Health Centers is trying to ramp up telemedicine visits — using both phone and video — to help patients keep common ailments like diabetes, high blood pressure, asthma and depression in check. The organization spent a portion of the $100,000 it received from the first round of stimulus spending on 40 new tablets for providers to conduct video visits. But while Medicaid now pays for such visits, they can be difficult for low-income patients who often “don’t have the minutes on their phone, don’t have the data plan,” Mr. Wagner said.Family Health Centers is trying to ramp up telemedicine visits — using both phone and video — to help patients keep common ailments like diabetes, high blood pressure, asthma and depression in check. The organization spent a portion of the $100,000 it received from the first round of stimulus spending on 40 new tablets for providers to conduct video visits. But while Medicaid now pays for such visits, they can be difficult for low-income patients who often “don’t have the minutes on their phone, don’t have the data plan,” Mr. Wagner said.
Updated June 12, 2020Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
For now, Mr. Wagner’s clinics are devoting afternoons to screening patients who might be infected with the coronavirus; they wait in the parking lot until an exam room is free. They have tested more than 100 patients to date, including 14 who were positive for the virus.For now, Mr. Wagner’s clinics are devoting afternoons to screening patients who might be infected with the coronavirus; they wait in the parking lot until an exam room is free. They have tested more than 100 patients to date, including 14 who were positive for the virus.
Mr. Wagner said he is particularly concerned about educating patients who are homeless or refugees about the virus; Family Health Centers has a site dedicated to each of these populations.Mr. Wagner said he is particularly concerned about educating patients who are homeless or refugees about the virus; Family Health Centers has a site dedicated to each of these populations.
In Ottumwa, Iowa, Dr. Ken Jones, the dental director for River Hills Community Health Center, said he feels that the need for clinics in his service area will only grow as the epidemic and its harsh economic impact both unfold at the same time.In Ottumwa, Iowa, Dr. Ken Jones, the dental director for River Hills Community Health Center, said he feels that the need for clinics in his service area will only grow as the epidemic and its harsh economic impact both unfold at the same time.
“In southeast Iowa we serve eight counties, the poverty belt, so we already have a high number of uninsured patients,” Dr. Jones said. Widespread layoffs will only increase the ranks of the uninsured, he said. “I think the role of the community health centers is just going to be that much more important.”“In southeast Iowa we serve eight counties, the poverty belt, so we already have a high number of uninsured patients,” Dr. Jones said. Widespread layoffs will only increase the ranks of the uninsured, he said. “I think the role of the community health centers is just going to be that much more important.”
One dentist on Dr. Jones’s staff, Jessica Williams, who is now performing only urgent care dental work, said the already high infection risk in her job has been compounded by the unknowns of the coronavirus’s spread and the staff reductions on the dental team. “I have to put that fear aside,” Dr. Williams wrote in an email, describing two patients who came in recently with bad infections and dire pain.One dentist on Dr. Jones’s staff, Jessica Williams, who is now performing only urgent care dental work, said the already high infection risk in her job has been compounded by the unknowns of the coronavirus’s spread and the staff reductions on the dental team. “I have to put that fear aside,” Dr. Williams wrote in an email, describing two patients who came in recently with bad infections and dire pain.
“When I took out their abscessed, crumbling teeth, scooped out the pus and infected tissue, and said ‘It’s out,’ they sighed, thanked God, and thanked me profusely. In that order. It’s just a reminder that those patients appreciate us, see the value in our work, our sacrifice. Reminds me of the job I signed up for and why.”“When I took out their abscessed, crumbling teeth, scooped out the pus and infected tissue, and said ‘It’s out,’ they sighed, thanked God, and thanked me profusely. In that order. It’s just a reminder that those patients appreciate us, see the value in our work, our sacrifice. Reminds me of the job I signed up for and why.”
In Whatcom, County, Wash., which is served by Sea Mar Community Health Centers, based in Seattle, 10,696 people have filed for unemployment over the last two weeks, in a county with about 229,000 people.In Whatcom, County, Wash., which is served by Sea Mar Community Health Centers, based in Seattle, 10,696 people have filed for unemployment over the last two weeks, in a county with about 229,000 people.
Hard times, said Dr. Christine Hancock, a family practitioner at Sea Mar, will lead more economically struggling or uninsured patients to Sea Mar’s doors. “Patients basically don’t have anywhere to go except for a few community health centers in the county,” she said. “It’s just kind of the reality.”Hard times, said Dr. Christine Hancock, a family practitioner at Sea Mar, will lead more economically struggling or uninsured patients to Sea Mar’s doors. “Patients basically don’t have anywhere to go except for a few community health centers in the county,” she said. “It’s just kind of the reality.”
Kirk Johnson reported from Seattle, and Abby Goodnough from Washington.Kirk Johnson reported from Seattle, and Abby Goodnough from Washington.