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| Why California’s Community Health Clinics Are Vital, but Hurting | Why California’s Community Health Clinics Are Vital, but Hurting |
| (about 20 hours later) | |
| Good morning. | Good morning. |
| Over the weekend, millions of Californians celebrated Easter and Passover in a changed world. For many of faith — or not — recent holidays have been occasions for reflection and gratitude. | Over the weekend, millions of Californians celebrated Easter and Passover in a changed world. For many of faith — or not — recent holidays have been occasions for reflection and gratitude. |
| If you’ve felt inspired to help, the state has a clearinghouse site for ways you can safely serve your community. | If you’ve felt inspired to help, the state has a clearinghouse site for ways you can safely serve your community. |
| (Here’s the sign-up, if you don’t already get California Today delivered to your inbox.) | (Here’s the sign-up, if you don’t already get California Today delivered to your inbox.) |
| Today, we have another dispatch from our partners at the University of California, Berkeley Graduate School of Journalism, written by Miki Katoni and Nina Sparling, about the challenges facing community health centers: | Today, we have another dispatch from our partners at the University of California, Berkeley Graduate School of Journalism, written by Miki Katoni and Nina Sparling, about the challenges facing community health centers: |
| OAKLEY, Calif.— With chronic thyroid problems and stents in her heart, Caren Abell is one of millions of Californians with underlying health problems that make them especially vulnerable to the coronavirus. | OAKLEY, Calif.— With chronic thyroid problems and stents in her heart, Caren Abell is one of millions of Californians with underlying health problems that make them especially vulnerable to the coronavirus. |
| Ms. Abell, 53 and unemployed, relies for primary care on La Clínica de la Raza, the only health clinic in this Bay Area suburb of 41,000. But now, it has been plunged into uncertainty. | Ms. Abell, 53 and unemployed, relies for primary care on La Clínica de la Raza, the only health clinic in this Bay Area suburb of 41,000. But now, it has been plunged into uncertainty. |
| La Clínica is part of a sprawling network of community health centers, mostly tucked in low-income neighborhoods, that have suffered huge losses of revenue in recent weeks as the pandemic prompted them to stop most patient visits to limit the disease’s spread. | La Clínica is part of a sprawling network of community health centers, mostly tucked in low-income neighborhoods, that have suffered huge losses of revenue in recent weeks as the pandemic prompted them to stop most patient visits to limit the disease’s spread. |
| Because the centers get most of their income from patient visits reimbursed by Medicaid, some clinic directors said they may have to close down in a matter of weeks or months. | Because the centers get most of their income from patient visits reimbursed by Medicaid, some clinic directors said they may have to close down in a matter of weeks or months. |
| “I’m not sleeping,” said Jane Garcia, chief executive of La Clínica, which has 35 sites in three Bay Area counties. The clinics, serving 90,000 people a year, have lost about $3 million in revenue over the past month, forcing La Clínica to raid its reserve funds. Nobody has any idea where its patients will go if it is forced to shut down. | “I’m not sleeping,” said Jane Garcia, chief executive of La Clínica, which has 35 sites in three Bay Area counties. The clinics, serving 90,000 people a year, have lost about $3 million in revenue over the past month, forcing La Clínica to raid its reserve funds. Nobody has any idea where its patients will go if it is forced to shut down. |
| “I really don’t even know what would be available out there,” Ms. Abell said. | “I really don’t even know what would be available out there,” Ms. Abell said. |
| La Clínica, and other community health centers like it, provides a range of services, including annual checkups, dental care and access to insulin for people who have nowhere else to turn. And many La Clínica patients have heart disease, hypertension or diabetes, the sort of pre-existing conditions that increase the lethality of Covid-19. “I don’t think anyone, really any part of the delivery system, is in a position to absorb what we’re doing,” Ms. Garcia said. | La Clínica, and other community health centers like it, provides a range of services, including annual checkups, dental care and access to insulin for people who have nowhere else to turn. And many La Clínica patients have heart disease, hypertension or diabetes, the sort of pre-existing conditions that increase the lethality of Covid-19. “I don’t think anyone, really any part of the delivery system, is in a position to absorb what we’re doing,” Ms. Garcia said. |
| While there are nearly 13,000 community health center clinics in the United States, they play an especially important role in California, providing routine medical services for one in six Californians, including one third of the state’s Medicaid patients, nearly 500,000 migrant workers and 250,000 homeless residents. | While there are nearly 13,000 community health center clinics in the United States, they play an especially important role in California, providing routine medical services for one in six Californians, including one third of the state’s Medicaid patients, nearly 500,000 migrant workers and 250,000 homeless residents. |
| “Their revenues are crashing at the worst possible moment,” Steve Glazer, a California state senator whose district includes La Clínica, said in an email. | “Their revenues are crashing at the worst possible moment,” Steve Glazer, a California state senator whose district includes La Clínica, said in an email. |
| Business plunged 80 percent overnight at Gardner Health Services, which runs seven health centers in Santa Clara and San Mateo Counties and serves about 50,000 patients. | Business plunged 80 percent overnight at Gardner Health Services, which runs seven health centers in Santa Clara and San Mateo Counties and serves about 50,000 patients. |
| In Los Angeles, South Central Family Health Center, which sees 25,000 patients a year, lost $90,000 in revenue during the last week of March. “That’s immediately unsustainable,” David Roman, a spokesman for the center, said. | In Los Angeles, South Central Family Health Center, which sees 25,000 patients a year, lost $90,000 in revenue during the last week of March. “That’s immediately unsustainable,” David Roman, a spokesman for the center, said. |
| Government authorities said they were aware of the problem and trying to help. Last month, the Trump administration awarded $100 million to health centers across the nation, of which nearly $14 million went to California. But out of this pool of assistance, only $145,000 found its way to La Clínica, barely enough to cover about a half-day of expenses for its clinics. | Government authorities said they were aware of the problem and trying to help. Last month, the Trump administration awarded $100 million to health centers across the nation, of which nearly $14 million went to California. But out of this pool of assistance, only $145,000 found its way to La Clínica, barely enough to cover about a half-day of expenses for its clinics. |
| [See our map of coronavirus cases in California by county.] | [See our map of coronavirus cases in California by county.] |
| More help arrived via the recently approved $2 trillion federal package to address the pandemic. The relief bill included $1.32 billion for community health centers nationwide, a 25 percent increase to the $5.6 billion the federal government is already spending on the centers this year. California’s share was $192 million. | More help arrived via the recently approved $2 trillion federal package to address the pandemic. The relief bill included $1.32 billion for community health centers nationwide, a 25 percent increase to the $5.6 billion the federal government is already spending on the centers this year. California’s share was $192 million. |
| State officials have also acted. Dr. Bradley P. Gilbert, director of the California Department of Health Care Services, said in an email that his office was pushing for community health centers to get reimbursed through Medicaid for seeing patients remotely by telephone or over the internet. | State officials have also acted. Dr. Bradley P. Gilbert, director of the California Department of Health Care Services, said in an email that his office was pushing for community health centers to get reimbursed through Medicaid for seeing patients remotely by telephone or over the internet. |
| Carmela Castellano-Garcia, chief executive of the California Primary Care Association, a lobbying group for community health centers, said the change, if adopted as expected, would give clinics a reprieve. But, she added, the struggle for survival is far from over. | Carmela Castellano-Garcia, chief executive of the California Primary Care Association, a lobbying group for community health centers, said the change, if adopted as expected, would give clinics a reprieve. But, she added, the struggle for survival is far from over. |
| [Read more about how outbreaks hit low-income black and Latino communities harder.] | [Read more about how outbreaks hit low-income black and Latino communities harder.] |
| Receiving health care over the phone is far from ideal for many of the people who rely on community health centers. They need their blood pressure monitored and someone to make sure they are taking their medicines, Dr. Paul Bayard, La Clínica’s chief medical officer, said. “Your vulnerable populations who haven’t been evaluated will be more at risk for things like heart attacks, strokes and falls,” he said. | Receiving health care over the phone is far from ideal for many of the people who rely on community health centers. They need their blood pressure monitored and someone to make sure they are taking their medicines, Dr. Paul Bayard, La Clínica’s chief medical officer, said. “Your vulnerable populations who haven’t been evaluated will be more at risk for things like heart attacks, strokes and falls,” he said. |
| Updated June 5, 2020 | Updated June 5, 2020 |
| 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. | |
| 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. |
| 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. | 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. |
| 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. |
| The Oakley branch of La Clínica is quiet these days. Ms. Abell is struggling to adjust to the new reality of trying to get health care over the phone. | The Oakley branch of La Clínica is quiet these days. Ms. Abell is struggling to adjust to the new reality of trying to get health care over the phone. |
| Her hands are so swollen by arthritis she can’t flip a light switch without pain. Her hands need to be X-rayed, a service La Clínica doesn’t provide, but her primary care doctor advised against going to the hospital because of the pandemic. | Her hands are so swollen by arthritis she can’t flip a light switch without pain. Her hands need to be X-rayed, a service La Clínica doesn’t provide, but her primary care doctor advised against going to the hospital because of the pandemic. |
| “I’m just kind of in limbo over here,” Ms. Abell said. | “I’m just kind of in limbo over here,” Ms. Abell said. |
| Katey Rusch contributed reporting. | Katey Rusch contributed reporting. |
| We often link to sites that limit access for nonsubscribers. We appreciate your reading Times coverage, but we also encourage you to support local news if you can. | We often link to sites that limit access for nonsubscribers. We appreciate your reading Times coverage, but we also encourage you to support local news if you can. |
| As officials order Americans to stay at home, there is no more precious resource than space — and cars normally take up a lot of it. So some cities, including Oakland, are shutting down streets to vehicles in what many hope will be a “welcomed reclamation movement.” [The New York Times] | As officials order Americans to stay at home, there is no more precious resource than space — and cars normally take up a lot of it. So some cities, including Oakland, are shutting down streets to vehicles in what many hope will be a “welcomed reclamation movement.” [The New York Times] |
| On Sunday, L.A. officials said 31 people had died from the coronavirus, the largest single-day jump in the state’s most populous county since the pandemic began. [The Los Angeles Times] | On Sunday, L.A. officials said 31 people had died from the coronavirus, the largest single-day jump in the state’s most populous county since the pandemic began. [The Los Angeles Times] |
| Read more about what an expert is watching in coronavirus numbers. [The New York Times] | Read more about what an expert is watching in coronavirus numbers. [The New York Times] |
| In an effort to keep the coronavirus from spreading in nursing homes, which have been the site of terrifying outbreaks, Gov. Gavin Newsom said some nursing facility patients who have not tested positive for the virus will be moved to the Navy hospital ship Mercy. [The Sacramento Bee] | In an effort to keep the coronavirus from spreading in nursing homes, which have been the site of terrifying outbreaks, Gov. Gavin Newsom said some nursing facility patients who have not tested positive for the virus will be moved to the Navy hospital ship Mercy. [The Sacramento Bee] |
| If you missed it, read more about the ship’s mission in Southern California. [The New York Times] | If you missed it, read more about the ship’s mission in Southern California. [The New York Times] |
| When Bob Iger, Disney’s chief executive, stepped down abruptly, it prompted questions: Had Mr. Iger, with his deep ties to China and legendary timing, seen the coronavirus about to devastate his global realm? Did he get out just in time? Mr. Iger said that almost the opposite was the case. [The New York Times] | When Bob Iger, Disney’s chief executive, stepped down abruptly, it prompted questions: Had Mr. Iger, with his deep ties to China and legendary timing, seen the coronavirus about to devastate his global realm? Did he get out just in time? Mr. Iger said that almost the opposite was the case. [The New York Times] |
| Once upon a time, last weekend would’ve marked the opening of Coachella and, thus, “festival season” around the world. Now, fashion companies are figuring out how to adapt. [The New York Times] | Once upon a time, last weekend would’ve marked the opening of Coachella and, thus, “festival season” around the world. Now, fashion companies are figuring out how to adapt. [The New York Times] |
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| Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter. | Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter. |
| California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley. | California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley. |