NPR and PBS Newshour interviewed several HealthPoint providers about the daily realities of caring for communities during the COVID-19 crisis. We've paraphrased their stories in this post. Acknowledgements and thanks to Will Stone for NPR and Isabella Isaacs-Thomas for PBS Newshour for reporting on community health centers' response to the crisis.
Rapidly redesigning systems
About 29 million people in the U.S rely on community health centers, which provide care to low-income and uninsured patients. And they are under pressure to rapidly pivot to respond to the pandemic.
Under normal circumstances, HealthPoint would encourage patients to visit the clinic for their medical needs and to pick up prescriptions.
"Usually our lobby is slammed," says Dr. Esther Johnston of HealthPoint Auburn North. "It's open space and everyone is together."
But now only a few patients in surgical masks wait for appointments. And HealthPoint is telling patients to stay away unless they absolutely need in-person care.
"It is a bit frustrating and demoralizing, but it's the reality of the situation," she says.
Now, at the entryway of HealthPoint clinics, staff query everyone to identify COVID-19 symptoms and monitor patients to make sure they remain at a distance from each other once inside.
Johnston says their clinic was not set up to house an influx of patients with infectious diseases. There are limited exam rooms and each one needs to be shut down and cleaned after a patient suspected of COVID-19 comes in.
"We just don't have enough space to be able to do that on a routine basis," she says. Johnston worries about what's coming as cases rise in her area.
"We pride ourselves on being a primary care home," Johnston says. "We don't have enough N95 masks, nor to be honest were we prepared for a situation where everyone had to be properly fitted."
HealthPoint's chief medical officer Dr. Judy Featherstone says most appointments are now done over the phone. Her staff is fielding calls from people who are concerned about symptoms, as well as new patients who want to have a doctor in case they contract COVID-19.
"It is a bit like taking twenty years of work and redesigning it in a week," says Featherstone.
Ramping up testing
Like many clinics in Washington, HealthPoint has set up outdoor testing sites, but the supply of kits and protective gear, or PPE, has so far limited how many patients they can actually test for COVID-19.
"We’re wearing full protective gear,” said Dr. Shoshana Aleinikoff, medical director of HealthPoint Midway. “We’re doing these tests in a tent outside in our parking lot just to take extra precautions for our staff’s safety and trying to reduce any possible spread in our clinic.”
When potentially infected patients arrive, staff members greet them at the door and ask most patients to wait in their cars to be tested inside tents that have been set up in the parking lot. A small number of patients who need to be seen by a physician are brought into a specific waiting room that’s isolated from other patients who aren’t presenting respiratory symptoms.
Like many health care centers across the country, HealthPoint has received a limited number of test kits, and there is a backlog of processing results in the state. As a result, HealthPoint has needed to prioritize testing for patients at high risk. There is hope that more test kits--and the PPE needed by staff to perform them--will arrive in the future.
Struggling to conserve equipment
Suzanne Laurel, the medical director at HealthPoint Auburn, said she and her staff are conserving their PPE in anticipation of a likely shortage down the road. They are reusing masks when possible and disinfecting gloves and goggles rather than using disposable ones. They have also ordered launderable white coats for providers to wear, given the shortage of protective gowns.
Thinking about the next few weeks or months can be “overwhelming,” Laurel said. But every day, she and her staff meet for daily briefings to discuss the latest updates on COVID-19 and regularly go over reminders of best practices for using PPE, washing hands thoroughly and other important measures to reduce their chances of infection.
“I have utter confidence that the health care workers that I work with are here for the long haul and ready to take care of whoever comes in, no matter their ability to pay for a test, regardless of their illness status. It’s what we’ve always done here in community health centers and what we’ll continue to do,” Laurel said. “I just hope that we will get the resources we need to be able to do it safely for our staff.”