Nearly three years into the COVID-19 pandemic, the United States is still reeling, with multiple variants of the virus having caused more than one million deaths. Up to twenty-three million Americans may be battling the symptoms of long COVID, including chronic fatigue, brain fog, and shortness of breath, leaving an estimated one million of them unable to work, according to the U.S. Government Accountability Office.
Mental health has also been affected on a mass scale, with surveys indicating an increase in anxiety, depression, and alcohol consumption across the U.S. population, as well as difficulty sleeping and eating.
The effect of all of this on low-income communities and communities of color is particularly severe. In 2021, Black and Latinx people experienced a 2.9- and three-year decline in life expectancy, respectively, largely due to COVID-19 deaths, according to the Brookings Institution. That is 2.5 times the decline for white people during the same period. In addition to hypertension, diabetes, and other chronic health conditions that often go untreated, poor Americans also face higher incidences of eviction, food insecurity, and other socioeconomic problems that can lead to illness.
Fortunately, a powerful ally exists in the 1,400 community health centers around the United States, which have served as a medical safety net since their founding during the civil rights movement of the 1960s. These nonprofit health centers provide care to patients regardless of their ability to pay. About 20 percent of patients who use their services are uninsured, and 59 percent receive health insurance through Medicaid or other government programs. Ninety percent of these patients are considered low income.
In 2021, community health centers provided care for more than thirty million Americans at 14,000 locations across the country, according to the National Association of Community Health Centers (NACHC), an advocacy organization founded in 1971. That was a record number which included one in five rural Americans.
The centers were also at the forefront of a national movement to vaccinate people disproportionately affected by the pandemic, such as essential workers, agricultural and migrant workers, public housing residents, the elderly, and people experiencing homelessness. To date, 72 percent of the 22.2 million vaccinations provided by the centers were administered to people of color.
“Our medical model emphasizes the importance of looking beyond the walls of our centers to provide primary health care, dentistry, behavioral health, and other services, as well as socioeconomic support to people who live in the shadows,” Ron Yee, chief medical officer at NACHC, tells The Progressive.
In 2021, geographical areas that had community health centers had 200 fewer cases of COVID-19 and nine fewer deaths per 100,000 people, compared with areas that didn’t have centers.
“From day one of the pandemic, we used this model to attack the virus on every front,” Yee says. “In addition to knocking on doors to educate people about how they could reduce their risks, our staff distributed more than 7.6 million N95 masks.”
Staff at community health centers across the country have also set up vaccination sites where essential workers are employed, such as farms and outside of stores, as well as at places where people congregate, such as laundromats and schools.
Their efforts have saved lives. In 2021, geographical areas that had community health centers had 200 fewer cases of COVID-19 and nine fewer deaths per 100,000 people, compared with areas that didn’t have centers, a joint study by NACHC and the Morehouse School of Medicine’s National COVID-19 Resiliency Network found.
“Although we are now in a transition phase, where the number of COVID-19 cases is declining, vaccinations are still a major priority because we want to ensure that our patients won’t succumb to new strains,” Yee says. “We are also implementing new strategies that centers used during the pandemic to serve our long-term patients as well as new patients who will be entering our doors following horrific events like hurricanes and acts of violence.”
Albany Area Primary Health Care (AAPHC), a network of centers that has served Southwest Georgia since 1979, regarded the March 2020 World Health Organization announcement that the COVID-19 outbreak had become a pandemic as the equivalent of a four-alarm fire.
“We immediately asked what had worked at our twenty-seven sites and how the pandemic might affect our ability to serve patients who were terrified to leave their homes,” AAPHC Chief Executive Officer Shelley Spires says. “To encourage diagnosis and treatment, we instituted a plan to substitute telemedicine sessions for clinic visits and capitalize on the close bonds that the staff had developed with patients over the years to overcome hurdles in compliance.”
AAPHC obtained a $50,000 grant to buy home kits to measure blood pressure and other vital signs needed for telemedicine checkups. Many people didn’t know how to use these devices, so nurses visited patients’ homes to offer instruction.
These visits had an unexpected benefit: boosting patients’ compliance. Nurses took the opportunity to educate family members sheltering at home about their loved ones’ medications and diets so that they could offer encouragement and support to patients to help them adhere to treatment regimens.
“Unemployment, debts, and the loss of loved ones can cause patients to resume unhealthy habits and become seriously ill,” Spires tells The Progressive. “Having a nurse and other staff members who can find solutions for food insecurity, eviction, and other daunting problems made a significant difference in the health of patients who were under severe stress, even before the pandemic.”
Ensuring the well-being of staff was another priority, Spires says. An employee died during the first week of the pandemic, and other staff members lost loved ones as the virus spread. Daily town hall meetings enabled staff members to express their feelings. Activities also helped ease the stress of long working hours, lack of sleep, and relentless uncertainty.
“Community health centers were the first line of defense for people who had nowhere to turn during COVID-19, and they will continue to be a beacon of hope.”
Today, AAPHC is expanding services provided outside its walls. In addition to primary care, mobile units offer isolated communities mammograms, prenatal care, and other women’s health services, as well as dentistry. Behavioral health services offered included a group for patients suffering from anxiety, which skyrocketed during the pandemic, Spires says.
NACHC has encouraged these efforts by conducting an extensive analysis of how community health centers across the nation have responded to challenges in thirteen categories.
“How did our center triage care? Where did our patients go for dental care? How did people in the community respond to curbside COVID-19 tests? Did patients with diabetes follow their treatment plans?”
“These were just a few of the questions,” Yee says. “We also conducted seventy hours of interviews with patients to explore matters such as why some people refused to be vaccinated when offered the shots.”
The analysis found that “close relationships with public health entities made a difference in the response of centers to changes in the number of cases and types of strains,” Julia Skapik, NACHC’s Medical Director for informatics, tells The Progressive. “Coordination with private groups to solve problems such as the lack of stable housing and access to nutrition was also critical to improve medical outcomes.”
The Callen-Lorde Community Health Center in New York City is now using this proactive approach to confront the growing threat of monkeypox. As of November 4, 2022, the U.S. Centers for Disease Control and Prevention had reported more than 28,600 cases of monkeypox in all fifty states, Washington, D.C., and Puerto Rico. Many of Callen-Lorde’s patients are young and gay or bisexual men who are at risk for the painful virus. In addition to a patient awareness campaign, the center is working with the New York City Health Department to determine how many vaccines and treatments it will be able to access if the virus gains momentum.
“Guidelines changed quickly during COVID-19, so centers need to keep informed of the latest information from authorities,” Skapik says.
To ensure that high-risk patients like those at Callen-Lorde will have the resources they need, the NACHC joined nearly thirty other local, state, and national organizations in writing a letter to Congress in September supporting President Joe Biden’s request for $4.5 billion to fight monkeypox, both at home and abroad.
The lessons of responding to the mental health needs of center staff during the pandemic proved valuable in the response by Community Health Development after a mass shooter entered Robb Elementary School in Uvalde, Texas, on May 24, 2022, and killed nineteen children and two teachers and injured seventeen others.
The community health center recognized that the first priority was to make sure that its staff was in a safe frame of mind before they began treating patients. Nine staff members lost family members in the shooting, including two nurses whose children died in the attack. Within a day, a crisis center was set up where volunteer behavioral health practitioners began tending to the emotional fallout among the staff.
Community Health Development had been providing medical, dental, and behavioral health services to one-third of the county, so it quickly realized that a long-term plan was needed to help grieving patients rebuild their lives and develop long-term resilience.
In addition to school-based health clinics for children and families, the organization plans to establish a multipurpose center close to a local Walmart in order to provide medical, dental, and behavioral health care, as well as resources to connect patients with services like housing, jobs, and government-sponsored insurance.
Central City Community Health Center in the greater Los Angeles area has increased its efforts to provide care for people experiencing homelessness, who were profoundly affected by COVID-19. Since 2003, the center has offered mental and physical health, dental, and substance abuse services and social support at clinics in Los Angeles, Orange, Riverside, and San Bernardino Counties. Now it is taking these services on the road. Its primary clinic uses outreach teams to provide care at fourteen shelters and group homes, including street outreach.
Other community health centers like the HOPE Clinic in Houston, Texas, are meeting the needs of newly arrived refugees from war-torn countries like Afghanistan. Founded in 2002 by the Asian American Health Coalition, the HOPE Clinic has a long history of providing services to patients from Syria, Myanmar, Nepal, and other Asian countries, as Texas is the third largest refugee resettlement state in the country.
Since December 2021, HOPE has treated more than 733 Afghans. In addition to prenatal, dental, optical, and behavioral health care, the Afghani patients have received COVID-19 and tuberculosis vaccinations. To meet these costs, HOPE received a $50,000 grant from Direct Relief, a nonprofit humanitarian organization.
Translators helped the new arrivals navigate the U.S. health care system. Some patients had difficulty filling prescriptions at a pharmacy. Others struggled with transportation and scheduling appointments. Others were uncomfortable with pelvic exams or worried about providing blood for prenatal testing.
“Patients are more forthcoming when it’s their language and their culture, and when their culture is not just accepted but celebrated,” HOPE Outreach Specialist Lulu Toumajian told Direct Relief Senior Editor Talya Meyers in a blog post for NACHC.
The HOPE clinic plans to apply these lessons to caring for Ukrainians, who are expected to begin arriving due to the ongoing war with Russia.
When COVID-19 began to surge, physicians at the La Casa Family Health Center in New Mexico recognized that workers at local dairy farms faced high risks because people who pick, raise, and process foods are often the first workers to be affected by the outbreak of a new virus, as NACHC’s podcast, Health Centers on the Front Lines, noted.
But the physicians’ plan to provide education and protective measures for these workers hit a wall when many patients refused to discuss their employment due to privacy concerns around their immigration status.
To overcome this, the physicians enlisted the help of the clinic’s front-office employees, who were able to help develop a rapport with and gain the trust of workers from various cultural and linguistic backgrounds. The front-office staff helped to alleviate the workers’ concerns and explained how patient information would be protected by confidentiality, not only to help them avoid COVID-19, but also to cope with it and other respiratory diseases they might contract.
“As these examples show, community health centers were the first line of defense for people who had nowhere to turn during COVID-19,” says the NACHC’s Skapik, “and they will continue to be a beacon of hope as the country continues to battle the virus and other threats.”