Community health centers serve nearly 29 million Americans, including 1 in 7 of all Californians, and are part of the backbone of the health care safety net. Yet year after year, we face an existential and financial crisis, which is particularly amplified amidst the COVID-19 pandemic as federal funding dwindles, personal protective equipment (PPE) scarce, and outpatient visits dramatically drop. The future of Community Health Centers is in peril.
North East Medical Services (NEMS) is one such community health center in the San Francisco Bay Area serving over 70,000 patients, many of whom are low-income, best-served in a language other than English, and are from immigrant families. NEMS is one of the largest healthcare providers for Asian Americans in the United States and has already begun testing, diagnosing and treating San Franciscans with COVID-19.
Even as a critical part of the healthcare safety net, NEMS has had to reduce operations in the wake of the COVID-19 pandemic. Due to local and state shelter-in-place orders, we have reduced primary care visits in our clinics by nearly 80%, and pivoted quickly to video and phone visits in order to maintain contact with our patients. This reduction in visits has caused a decrease in revenue not only for NEMS, but it is estimated that $3.2 billion dollar will be lost among the 1,400 community health centers across the United States. Congress has recently passed an Economic Stimulus Package, containing billions of dollars in funding for health centers and hospitals, yet community health centers will only receive half the amount—$1.32 billion dollars—necessary to cover patient care, staff salaries, and additional supplies. Without additional revenue or funding, it will be nearly impossible to continue directing needed resources to contain the COVID-19 pandemic.
Further complicating this crisis is the lack of availability of personal protective equipment or PPE. PPE is necessary to keep medical staff safe when they are treating or testing patients suspected of having COVID-19. Due to worldwide shortages, even the most prestigious hospitals and health systems are not able to access gowns, gloves, masks, and other necessary materials. As a community health center, it is exponentially difficult to access PPE, as we are often relegated to the bottom of the priority list for resources. Supply chains have dried up, and NEMS is currently experiencing two-months or longer wait time for PPE including hand sanitizer and face shields. National and state stockpiles have recently been made available, but as of now are reserved for hospitals and first responders only. This leaves little to no resources for community health centers; even though it is our core responsibility as preventive health care providers to test and treat COVID-19 patients and divert them from the more costly hospital or emergency room setting. We simply do not have the basic resources to address and contain this pandemic within our community, even if it is expected of us to do so.
In order to confront this crisis, NEMS has set up drive-through testing centers at four sites in the Bay Area for our patients to be tested. This helps preserve PPE and keeps other patients and doctors safe by keeping potentially sick patients out of waiting rooms, elevators, and other common areas within the clinic. We have also rapidly scaled up our telehealth services in order to continue providing routine care to our patients and minimize risk of exposure. These efforts are necessary to continue providing care to the community, but unfortunately cannot be sustained with the current funding landscape, lack of PPE, and prolonged threat of the pandemic.
Community health centers are the backbone of the healthcare safety net and cannot be overlooked as essential health care providers during this ongoing pandemic. Failure to adequately fund or support organizations like NEMS will result in an even more dire public health crisis that will cripple our healthcare system. As unemployment claims and lay-offs surge across the nation, community health centers and the safety net will be even more integral to our system of care in the coming months, and will be necessary to provide medical care for the countless Americans who have no other healthcare options. If we are to forge ahead with a fighting chance at containing COVID-19, community health centers must be part of the solution now, and in the months and years to come.
**NEMS is asking for the public’s help to collect and donate PPE and essential supplies. Community members should contact Andrey Chow at Andrey.Chow@nems.org if they can donate surgical gowns, face shields, protective goggles, or masks.**
Dr. Eddie Chan is president & CEO of North East Medical Services, a non-profit outpatient medical center that was founded in San Francisco’s Chinatown almost 50 years ago.