As coronavirus spreads across the nation, health centers across the state are racing to educate some of their most vulnerable patients.

By Liora Engel-Smith

As the state contends with its second COVID-19 case, this one in Chatham County, North Carolina’s community health centers are stepping up their outreach to some of the most vulnerable members of every community: the uninsured and medically fragile.

By recent count, more than a million North Carolinians lacked health insurance. About a quarter of them — or just over 245,000 uninsured people — were seen at a community health center in 2018, according to the North Carolina Community Health Center Association.

In an outbreak where education — proper handwashing and sneezing etiquette — are the first line of defense, reaching out to people with correct information has gained new urgency. North Carolina has yet to see a community-wide spread of the new COVID-19, also known as coronavirus, but state health and human services Sec. Mandy Cohen said last week her department expects to see more cases.

Outreach to patients, many of whom are uninsured and underinsured, has proved to be a complex task even as the disease is not yet widespread, staff members at health care centers across the state said. Barriers are numerous, health center providers said, from reaching patients themselves to contending with limited resources as they do so.

COVID-19: what’s my risk?

Low-income patients may not have regular access to phone or internet. They may not have the time or ability to read and understand how to protect themselves and their families.

“It’s like church, if they don’t come here, they may not get the communication,” said Kim Schwartz, CEO of Roanoke Chowan Community Health Center, which serves several counties in eastern North Carolina.

At Roanoke Chowan, that outreach involves fliers with information about the health center and coronavirus everywhere staff could think of: the new bingo parlor, assisted living facilities, local community colleges and churches, Schwartz said. Staff also sent electronic messages to all patients and posted large signs at the entrances to the center’s six clinics to advise patients with cold and flu-like symptoms.

The contagious respiratory virus spreads through coughing, sneezing, and close contact with an infected person, according to the Centers for Disease Control and Prevention, so health centers have been encouraging patients to call first if they develop flu-like symptoms. That recommendation has a dual purpose: it minimizes the spread of the disease, but it also allows providers to triage people and prevent crowded waiting rooms, said Dr. Kenneth Moore, chief medical officer at OIC of Rocky Mount, a community health center in Edgecombe County.

OIC is planning to publicize that message by running a television ad at a local station. The ad will most likely reach people who don’t have a telephone or internet connection, Moore said.

OIC will also record a hold message with information on COVID-19 to educate patients who may not yet know about the virus but are calling for another reason, he added.

In addition to these education efforts, Moore said OIC staff members are also calling their most medically fragile patients — people with chronic diseases and weakened immune systems — to educate them.

As the public becomes more aware of COVID-19, some patients are reaching out to OIC on their own.

“I think we’re at the tip of the iceberg,” Moore said. “[On Wednesday] the call center was saying that they noticed an uptick in the number of calls in general concerning coronavirus and people without symptoms are just coming in and asking ‘what should I do?’”

Word of mouth is still king

At AppHealthCare, a center that serves Watauga, Ashe and Alleghany counties, the staff is taking advantage of a common feature of rural life: that word of mouth travels faster than anything, said Jennifer Greene, public health director of the center, which also serves as a regional health department.

The department has reached out to community leaders with information on COVID-19 and the importance of handwashing, Greene said, to make sure they have the correct information to share.

AppHealthCare has also been dispersing educational materials over social media and asking various organizations to re-share posts that combat misinformation about the new infection.

“We’re using different channels to get that information out,” she added. “ … In these rural communities, we have to try to be creative.”

Planning for potential spread

Outreach may become even more important should the disease spread, because patients without health insurance may not seek help right away when they develop symptoms of the disease.

But these activities — outreach and triaging — require capacity. And uncertainties surrounding federal funding to community centers may impede these efforts, said Leslie Wolcott, communication and emergency preparedness coordinator at the North Carolina Community Health Center Association.

Current federal funding to community health centers is set to expire in May after nearly having lapsed last year, Wolcott said.

“That affects our emergency preparedness planning,” she said. “We could be a lot more secure in our planning if we had federal funding for more than a few months at a time.”

Greene, for her part, said that funding uncertainty means that her center, which cares for more than 4,500 patients, is already running on a lean staff with little wiggle room for bringing in additional staff if the need arises.

Some coronavirus-specific funding is headed to health centers. Last week, President Trump signed an $8.3 billion spending bill that included $100 million in funding to community health centers. But, the National Association of Community Health Centers noted in a press release that the lack of long-term funding limits community centers “at a time when a sustained and robust public health response is needed.”

“These services are not a bonus,” Greene said. “They are critical, they are foundational, and we need them. If nothing else, I hope that it’s something that we can walk away with locally at the state level and at the federal level.”