Keeping up with COVID-19 surges proves difficult for area health centers 

During the pandemic, health care providers have had to shift away from ongoing care priorities to respond to surges in COVID-19. 

The result has been harmful across Pennsylvania’s health care industry, with patients putting off preventive screenings and check-ups and having higher acuity medical issues by the time they are seen. 

The most recent explosion in the omicron variant has once again disrupted routine care at a time where patients began returning to their primary care doctors, something that was particularly felt among providers working with underserved communities. 

“When we are in a surge like this and we have to go to telehealth, close sites and change hours, that means that a child isn’t seen today for a well child check or a client isn’t seen for their disease follow-up,” said Jenny Englerth, president and CEO of Family First Health in York. 

Family First Health is one of many federally qualified health centers (FQHCs), community-based health care providers that receive federal dollars to provide primary care services in underserved communities. 

Continuing care during a surge 

The juggling act of responding to COVID-19 surges and fulfilling the mission of a FQHC to make primary care accessible to the region has been difficult for the centers, which like many health care facilities today are understaffed. 

Last year, Lancaster-based Union Community Care saw a high volume of patients return for care for the first time in many months, most commonly for chronic conditions like diabetes and hypertension, said Dr. Anne-Marie Derrico, chief medical officer at Union. 

“Many had run out of medications and were due for refills and had not had routine blood work done in many months, or even more than a year,” said Derrico. “Blood pressures and diabetes were often out of control in these patients, putting them at risk for heart attacks, strokes and kidney disease as well as other complications.” 

Union’s pediatric well child visits, and subsequent vaccination rates, were low in 2020 and 2021. Well child checks for children aged 0 to 15 were down 17% last year and are just beginning to improve, said Derrico. 

Harrisburg-based Hamilton Health Center has been able to continue ordering routine screenings such as mammograms and colonoscopies, and running reports for patients with poorly controlled diabetes and children due for vaccinations. However, just because providers are continuing to order and recommend these screenings and vaccinations, does not mean that patients feel comfortable having them performed during the pandemic, said Dr. Bolanle Limann, chief medical officer at Hamilton. 

“The question is are patients comfortable completing screening measures and do they view this as priority. A 70-year-old woman may say that her mammogram isn’t a priority during these unprecedented times,” said Limann. “It may not be a priority for a patient to go get a colonoscopy which requires at least two visits with a specialists, a gastroenterologist.” 

The most recent surge of COVID-19 has meant that preventative care has once again taken a back seat to responding to the pandemic with patients coming into the FQHCs for COVID-19 testing, vaccinations and more. 

Telehealth has proven to be an important tool for providers to continue care for vulnerable patients during these surges, but telehealth is not ideal for many types of visits and staff have a limited ability to see patients since so many resources have been diverted to testing, said Derrico. 

Stretched thin 

That diversion of resources could prove detrimental to FQHCs if they continue to be forced into taking staff away from their primary care duties. 

“I am concerned about our ongoing financial health if we have to continue to deal with these surges.” said Englerth. “We can’t garner the same amount of revenue during a surge as we can when delivering ongoing primary care services.” 

Englerth went on to add that if there is a silver lining to the pandemic it is that the model of delivering primary care has been impacted positively. For example, telehealth offerings have become widespread whereas it was uncommon for a provider to offer telehealth services before the pandemic. 

That silver lining may be moot for FQHCs if they lack the time, space or energy to be able to build a sustainable model to meet the needs of their growing patient population, she said. 

“We will be strained for resources in a variety of ways,” said Englerth. “We will have the right ideas when it comes to things like mental health delivery, but it will take more recourses than ever to have more opportunities.” 

The U.S.’s healthcare workforce decreased 3.5% from February 2020 to February 2021, according to a report using data from the U.S. Bureau of Labor Statistics by nonprofit research firm the Altarum Institute. 

FQHCs in the midstate have felt this decline in staff and, like their contemporaries, cannot find new staff to recruit. The staff that remain are both physically and emotionally exhausted. 

“Stressors are coming from multiple areas and not just work,” said Limann. “The wear and tear from this two plus year pandemic is manifesting in multiple ways.” 

This problem has been worsened by the fact that staff members themselves are in isolation or quarantine. Hamilton Health, for example, has one full time RN set aside just for testing and communicating with employees with COVID-19. 

“There has been an exponential surge in COVID cases in December 2020 and January 2021, not just in our patients but also our staff,” said Limann.