A National Study of Community Health Centers' Readiness to Address COVID‐19

Research Objective

Community health centers (CHCs) serve as the patient medical home for populations that are disproportionately more susceptible to COVID‐19; yet, there is a lack of understanding of the current efforts in place by CHCs across the United States working to prepare for and respond to the current pandemic. The purpose of this mixed‐methods assessment was to understand community health centers’ needs and readiness to address COVID‐19.

Study Design

We conducted a sequential explanatory mixed‐methods approach. A pilot‐tested, web‐based, cross‐sectional survey regarding organizational and individual staff needs, and best practices currently in place to prepare for and prevent spread of COVID‐19, was administered to and completed by 240 primary care employees from 201 organizations across 44 states, the District of Columbia, and Puerto Rico. Focus group interviews were subsequently conducted with a convenience sample (n = 39) from the survey respondents to understand the needs and current efforts in place by CHCs across the United States working to prepare for and respond to COVID‐19. We applied the transcript‐based analysis approach to the focus group data and derived themes using the constant comparative method.

Population Studied

The majority of respondents (59%) held administrative leadership roles at their respective agencies, while the remainder of the participants served in patient‐facing roles as physicians (8%), nurses (13%), and medical support staff (20%). Over a third (38%) of the participants came from practices in the Northeast region of the country, with the rest of respondents coming from the West (19%), South (19%), and Midwest (23%) regions, and minor representation from Puerto Rico (1%).

Principal Findings

Respondents identified guidance regarding COVID‐19 infection prevention and control (77.1%), safety precautions (72.1%), and screening, diagnostic testing, and management of patients (67.1%) as their major educational needs. Findings from the focus groups highlighted five key themes relevant to foundational aspects of readiness: leadership, communication, formal policies and procedures, resources, and workforce capacity. Responses from the focus groups clearly reflected the difficulty imposed on an already stretched, understaffed workforce in pivoting to rapidly address the expected surge in demand from patients related to the pandemic.

Conclusions

The COVID‐19 pandemic has exacerbated long‐standing capacity issues that CHCs face, making it challenging for these safety‐net practices to adequately respond to the current disease outbreak. In addition to the more universal concerns about lack of testing and personal protective equipment, these findings highlight the special challenge posed by lack of staffing resources in CHCs as recruitment and retention of staff in rural and other medically underserved practice locations has burdened health centers long before the current pandemic.

Implications for Policy or Practice

The COVID‐19 pandemic is occurring at a time when CHCs nationwide are experiencing great economic uncertainty. There is a need for Congress to prioritize reauthorization of funding for CHCs in order to prevent major hiring freezes, layoffs, and reduced patient care services, especially during a pandemic. Similarly, greater Federal financial support for CHCs is needed to ensure these practices have the capacity to continue serving the most vulnerable members of society, thereby helping relieve the stress on hospitals and flatten the spread of COVID‐19.

Extracellular export of sphingosine kinase-1a contributes to the vascular S1P gradient

Sphingosine 1-phosphate (S1P), produced by Sphks (sphingosine kinases), is a multifunctional lipid mediator that regulates immune cell trafficking and vascular development. Mammals maintain a large concentration gradient of S1P between vascular and extravascular compartments. Mechanisms by which S1P is released from cells and concentrated in the plasma are poorly understood. We recently demonstrated [Ancellin, Colmont, Su, Li, Mittereder, Chae, Stefansson, Liau and Hla (2002) J. Biol. Chem. 277, 6667-6675] that Sphk1 activity is constitutively secreted by vascular endothelial cells. In the present study, we show that among the five Sphk isoforms expressed in endothelial cells, the Sphk-1a isoform is selectively secreted in HEK-293 cells (human embryonic kidney cells) and human umbilical-vein endothelial cells. In sharp contrast, Sphk2 is not secreted. The exported Sphk-1a isoform is enzymatically active and produced sufficient S1P to induce S1P receptor internalization. Wild-type mouse plasma contains significant Sphk activity (179 pmol x min(-1) x g(-1)). In contrast, Sphk1-/- mouse plasma has undetectable Sphk activity and approx. 65% reduction in S1P levels. Moreover, human plasma contains enzymatically active Sphk1 (46 pmol x min(-1) x g(-1)). These results suggest that export of Sphk-1a occurs under physiological conditions and may contribute to the establishment of the vascular S1P gradient.

Genetic red cell disorders and severity of falciparum malaria in Myanmar

A hospital-based survey was undertaken to investigate the relationship between the incidence and severity of malaria infection and various red cell disorders in Myanmar. The mean parasitaemia levels of patients with alpha- or beta-thalassaemia trait or with severe glucose-6-phosphate dehydrogenase (G6PD) deficiency were lower than those of individuals with normal haemoglobin AA or with heterozygous haemoglobin E. The double genetic defect of thalassaemia trait and severe G6PD deficiency appeared to confer some degree of protection against malaria.

The in vivo and in vitro sensitivity of Plasmodium falciparum to quinine

The in vivo and in vitro sensitivity of P. falciparum to quinine were studied simultaneously on 20 isolates of P. falciparum from infected patients in Rangoon and in Tharrawaddy Township. The in vivo study showed 85% sensitive and 5% resistance at RI level. The peak plasma quinine level in all the cases were above mean MIC on days 1, 3, 5 and 7. Schizont maturation was inhibited at 128 p.mol/well in 15% of the cases but the rest were at or below 64 p.mol/well in vitro test. However, no relationship was detected between the in vivo and in vitro sensitivity of quinine.

Lithium toxicity in a neonate

Severe transplacental lithium toxicity in a neonate is described. There were gross functional lesions of the cardiovascular, renal, and neuromuscular systems with no structural abnormalities. At 1 year of age cardiovascular and renal function is normal, but there is developmental delay.