When I stepped into the leadership role of Lancaster Health Center just nine months ago, I could never have imagined that our community health center staff would be tested to the degree we’ve experienced with the COVID-19 pandemic.
Lancaster Health Center (formerly Southeast Lancaster Health Services) is one of 1,300 community health centers across the nation that serve as health safety nets, providing high-quality medical, dental, mental health and social services for those with Medicaid, Medicare and the uninsured. All are welcome regardless of ability to pay and all services are available on a sliding fee based on family income. Those who cannot afford care do not pay anything for services. Lancaster Health Center serves more than 22,000 patients across Lancaster County, through 85,000 visits per year.
Community health is public health in action. Public health is a wide field encompassing education, direct services, scientific research, data and policy to prevent disease and enhance the health of a population. As public health practitioners, we view our work through the lens of the individual, family, community and larger society.
By taking a public health approach, Lancaster Health Center decided to start testing for COVID-19 early on. To date, we have tested 342 patients, and are caring for 106 who tested positive for COVID-19, the respiratory disease caused by a novel coronavirus. Thankfully, most are recovering at home while 10 have been hospitalized and, unfortunately, one person has died.
Having personal protective equipment on hand — and engaging our supply vendors early and often — allowed Lancaster Health Center to begin and continue testing those most vulnerable. Patients are tested based on Centers for Disease Control and Prevention protocol, so that means testing patients with symptoms — dry cough, fever, shortness of breath.
Equally important, our public health lens led us to begin contact tracing on March 30 when our first positive case of COVID-19 was confirmed.
According to the World Health Organization, contact tracing is the systematic approach to identifying positive cases, connecting with individuals who had contact with the person who tested positive for COVID-19, and regular follow-up with those contacts to monitor for symptoms. Widespread testing and contact tracing are how we flatten the curve of COVID-19 infection and return our community to a semblance of normalcy.
Lancaster Health Center nurses have spoken to more than 250 community members potentially exposed to COVID-19 to ensure they self-isolate and monitor their health for symptoms. The nurses also answer any questions patients may have, such as how the disease spreads and ways to prevent exposure to others.
By staying home for 14 days, these community members who may have been exposed — whether they are symptomatic or not — will prevent spreading the disease to others. Alerting contacts and encouraging them to stay home is vital, given that approximately 25% of individuals with COVID-19 have no symptoms, according to CDC Director Dr. Robert Redfield.
A public health approach also requires that we explore who is disproportionately impacted by COVID-19 or particularly vulnerable to the disease. Although community demographic data — i.e., age, race, ethnicity — for deaths due to COVID-19 are not available due to limited local public health capacity, Lancaster Health Center has chosen to proactively map positive cases to identify “hot spots.” Preliminary mapping reveals higher rates of COVID-19 among those in multifamily dwellings.
Additionally, we have reached deeper into our refugee population in partnership with Church World Service, to ensure that speaking and reading English are not prerequisites to accessing reliable information on how to protect against infection.
Disparities in health status and health outcomes are complex. We know those disparities have roots in social ills and unequal access to information, resources and protective factors. But we believe disparities are not insurmountable.
By working collectively, we can — and will — flatten the curve of COVID-19 infection in Lancaster County and hopefully come through this pandemic with a deeper appreciation for our health, our families and the humanity that connects us all to each other.
Alisa Jones is president and CEO of Lancaster Health Center. She has a master’s degree in public health and more than 20 years of experience in community health, including maternal and child health and health equity.