Rachael Banks had planned to start Public Health Week by highlighting the work of Racial and Ethnic Approaches to Community Health, celebrating a grand opening of a new WIC office in North Portland and laying out an 18-month policy agenda to curb nicotine use, improve access to safe physical activity and combat alcohol and drug abuse.
As Multnomah County’s public health director, Banks oversees programs within one overarching mission: prevent sickness and death. Public Health is where maternal child health, violence prevention and healthy homes and safe streets strike at the knees of injustice and build resilience within those communities hardest hit by racism and social inequality. [View your local public health heroes during a daylong workshop in 2019]
Instead, on Monday, Banks appeared in a virtual press briefing alongside her partners in community health clinics to urge residents with chronic disease to continue seeking healthcare to manage those conditions, even as health officials across the globe ask residents to stay home to slow the spread of COVID-19.
“While we are rightly and squarely focused right now on responding to COVID-19, there’s a link to our long-term work, the work we do every day in public health,’’ Banks said. “There’s a link that I want to make sure doesn’t get lost, and that’s chronic disease prevention.”
Chronic Disease and COVID-19
In the same way that older adults are at higher risk of complications from this new virus, people with chronic disease are also at higher risk of serious illness from COVID-19.
Early research shows patients with at least one underlying health condition are more likely to need intensive care and hospitalization. The most commonly reported conditions were lung disease, diabetes and cardiovascular disease.
Among those Multnomah County residents who have tested positive for COVID-19 and have been interviewed thus far:
19 percent have lung disease — nearly four times the rate of lung disease among the County’s overall population.
15 percent have underlying diabetes — nearly twice the rate experienced by the overall population.
13 percent have cardiovascular disease — more than twice the rate of the overall population.
Health and justice
And in the same way COVID-19 disproportionately strikes people with underlying conditions, chronic disease disproportionately strikes Black, Indigenous and people of color, as well as those who live on a low income, Banks pointed out on Monday.
In Multnomah County, consider:
Black and African American residents experience 25 percent more deaths from heart disease and nearly 70 percent more deaths from stroke. They have more than twice the rate of diabetes and are two-and-a-half times more likely to die of the disease.
"The disproportionate deaths and rates of chronic disease are not the fault of Black and African American people," Banks said. "Rather they are symptoms of an unjust society."
Not only are rates of chronic disease higher among communities of color, but those residents are overrepresented in essential positions where they have a disproportionate risk of exposure to this virus. And in no profession is that more glaring than among healthcare workers in long-term care facilities.
“Those jobs pay lower wages and may leave people without the sick leave or other benefits to take care of their own health,” Banks said. “So while we in public health have said, and will continue to say, ‘please continue to stay home if you’re sick,’ we want to make sure our residents know that we are here for you and folks with chronic disease.”
Clinics still open, accepting new patients
Banks was joined Monday by Tasha Wheatt-Delancy, interim executive director of the Multnomah County Community Health Center and Integrated Clinical Services, Dr. Laura Byerly, medical director at Virginia Garcia Memorial Health Center and Lori-Ann Lima, a family nurse practitioner with Wallace Medical Concern.
Wheatt-Delancy oversees a network of 23 County clinics across 18 locations, including primary care clinics, pharmacies, student health centers, dental clinics and HIV support.
As the largest safety net provider in the state, Multnomah County’s clinics provide services to many residents who have complex medical needs, including chronic conditions such as diabetes and asthma, and many have experienced untreated medical conditions, depression, addiction, homelessness, or trauma.
Wheat-Delancy said clinics are working to make sure those patients still get the care they need during the pandemic, even as staff shift appointments to telephone whenever possible.
“Some of our patients are especially vulnerable and need to stay home,” she said Monday. “For those individuals, we’re working with them to make sure they get their medications, healthy food and care advice.”
Clinics continue to see patients at their offices, but request that patients call first to discuss care needs by phone. All clinic pharmacies remain open, as well. While most student health centers have closed temporarily, Parkrose Student Health Center remains open to provide care to adolescents.
“We want you to know that our services remain available to you. If you are looking for a new medical home, we are accepting new patients,” Wheat-Delancy said. “Whether you’re sick or well or if you just have questions — you can reach out for care.”
Like Multnomah County’s clinical system, Virginia Garcia Memorial Health Center serves thousands of patients across Washington and Yamhill counties. And like Multnomah County, those clinics have also shifted to a telephone-first model.
“We have also shifted from mostly in-person to mostly telephone visits,” said medical director Byerly. But the clinics do still see people in person.
“We are trying to do all contacts by phone first, to evaluate what you need to make that process smooth and minimize the chance of sharing the virus.”
Virgina Garcia is also mailing medications to patients who have chronic illness and working with community health workers to deliver medications to people who need to stay home.
“It’s been a really amazing transition, moving to a whole other way of doing care,” Byerly said.
Like Virginia Garcia, Wallace Medical Concern is accepting new patients. And like other primary care clinics, they’re asking all patients to first contact them by phone to discuss their needs, before scheduling an in-person visit.
“Some people have urgent needs and need to be seen,” said Lima, the family nurse practitioner with Wallace. “And we want you to get the care you need so you don’t end up in the hospital.”
Anyone who does come to the clinic — patients and staff — get checked for symptoms of COVID-19, and are asked to wear a mask during clinic appointments.
Lima said the team at that East Portland clinic has welcomed the opportunity to expand its concept of how they deliver care.
“It has been an interesting challenge,” she said.