Addressing health disparities is difficult during the best of times, but this pandemic has brought the differences between racial and ethnic groups into even sharper contrast. The COVID-19 death rate for African Americans is 62.4 per 100,000 in St. Louis County, compared to 32.9 for whites and 10.6 for all other racial groups.
“At the beginning of the COVID-19 pandemic, we knew that underserved populations would be disproportionately impacted,” said Dr. Kendra Holmes, Vice President and Chief Operating Officer for Affinia Healthcare. The healthcare system provides affordable primary and preventive heath care throughout the St. Louis region, including a health center in Pagedale.
“Health disparities contribute to the complications of COVID-19, so we have to make sure that they’re controlled,” Holmes explained. In North St. Louis County, for example, conditions like diabetes, hypertension, and asthma are endemic. “Those chronic diseases don’t go away just because of COVID-19.”
This meant that Affinia needed to take a two-part approach to the pandemic. First, it had to make sure its providers kept seeing patients. Second, it needed to look closely at the data to see how it could slow the infection and death rates in the community.
Ensuring ongoing care
As stay-at-home orders went into effect, Holmes and her Affinia colleagues fought hard to continue providing care. They had already been combatting high rates of undiagnosed and untreated diabetes and other conditions since the Pagedale center opened three years ago—and they knew that many of those patients had gone to the emergency room for routine care. Holmes didn’t want to see that pattern return.
Between mid-March and mid-May, Affinia pivoted to provide routine care via telehealth. However, because of a decline in patient volume, its revenue fell. The center in Pagedale had to cut back to operating three days per week.
Combatting COVID wasn’t a direct focus of the routine care services, but Holmes knew residents of the community were concerned about members of their household who might have the virus. “A lot of people are afraid,” she said. Testing was critical so people who were infected could take additional precautions to keep their loved ones safe. “In a lot of impoverished communities, they don’t have the privilege of social distancing,” Holmes said. “If you have a two-bedroom apartment, you can’t necessarily have separate restrooms and eating areas.”
Setting up testing in the community
As the number of cases rose in North St. Louis County—and community leaders and residents alike noted the lack of nearby testing stations—Affinia jumped into action with the Community Impact Network and its partners in the Normandy Schools Collaborative footprint, where Affinia operates a school-based health service at Normandy High School in addition to the Pagedale health center.
The need to address health disparities through convenient, free testing was obvious to Jaison K.D. McCall, Managing Director of the Community Impact Network. “When we started the conversation, there were no COVID testing sites in areas which are predominantly people of color,” McCall noted.
In its day-to-day work, the Community Impact Network convenes numerous partners in order to help organize and facilitate the delivery of resources and services for people living in the Normandy Schools Collaborative footprint. As the COVID-19 pandemic hit the St. Louis area, the Network formed and funded an emergency relief task force which included Affinia, Operation Food Search, the St. Louis Area Diaper Bank, Beyond Housing, United 4 Children, the Society of St. Vincent DePaul, the Normandy Schools Collaborative, and more. These partners received grant funding from the Network for immediate needs within the community—collectively addressing issues including food insecurity, rent and utility assistance, COVID-19 testing, and more.
Affinia’s strong relationships with the Network, Beyond Housing, and other organizations were key in getting a mobile testing site moving forward quickly. “The Community Impact Network helped us fund the drive-thru testing location at 6763 Page Ave., right behind the 24:1 Cinema,” Holmes said. “We had a great relationship with Quest Diagnostic, so we got test kits early on. We also worked with the St. Louis City Department of Health, who also provided testing kits.”
By mid-May, the mobile station had conducted more than 400 tests. “In this area, a 10-12% positive rate has been the average,” Holmes said.
In an unexpected but very positive side effect, residents have used the nurse triage line (314-833-2777) to ask questions about the virus—which gave Affinia’s staff an opportunity to combat misinformation. “It turned out to be an educational tool,” Holmes said. “There’s a trust issue as well. People don’t necessarily trust that the test will be right. I’ve even heard people say that the test gives them COVID-19. So for them to be able to speak to a nurse and ask questions has been a great resource for the community.”
After the Centers for Disease Control and Prevention changed its guidance in early May to recommend that asymptomatic people in hard-hit ethnic and racial groups be tested, Affinia saw an increase in the number of people coming to the station. It also ended the requirement that people call the nurse triage line for appointments; now local residents can stop by at their convenience during operating hours, Monday-Friday 9 a.m.-4 p.m.
Impacting the pandemic one patient at a time
When a person tests positive, Affinia reports the results to the St. Louis County health department, but it also follows up with the patient. “We have a physician assigned to those individuals,” Holmes said. “We do daily and weekly follow-ups. We also have a nurse contact them to see if they’re having any difficulty breathing and how their blood pressure is. We’ll call to make sure they quarantine at home. And we catch any increase in symptoms before it gets worse—so they get help before they have pneumonia or respiratory distress or depression.”
The Affinia staff works closely with Christian and BJC hospitals. In some cases, the drive-thru station has referred people with severe respiratory symptoms straight to the hospitals.
“We would like to continue the station through the end of June,” Holmes said. “Public health officials are predicting there will be another peak. We want to be able to provide testing if the peak occurs.”
When a validated, accurate antibody test becomes available, Affinia will also offer that so people who have had COVID-19 and recovered will know their status. But Holmes cautioned that none of the antibody tests currently being offered (often costing $150 or more) meets the criteria for validation, and people who purchase them may not be getting accurate results.
Keeping the community informed is one of Holmes’ long-term goals—and one that McCall from the Community Impact Network shares. “This pandemic has shown that we need to be ever closer with them moving forward,” he said.
“The emergency response partnership has been key to getting the word out,” Holmes said. “The linkages to Beyond Housing, the St. Louis Area Diaper Bank, and the other partners create a sense of trust. It’s an all-hands-on-deck approach to making the community prosperous.”
To organize and facilitate delivery of resources and services during the COVID-19 pandemic, the Community Impact Network formed and funded an emergency relief task force comprised of a variety of its partners including Operation Food Search, the St. Louis Area Diaper Bank, Affinia Healthcare, Beyond Housing, United 4 Children, the Society of St. Vincent de Paul, and the Normandy Schools Collaborative. The partner organizations received grant funding for immediate needs within the Normandy Schools Collaborative footprint in North St. Louis County—grants which allowed the partners to collectively address issues including food insecurity, rent and utility assistance, COVID-19 testing, and more.
In addition, the Network continues to convene its four Coalitions—5byAge5, Back2Basics, Youth1st, and WOW—and to offer behind-the-scenes support to the many ongoing initiatives offered by the 85 organizations with which it has membership agreements. Through fostering authentic, trusting relationships, the Community Impact Network aims to create an environment where nonprofit social service sector providers can experience and demonstrate improved success.