What the Coronavirus (Covid-19) Response Can Learn from Community Health Care

By: Andrew Schroeder, Ph.D., MPP., VP of Research and Analysis, Direct Relief

Response to every epidemic outbreak rests on two critical tools: trust and reliable information. During the response to the Ebola outbreak in West Africa in 2014, many in the global health, emergency medicine and disaster response communities did heroic work. But what really made a difference in the end to stopping the spread of the virus was behavior change and the self-organized activity of local communities. Villages that altered their burial practices, their travel routes, and even their handshakes ultimately snuffed out the last cases of Ebola from Liberia, Guinea, and Sierra Leone.

To do this, they needed to know which messages to trust and which practices to follow. They also needed regular support and care in order to make these behavioral transitions happen, including communications campaigns, community health workers, functional supply chains, and regular infusions of health resources which bought enough time for behavioral changes to take hold and the case curves to flatten out.

Health workers at North East Medical Services in San Francisco, CA are maintaining essential services for vulnerable communities while protecting themselves from Covid-19 infections.

Trust and the Coronavirus

These lessons have been brought back with a vengeance during the response to the novel coronavirus (Covid-19) which has circled the world and brought whole countries and economies to a standstill since it was first detected in the Hubei province of China in December 2019. With specific treatments scarce and a vaccine still 12-18 months away, the most important factor for controlling the virus is communities recognizing the severity of the problem and changing their behaviors, often in a very short time.

Washing your hands regularly, not touching your face, avoiding large gatherings, and social distancing up to and including self-isolation, all make significant differences in the spread of the coronavirus, if enough people carry them out. To make those decisions, which often come with costs that are borne unequally by more vulnerable communities, people need to trust the messages they are being given and know that they will have care and support available should they need them.

Direct Relief supports community health centers across the United States in response to this outbreak, as we do in so many other disasters from storms and floods to wildfires and tornadoes, because they are the high quality, trusted health actors in their communities. Community health centers operate in medically underserved areas, and treat the most vulnerable patients, those without insurance or living in poverty. That’s important particularly in viral outbreaks because infectious diseases often spread specifically because of the gaps in health systems, where people might not otherwise be able to access testing, care and treatment, and therefore continue to spread infections.

A shipment of personal protective equipment for health centers in the Covid-19 epicenter in Seattle leaves from the Direct Relief warehouse in Santa Barbara.

What makes community health centers effective at improving healthy behaviors is not their location, but their incorporation of patients and health experts into the core culture of the institution. That includes having representation on their boards of directors and regular outreach which makes them the most trusted voices for health care in vulnerable communities. By efficiently infusing health resources into these places of trusted and quality health practice, we can improve healthcare from the bottom up and make sure that community agreement exists when it is needed most – that it’s never broken simply because of things like medication shortages or lack of access to basic goods, like masks and gloves, which protect community health workers.

Social Vulnerability Matters Even More During Outbreaks

No disaster, including viral outbreaks, is ever “natural,” in the sense that its impact is felt independently of the social landscape in which it occurs. What makes an event a disaster as opposed to just an event is precisely the vulnerabilities of communities in which those events occur. A highly infectious virus occurring in a place where people cannot access testing, treatment and health education, or do things like take sick leave to self-isolate without placing their jobs and families at risk, is a very different and more risky environment than one where those vulnerabilities don’t exist.

Community health care was in many ways founded upon the insight that reducing social vulnerabilities outside the medical system makes the practice of medicine itself more effective. Making sure that cost, location, language and mobility are not barriers to access reduces the chances that manageable problems become unmanageable crises. This is true as much for elderly diabetics on a regular day who need to change their diet and exercise habits as for people seeking to protect themselves from the coronavirus during the current epidemic.

Building trust in institutions like community health centers is not simply something which happens inside the walls of health clinics; it happens in the communities themselves as people regularly interact with outreach workers and connect with clinical staff who live with them in their neighborhoods. When clinicians share the same community spaces as patients, they understand their needs and vulnerabilities and can ensure that those needs are accounted for in the daily practice of medicine. This reservoir of trust then pays off in significant ways at times of crisis when we need more than ever to make sure that people listen to the right voices, change their behaviors, and take the steps necessary to protect themselves and others around them.

Direct Relief supports community health centers, in the U.S. as much as throughout the world, with access to essential medical resources, not only in times of crisis but every day of the year. That way, we too are understood as a trusted actor in vulnerable communities when people need to rely on that trust the most. Often just knowing that people and institutions are there for you with the right information and resources at the right time, as basic as hand washing and providing protective masks and gloves for health workers, is all it takes to ensure that the messages, which truly make the difference between controlling a virus and letting it spread uncontained, actually do get through.

Learn more about Direct Relief’s COVID-19 relief efforts here.

About the Author

Andrew Schroeder, Ph.D., MPP., VP of Research and Analysis

Dr. Andrew Schroeder is the Vice President of Research and Analysis for Direct Relief. He leads
Direct Relief’s work in GIS mapping, data collection, epidemiological research and humanitarian
informatics. His work has been featured or cited by publications ranging from The Lancet, The New York Times, The Washington Post, Fast Company, Motherboard Vice, The New Humanitarian, Prehospital and Disaster Medicine and the International Journal of Cancer.

Dr. Schroeder earned his Ph.D. in Social and Cultural Analysis from New York University and his Masters of Public Policy (MPP) from the Gerald R. Ford School of Public Policy at the University of Michigan specializing in social analytic methods, information technology policy and international development. In addition to his work for Direct Relief he is the co-founder of the non-profit WeRobotics.org which builds local capacity in robotics for social good, and a member of the international board of ADA-AI, which focuses on applications of robotics and artificial intelligence technologies for humanitarian aid, global health and development.