The COVID-19 pandemic is hitting low-income, underserved populations particularly hard, experts say.
Many people who have been furloughed or lost their jobs are struggling to pay for basic needs, increasing the risk for food insecurity and homelessness in some neighborhoods in hard-hit areas like New York and New Jersey.
And in communities of color across the country, COVID-19 has exposed existing inequalities, causing an already unleveled playing field to tip over.
Case in point: Newark, New Jersey is a predominantly African American community.
Even so, the disparately high numbers of COVID patients coming into Newark Beth Israel Medical Center who are African American—about 95%—have been stark, said Dr. Frederick Waldron.
“The numbers have been overwhelming,” Waldron said. “What is different is the acuity. Most of the patients now are very very sick. The ER is almost saturated with COVID patients, some of them intubated.”
At play in that community, he said, is the fact African American patients are more likely to have co-morbidities. They have also tended to have poorer access to testing relative to the rest of the population.
“They make up a greater percentage of those providing essential services which require them to go to work. They may not have the money to buy large stores of food that is sometimes required,” Waldron said. “For many, there is an issue of where they live: Sometimes there is overcrowding and they are not able to maintain that six feet that’s generally required.”
In Chicago, African Americans make up 30% of the population but, as of late April, 77% of COVID-19 deaths were residents in black and brown communities, according to Darlene Hightower, vice president of community health equity at Rush University Medical Center.
“Many people were surprised by the racial disparities. But for me and my team, it’s not surprising at all. We see these disparities all the time, and this is sounding the alarm even more for the need for the work that we’re doing,” she said. Hightower and her team focus on providing access to quality healthcare for underserved populations and also work to address “upstream” social factors that impact health such as jobs and education.
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Getting food on the table is the biggest issue facing disadvantaged populations, said Errol Pierre, senior vice president, state programs at Healthfirst, a New York City-based insurer with a large Medicaid population.
New York City is a “tale of two cities,” Pierre said, as affluent residents have the option to work from home or leave the city. With many social service organizations shutting down during the pandemic, disadvantaged residents are struggling without a safety net.
“Disposable income has dried up so people can’t purchase food. In some lower-income communities and communities of color, there are long lines at the grocery stores or the stores are out of things. One-third of the food pantries in the city have closed down,” he said.
Not-for-profit insurer Healthfirst serves 1.4 million members in New York City and Long Island, with about 1 million Medicaid members. During COVID, there has been an unprecedented demand for financial assistance, he said.
On a typical day, about 400 New Yorkers will request Medicaid assistance through Healthfirst and that has spiked to 900 applications a day amid COVID-19, Pierre said.
Reaching the most vulnerable populations
Many hospitals are addressing these issues through programs in place before the pandemic began. At Newark Beth Israel Medical Center, which is part of the RWJBarnabas Health, providers screen individual patients for social determinants of health to identify which need additional support.
Those support programs offer help, for example, ensuring the patient has access to prescribed medications if they might have trouble accessing those drugs on their own, said Waldron.
One big challenge is connecting patients with available resources as some services have closed down while new ones have popped up. Startups like NowPow, UniteUs, and CityBlock Health were already working to bridge those gaps before COVID and their technology platforms are proving to be valuable now.
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At Healthfirst, care managers use NowPow’s community referral and analytics platform to find resources, in real-time, based on members' zip codes to meet their specific needs.
Healthfirst also accelerated the roll out its member-facing mobile app in April and is integrating NowPow’s referral tool into its app, Pierre said.
“That means members don’t have to come to us, we’re not the middle man, so they can just leverage the NowPow tool directly themselves,” Pierre said.
These apps are helping New Yorkers in need every day, he said. As one example, a Healthfirst member in Long Island lost his job, then tested positive for COVID. Quarantined at home with his family, he can’t leave his house to buy groceries.
“He is now able to use NowPow to filter down and find places that provide food and offer home delivery,” Pierre said.
During the COVID-19 pandemic, people need immediate resources, and NowPow's digital social services network is providing a “single source of truth” for COVID resources in Chicago neighborhoods, Hightower said.
“Nobody has the time right now to gather all that information to know what’s out there and what’s available. NowPow provides that information in real-time and that has been crucial. It enables community-based organizations to better serve their clients,” she said, noting that Rush has been working with the startup for two years.
NowPow also just launched the first in a series of interactive maps to show how the COVID-19 outbreak is affecting community resource availability in the United States. The first maps focus on food resources in three of the nation’s hardest-hit areas: New York City, Long Island, and Chicago. The map helps healthcare organizations to track geographies at-risk relative to available resources, the company said.
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During the pandemic, the need to address social determinants of health has only grown more critical, experts say. The current health crisis is likely exacerbating the social factors that impact health, such as joblessness, lack of education, and racial inequities, and this could have a major long-term impact on community health.
Health systems that are taking steps now to identify immediate unmet social needs in their patients will be in a better position to use data to address social determinants of health going forward, experts say.
“My hope is that this becomes an opportunity to look at the systemic barriers that exist in the communities,” said Hightower. “We have programs that are providing food to people for now, but we need to look at why that person needed food in the first place.”
“With light being shined on COVID, and the disparities that have been exposed, there is an opportunity to change the conversation,” Hightower said.