Health Equity

COVID-19: How a Chicago health system reaches communities of color

As the number of COVID-19 cases increased across the world, Cook County Health in Chicago turned to their disaster preparedness plans. Having completed disaster preparedness drills on a regular basis citywide, it became apparent that these plans would be put into action as COVID-19 reached the U.S. This led to an internal disaster declaration by the Chicago health system to evaluate resources and identify stress points. Ongoing efforts focus on reaching African American and low-income communities they serve.

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“We developed a group that looked at our surge plans because we thought this was the thing that overwhelmed hospitals overseas right away,” said Claudia Fegan, MD, chief medical officer at Cook County Health. “The more we learned from different cities about patients with COVID-19 in terms of how the disease evolves and how people are affected, we began to focus in on the resources we thought would be needed the most to take care of these patients.”

While Cook County Health first looked at their supply of personal protective equipment (PPE), their mission remains the same: health equity and caring for all regardless of their ability to pay. The health system continues to look at how to address health disparities in the communities they serve.

Emerging data on racial and ethnic patterns of the pandemic released by more than half of the states paints an alarming picture. It shows that COVID-19 is disproportionately impacting black communities. Unfortunately, a large percentage of case reports still do not contain race and ethnicity data. While preparedness for a surge in patients with COVID-19 helped Cook County Health, they continue to work diligently to address health disparities in communities of color.

Dr. Fegan recently shared some ways that Cook County Health continues to meet the needs of their African American communities during the COVID-19 crisis.

Increasing testing opportunities        

While the number of patients on ventilators in the ICU is leveling off for Cook County Health, the emergency department is still busy.

“The population we serve is especially anxious because of the statistics about the increased mortality among blacks,” said Dr. Fegan. “People really would like to be tested. People have concerns about whether they have it, whether the person next to them has it, whether family members have it and it’s altering every aspect of people’s daily life.”

Cook County Health continues to increase the availability and access to testing at both hospitals and all community health centers for patients.

“We’re hoping to be able to make more testing available to our patients,” said Dr. Fegan. “Certainly, patients who are calling their physician and have symptoms, the physician can order the test, but we have to be a little bit more proactive in terms of reaching out.”

While the health system continues to address the needs of high-risk patients, they work to “make testing available to a wider swatch of the community,” she said.

Learn more about why it is important to expand COVID-19 testing capacity before restarting the economy.

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Providing education through community organizations

Cook County Health is currently working on how to share important public health recommendations with their communities. This is often accomplished by texting patients to educate them about symptoms of COVID-19 and providing guidance and resources if needed.

“We aren’t encouraging them to come to the hospital, but what we need to do is tell them what signs and symptoms are worrisome that should bring them to the emergency department as opposed to just telling them to stay home,” said Dr. Fegan. “If they have shortness of breath, that is a worrisome symptom and we do want to see those folks and we want to see them sooner as opposed to later.”

To reach communities of color, Cook County Health also posts information online through their website, community newsletter, social media and with the help of their community partners. Working with partners in the community helps physicians and other professionals learn what efforts and resources are needed.

As a result, they can better provide important information about COVID-19, such as the added risks of being a smoker, having asthma or having had pneumonia in the past. “Then it’s likely that they do not have normal airways and that they are at higher risk for complications and adverse events,” she said.

Medical experts work with the community partners to speak to groups and organizations through social media events such as Facebook Live. This allows Cook County Health to reach patients where they’re at through active community organizations.  

“We continue to hold our FRESH trucks at our clinics, providing fruits and vegetables to patients who are food insecure and those in the community who are in need,” said Dr. Fegan. “We are communicating with our patients about the resources available to them, including a mental health hotline and information about SNAP and unemployment.”

Additionally, health professionals are staffing a call center to facilitate placement of discharged suburban residents to alternate housing. Transportation is available through Cook County Health fleet.

Using telehealth to address pre-existing conditions

“Right now we’re reaching out to our high-risk patients who we know have multiple illnesses, who are more likely to suffer a complication for this,” she said, adding that the primary care physicians are contacting them to “see how they’re doing because it’s now been a month and that’s a long time for them to go without someone checking on their symptoms.”

Through data from the emergency departments in the area, Cook County Health has been able to pull a list of more than 2,000 patients who are high-risk. The teams are reaching out to those patients to ensure they have the resources they need. If required, these physicians and other health professionals offer virtual appointments for them.

For example, if a patient has heart disease, teams will explain that while they felt fine before this current illness, they need to continue to take their heart medications. This places the patient at higher risk for developing complications, which means they should be examined.

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“Most of the time it is physicians calling the patients on the phone and talking to them, which they really like,” said Dr. Fegan. “They really enjoy that because it’s clear to them that they have their physician’s full attention at the time.”

This also “frees up our resources to take care of the patients who do come in, who are sick and who need immediate attention,” said Dr. Fegan.

Learn more from the AMA about how to establish telehealth and deliver patient care while practicing physical distancing during the COVID-19 pandemic.

Addressing incarcerated population

The communities around Cook County Health are disproportionately affected during this pandemic. One area of focus is to administer more tests to identify data and better care for these populations.

“We are looking at the data, but the problem is it’s hard for us because we haven’t had enough testing yet,” said Dr. Fegan. “Our testing has focused primarily on our health care providers and our testing in the jail at Cermak because that is a hotbed.”

“We don’t have enough social distancing and people who are incarcerated aren’t able to make the same sorts of choices that folks can at home,” she said.

For example, Cook County Health continues to serve their patients at Cermak by meeting all their medical needs, isolating those as needed and providing them with masks for further protection. Additionally, as the number of cases in the incarcerated population has skyrocketed, increasing health care workers are available to provide care in areas newly opened for patients with COVID-19.

“Cook County will continue to serve the community of Cook County,” said Dr. Fegan. “We want to be available for all who need us, and we appreciate the support we receive to continue to do it.”

The AMA continues to compile critical COVID-19 health equity resources to shine a light on the structural issues that contribute to and could exacerbate already existing inequities. Physicians can also access the AMA’s COVID-19 FAQs about health equity in a pandemic.