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Coronavirus testing at county clinics reveals higher infection rates

Medical personnel preparing to test for COVID- 19

Medical personnel preparing to test for COVID- 19 at Huntington High School in Huntington Friday April 10, 2020. Suffolk County has opened another testing site as part of a program targeting minority communities that are seeing a spike in the number of COVID-19 cases. Credit: Newsday/J. Conrad Williams Jr.

Coronavirus testing at community health centers in Nassau and Suffolk counties, where the preponderance of patients are minorities with low incomes, consistently has documented far higher rates of infection than in the overall county populations, state, county and clinic data show.

In Nassau in the week that ended April 4, 72% of health center patients tested positive, compared with 52% countywide. The next week, 61% tested positive at the centers, compared with 46% in the county. During the week ending May 9, the centers logged a 17% positive rate, compared with the 10% rate countywide.

In Suffolk in the week ending March 21, 41% of those tested at county clinics were positive, compared with 22% of residents tested countywide. In the week ending April 4, 71.5% tested positive at the health centers, compared with 51% countywide. And the week of May 9, the positive test rate was 22.5% at clinics, compared with just over 12% countywide.

"To me, it's unfortunately a window into health care disparities that don't need to be there," said David Nemiroff, president and chief executive of the nonprofit Long Island FQHC Inc., which operates county health centers in six Nassau communities.

"We deal with some of the biggest and most challenged populations," Nemiroff said. "Folks who had poor heath — this just highlighted how vulnerable that population was."

Robert Detor, chairman of NuHealth, the public benefit corporation that operates Nassau University Medical Center and the satellite health centers, said "going forward, it’s clear we need to invest in public education" about the Federally Qualified Health Centers, which receive federal funding to provide primary care services in underserved areas.

"If they're in primary care, you can address those issues of hypertension and diabetes," Detor said of clinic patients. "We knew it, but we didn’t know it was going to be this devastating" until the virus took advantage of such underlying medical conditions, "and it ended up as a death sentence." 

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The data collected by state, county and center officials provides a detailed look at how the coronavirus has spread among thousands of low-income minority residents.

The centers treat many low-income patients without insurance, and the client base is largely minority. 

In Nassau, 43% of clinic patients who have been tested for the coronavirus were Hispanic, 31.5% were black, 24.1% were white and 1.4% were Asian, according to county data.

In Suffolk, 70.6% of tests were administered to Hispanics, 17.3% to whites, 6% to blacks, 5% to "others" and .5% to Asians, according to the nonprofit Hudson River HealthCare, which operates the county's health centers.

Release of the clinic data comes as Gov. Andrew M. Cuomo continues to flag stubbornly high rates of infection in minority communities as a serious issue that needs to be addressed before New York, particularly downstate, can reopen fully.

Last Wednesday, Cuomo shared data showing predominantly black and Latino communities in New York City with significantly higher rates of COVID-19 infection than the general population. Antibody testing revealed that 27% of residents in those communities had tested positive, compared with a 19.9% infection rate citywide.

"You look all across the country, it's lower-income communities, predominantly minority, where we're still seeing an increase in the numbers," Cuomo said in his briefing Wednesday. "That's where the cases are still coming from. That's where the virus is still spreading."

Cuomo said he was asking all local governments to "focus on low-income communities, do the testing and do the outreach … That's where the cases are coming from. That's where the new hospitalizations are coming from. That's what's going into the hospital system. That's where you're going to see the highest number of deaths. That is our challenge."

Curran in particular has stressed the need to boost testing at the Nassau health centers, where 2,852 tests were given between the weeks ending March 21 and May 9, according to county data. The clinics are located in Roosevelt, Freeport, Elmont, Hempstead, Oceanside and Westbury. 

Suffolk's nine clinics administered 9,574 coronavirus tests in that period, according to Hudson River HealthCare.

In the same period, a total of 116,177 people were tested in Nassau, while 113,635 got tests in Suffolk.

Suffolk expanded testing to "hot-spot" locations separate from the clinic facilities themselves beginning April 8 in Huntington in an effort to zero in "early on" on communities of color that were disproportionately affected, said Vanessa Baird-Streeter, Suffolk deputy county executive for community recovery.

Nassau expanded to four hot-spot sites beginning April 22.

Nemiroff of Long Island FQHC, which stands for Federally Qualified Health Center, said generally it was difficult to procure test kits from vendors early in the pandemic, but patients who showed symptoms were treated as if they had tested positive for the virus.

"We just didn't have the ability to test people," Nemiroff said. "We were getting five kits per day per health center, in the beginning … "

In an interview on May 13, Curran said she had reached out to pastors and other clergy members in minority communities for help spreading the word about the availability of testing at the centers.

"I want more people to come," to the centers, Curran said. "The data shows that we need to do more testing."

In a briefing Friday, Curran expressed more satisfaction with the pace of testing at the community clinics. She said over the past few days there had been “an incredibly high rate of testing” for the coronavirus, particularly in the clinics.F

“We are reaching all of our residents, and we are doing enough testing,” Curran said. “That is very good news.”

Statewide and across the nation, community health centers faced challenges such as limited supplies of personal protective equipment, reduced revenue due to fewer patient visits for services such as dental care and the need to close some locations at schools.

More than 70 community health centers serve more than 2.4 million patients in New York each year, according to the Community Health Care Association of New York State.

According to data released by the federal Health Resources & Services Administration, 57% of patients tested at community health centers nationwide were racial or ethnic minorities. Members of those groups accounted for 56% of positive test results.

Martine Hackett, a Hofstra University professor who studies health disparities, had advocated for Nassau County to open more testing sites in hot spots. The pace of expansion was "too little, too late," she said.

“Areas that probably had the highest need were the ones that were the last to be served,” Hackett said.

"It was imperative for testing to be available within the communities that early on showed the highest number of positive cases, and to have that testing be made available rapidly and at no charge," Hackett said.

"The reason is … that we know that in these communities, transportation, having your own car, is not something that is as readily available as it is to people in other communities," she said.

Jim Sinkoff, deputy executive officer and chief financial officer for Hudson River HealthCare, said, “getting the test kits in the very initial phase of the crisis was difficult for everyone."

Sinkoff recalled that at the beginning of the pandemic, "everyone was really, really frightened, and our staff was frightened. Everyone was … staying at home, everyone was trying to understand what was going on — the breadth, the depth, everyone from the governor all the way down.”

Sinkoff continued: “I think what changed the tide was in collaboration with the county, we recognized that our patient population was not necessarily going to drive all the way to Jones Beach, from, say, Huntington, or Amityville. They needed to be able to walk into a place where they would feel confident like everyone else."

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