Vilma Delgado lives in the Throgs Neck section of the Bronx, the borough with the highest infection and death rates from COVID-19. Delgado, 62, knows two people who have died from the virus, so she no longer goes out just to stroll. Delgado was working to manage her anxiety well before the coronavirus outbreak, but her symptoms have worsened. Her mind races. She is fearful.
And being more confined to her apartment doesn’t help.
“In the middle of the day when I’m by myself, it feels like a spinning wheel,” Delgado said. “You know — like the world’s spinning around and you’re still in the middle?”
Delgado’s two adult children, who live with her, still go out to work every day. Her daughter is a medical assistant; her son works in the facilities department at a college. They live across the street from a cemetery, which Delgado finds appealing because it’s quiet. And she feels lucky to have a deck, giving her a small haven of outdoor space. She’s learned to meditate.
“Inhale, exhale. Inhale, exhale. That’s what I do all day,” Delgado explained.
She gets counseling through Union Community Health Center in the Bronx. It’s a place that offers a range of services — primary care, urgent care, pediatrics — and is now doing many of its appointments by phone, including therapy.
The Bronx was already at a steep disadvantage before the pandemic. It consistently ranks at the bottom of all New York counties for income and health outcomes. The virus is exacerbating feelings of uncertainty, and Union Community Health has seen an increase in patients seeking mental health services, said Mildred Casiano, director of behavioral health. She said therapists are speaking with 14 to 17 patients a day, on average.
“It’s an indicator of the amount of patients that are experiencing anxiety and depression,” Casiano said.
Many patients, like Delgado, had a diagnosis of anxiety or depression before the virus outbreak, but symptoms have intensified, said Casiano. Other patients are experiencing these symptoms for the first time.
Casiano said people speak of their loss of income, managing kids, or guilt over bringing the virus home to vulnerable family members. She said patients report an inability to sleep, constant crying, and grief.
“This is becoming a daily norm for us where we’re just saturated with stories of deaths,” Casiano said.
The staff at Union Community Health Center knew that the Bronx was going to be hard hit by the pandemic. The center serves a high-poverty population. It has 274 employees spread over six locations and a mobile unit, serving all of the Bronx, with approximately 40,000 patients on its roster. Many of them have chronic health issues, such as diabetes or asthma. Many are essential workers. And much of the center’s role has been making sure these thousands of patients are weathering the public health crisis, whether they contract COVID or not.
“Because we had so many chronically ill patients, we did do a very organized, structured outreach to all 40,000 of our patients,” said Douglas York, chief executive officer for the health center.
Those calls included informing patients on the latest about the virus and how to stay safe; that many health appointments were still being conducted over the phone, and some urgent ones in-person; that parents should still bring in their healthy children for immunizations. The health center has served as a filter for local hospitals, coaching patients on whether they should go to the emergency room.
In its outreach, providers also tried to glean the situation at home and how patients and their families were faring. They found that at least 50 percent of patients were experiencing food insecurity, York said.
“The worry about food and how are you going to eat — that’s a huge burden for our patients,” said Dr. Vanessa Salcedo, a pediatrician at Union who leads wellness initiatives in the community, and is managing the health center’s COVID response.
The health center’s always worked to connect people with social services; now that effort’s in overdrive — whether it’s helping patients find food pantries or get housing assistance. Staff are then following up to make sure people actually got what they needed. Salcedo gave the example of a call to a patient early in the crisis who had received a recent round of chemotherapy. The patient had a box of food delivered, but was unable to actually eat anything from it. So, Casiano, the behavioral health director, brought the patient food herself.
This kind of follow-up has required a new layer of coordination that the center has been doing out of necessity, said Salcedo, and because it was unclear who would fill that gap if the providers at Union did not.
“Our whole executive team is working, really, around the clock to develop these systems,” Salcedo said.
The health center has received some federal funding to help with its COVID response, like outreach to patients or other clinical changes, such as getting telemedicine up and running (a project still in the works).
But these changes have been a massive administrative lift, and an emotional one. The center lost approximately 80 percent of its revenue overnight, York said, when it suspended traditional health appointments, including dental services. It had to furlough some support staff. Providers are still dealing with a shortage of protective equipment, especially gowns and N95 masks. Some staff members have contracted COVID, including Salcedo. One staff member has died.
“We use each other as a support system,” said Casiano.
The first five weeks of the crisis were especially challenging for Union’s providers, she said, since staff were learning to manage a crisis while living it at the same time. Casiano now does wellness check-ins at staff meetings each Tuesday.
“We talk about what's going on with ourselves, our struggles, our own fears,” she said. “We are experiencing everything that our patients are experiencing, because the fear is real and so is the uncertainty.”
Salcedo added, “Our community is mourning from this epidemic, and we're still scared. We're scared of the risk resurgence. We're scared about when we start opening up — are we going to experience more deaths? We really need help.”
Salcedo said she worries about the patients who are not getting care for chronic illnesses, or those who may be ignoring urgent needs unrelated to COVID. She worries that as parts of the state reopen, and as infection numbers improve citywide, the Bronx will be even further left behind.
“We know that this is still the beginning for us,” Salcedo said.