Refugee Coronavirus
We have a 60% positive test rate at our refugee clinic. That was 3/31/20 when I originally wrote this post. Scroll to the end for updates.
Of course we have a high positive rate!
Poor people need their jobs. When we tell them to stay home, some of them return to work anyway. Guess who is making your food at the airport or packing your meat? And they live in dense housing. When you are paying $1,800 for a 2 bedroom on East Colfax, you are going to have 8 people in there, 4 sleeping on mats on the living room floor. That includes grandpa who arbitrarily rotates between purple, red, and orange inhalers for his hut lung. And the apartment next door has the same density. The whole building does. And the whole next building, the whole neighborhood. Coronavirus is going to rip through these blocks like smallpox on the first Thanksgiving. The #15 bus is a rolling fomite. Even the ones who have moved on up to the east side (Green Valley Ranch) have a dozen people in a 3 bed 2 bath, and the one or two breadwinners are bringing home corona attached to their paystub. If this sounds bad in America, their cousins still in camps overseas don’t stand a chance.
Our numbers are about same as confined places, like a refugee facility or a cruise ship, and less than unconfined places like the 20% overall U.S. test positivity rate. Even that 20% is considered indicative of too little testing.
To be exact: of people who we decide to test, which is 100% of people with any fever, cough, or fatigue, 60% have Covid-19. There are other people who come to our clinic for other medical issues, who we don’t test.
Our test percentage numbers are still early (a small n), but my conclusion is not:
Social isolation is a classist privilege.
We have positive Karen, Chin, Karenni, Rohingya, Nepali, Congolese and Caucasian. None Somali, Iraqi, Eritrean, or others as of today, but give us a few more days and we will.
We only really got tests a week ago. I won’t tell you the name of the lab, for the same reasons that you hoarded toilet paper from Sam’s.
We sure could use some more PPE. We have two N95s per employee. I’ve been using one for days. I don’t want to go to my second one until I have another one on deck, nevermind one in the hole. We have only a few gowns. If you hang it up the same way every day, it should be ok? We have migrated our patient visits from exam room, to waiting room, to lobby, to door, to outside in the parking lot at times. It’s like we scoot our chairs a few feet south every day, feeling like it does something to help, losing three HIPAA points for each scoot. Maybe next we will sit in the middle of the street.
Last week’s tax law will help our bottom line in a few ways. The business loss 5 year carryback provisions would be helpful if I wasn’t married filing jointly 5 years ago, or having to deal with attempts to impute my income to that of an average doctor. The Paycheck Protection Program will certainly help, although I had to lay off my whole dental staff last week. Can’t say I had to do that before. I suggested they get unemployment for a while. We also stopped our refugee Boy and girl Scout Camping trips for a while. That’s girl Boy Scouts, of course.
I have no idea where one pulls $2 trillion from (actually I think China, ironically), but the tax law is handy for my office, because our “payer mix” has shifted. We went from mostly Medicaid to half uninsured: breadwinners who make too much to qualify for Medicaid, too little to get Blue Cross, and are getting sick from work. Meanwhile our patients who have been on Medicaid for years are stable with enough refills of metformin at home.
I am swabbing all of our staff. They’re all young and healthy, so might even be asymptomatic. I want to catch the positives so we can know who is immune in a few weeks. Then we can send that person out to buy office snacks. Or send them flying on vacation without fear.
At Mango House we also have many refugee business tenants, including a half dozen restaurants. All are hurting for cash. But I am insisting all pay rent, and try to find the money thru the recent tax laws. I guess I will count the monthly rents tomorrow and see how far they stretch this time. Rashid’s grocery was selling out of rice, but recently closed because of positives in their community.
One observation about religion. Now I’ve had two instances where someone claimed Jesus was protecting them in some way. They were both caucasian Americans who interface with refugees in a helping way. I have not yet seen that in our other faith groups (Muslim, Hindu, Buddhist, Kirat, or a number of Christian churches of different dialects).
What can you do to help? Aside from sending us those N95s or gowns in your attic, just stay home. Masks made of other materials are not useful for clinical settings.
Those are all my observations for today. Here is a picture of our first round of N95s we found. I labelled them with my staff initials, like you label your kid’s lunch for school.
Update 4/17/20: after testing hundreds of patients, including many asymptomatic, we have settled at about 45% positive from all of our ethnic communities. In the last few days, our clinic has about a dozen positive per day, out of the 250–400 new positives in the state (about 3–5% of the state total). Dozens of our patients have been hospitalized, and while most have gotten out, at least one has died. JBS has closed for now, thankfully. Our staff is all negative so far, and we are doing a 4 day N95 rotation as we see all patients in the parking lot. We are short on gowns. Some more recent thoughts are here.
