Data Note: Findings from 28 months of Data from HRSA’s Health Center COVID-19 Survey

Jessica Sharac, Colleen Bedenbough, Feygele Jacobs, and Peter ShinThis data note provides an overview of findings from the Health Resources and Services Administration’s (HRSA’s) Health Center COVID-19 Survey. HRSA has conducted the survey of community health centers since April 2020, initially on a weekly basis, and bi-weekly starting in July 2021. The survey has queried health centers on their COVID-19 activities and response, including testing, vaccinating, and providing treatments for COVID-19, and gauged the impact of the pandemic on health centers’ operational capacity. Over this time period, the Geiger Gibson/RCHN Community Health Foundation Research Collaborative has published an ongoing series of reports on key findings from the Health Center COVID-19 Survey data. This data note updates current and trend data for a period of 28 months, from April 3, 2020 to the most recent survey of August 12, 2022. Health centers tested over 20 million patients for COVID-19 and distributed more than 9.1 million test kits.Figure 1 shows the number of health center patients who received diagnostic tests (PCR, antigen) for the novel coronavirus and those who tested positive at monthly intervals from April 2020 to August 2022. The number of patients tested rose and fell in line with COVID-19 case trends nationally and peaked at nearly 865,000 tested in mid-January 2022 during the Omicron spike. Over 28 months, health centers have tested more than 20 million patients for the COVID-19 virus and approximately 2.8 million patients have tested positive. Since March 2022, the number of patients tested has remained stable at fewer than 200,000 patients per each two-week period, while the number of patients testing positive has increased, from fewer than 6,400 patients as of March 25, 2022 to nearly 41,500  as of August 12, 2022.[1]Since December 2021, the HRSA COVID-19 Testing Supply Program has enabled community health centers to provide at-home COVID-19 self-testing kits and point-of-care testing supplies[2] at no cost for their patients and community members. From late December 2021 to August 12, 2022, the share of surveyed community health centers participating in the program grew from eight percent to 64 percent and health centers have distributed more than 9.1 million test kits through the HRSA COVID-19 Testing Supply Program (Figure 2). Health centers distributed more than 7.1 million masks to patients and community residents.Similar to the Testing Supply Program, starting in January 2022, community health centers were able to start ordering and distributing high-quality N95 masks at no cost to their patients and communities through the HRSA Health Center COVID-19 N95 Mask Program. Nearly four in ten (39 percent) surveyed health centers were participating in the program as of August 12, 2022. Community health centers  distributed more than 7.1 million masks through this program from January 28 to August 12, 2022 (Figure 2), with both testing supplies and masks most commonly distributed at the health center to both  patients as well as members of the general public, or offered at special vaccination events or other community events (Figure 3). Of 21.5 million COVID-19 vaccine doses administered, most recipients were racial/ethnic minorities.The survey has tracked the number of patients receiving COVID-19 vaccine doses, including doses administered by the health center and those received in other settings, since January 2021. Since then, HRSA has reported the number of patients who initiated (meaning they had their first dose of a two-dose vaccine) and completed (had their second dose of a two-dose vaccine or received the one-dose Johnson & Johnson vaccine) their vaccine series, and began reporting the number of health center patients who received additional vaccine (or “booster”) doses in September 2021. From January 2021 to August 2022, health center patients received a cumulative total of nearly 21.5 million COVID-19 vaccine doses (Figure 4), with HRSA reporting that more than 8.8 million doses were allocated from the Health Center COVID-19 Vaccine Program, through which the federal government has provided direct supplies of COVID-19 vaccines to community health centers since February 2021. HRSA has also reported that more than two in three (69 percent) vaccine doses were received by racial/ethnic minority health center patients, and more than three in four (76 percent) vaccine doses from the Health Center COVID-19 Vaccine Program were provided to racial/ethnic minority patients. While vaccine supply was cited as an early challenge to deploying COVID-19 vaccines by approximately two-thirds of surveyed health centers in January 2021 and a quarter in April 2021, this percentage fell to five percent by the end of 2021 and currently stands at three percent (Figure 5). Currently, nearly half of health centers (45 percent) report no challenges in deploying COVID-19 vaccines, although nearly a third (32 percent) report vaccine confidence as a challenge.Health centers are continuing to provide access to COVID-19 vaccination by hosting pop-up, school-based, and family vaccine clinics and providing vaccines through mobile vans. HRSA modified reporting on health centers’ use of mobile vans and pop-up vaccination clinics to report the percentage of health centers hosting mobile vans, pop-up, and/or school-based vaccination clinics in May 2021; since that time, this percentage has fallen from 42 percent to 27 percent as of August 12, 2022 (Figure 6). Similarly, HRSA has reported on the number of family vaccination clinics hosted by health centers since mid-December 2021; since that time, the number decreased from 1,666 to 671 as of August 12, 2022. Health centers are providing COVID-19 treatment, offering monoclonal antibody therapy and antiviral medication.The HRSA survey has reported on the provision of monoclonal antibody therapy since August 2021 and the number of therapeutic doses administered since September 2021. Since reporting was initiated, the share of health centers providing access to monoclonal antibody therapy, whether directly at the health center and/or by referral to another organization, has increased from 44 percent to 63 percent (Figure 7), while the share of health centers directly providing therapy has increased from five to nine percent. From September 2021 to August 12, 2022, health centers directly providing monoclonal antibody therapy have administered nearly 31,000 therapeutic doses to patients with COVID-19. HRSA’s Health Center COVID-19 Therapeutics Program was initiated in December 2021 to provide community health centers with direct supplies of COVID-19 oral antiviral medication to enable the outpatient treatment of their patients with mild to moderate COVID-19. The share of community health centers participating nationally grew from five percent as of January 2022 to 29 percent as of August 12, 2022 (Figure 8). Racial/ethnic minority patients accounted for nearly half (48 percent) of all patients who received this medication as of the most recent reporting period. Virtual visits continue to play a critical role in health centers’ provision of care. In the early months of the pandemic, community health centers had to rapidly pivot to providing care through telehealth to keep their staff members and patients safe. In April 2020, more than half of health center visits on average were conducted virtually (Figure 9). As of the most recent reporting period of August 12, 2022, one in seven (14 percent) health center visits on average were conducted virtually. This is consistent with Uniform Data System (UDS) data, which show that the share of virtual visits conducted by health centers nationally jumped from 0.4 percent in 2019 to 25 percent of visits in 2020, but decreased slightly to 21 percent of visits in 2021. ConclusionNearly two and a half years since COVID-19 was declared a pandemic, the HRSA Health Center COVID-19 Survey continues to document health centers’ response to the pandemic and their essential role in providing COVID-19 testing, prevention, and treatment for medically underserved patients and communities. Community health centers achievements over this period include testing more than 20 million patients for the COVID-19 virus and distributing more than 9.1 million COVID-19 test kits and more than 7.1 high-quality masks to their patients and community members. The data demonstrate the value of health centers as first responders as well as ongoing providers of essential primary and preventive care. Community health centers  will remain an essential core of the national response to the pandemic as the COVID-19 public health emergency extends into 2023 and as vaccines targeted to newer variants become available in the coming weeks. [1] i.e., rapid antigen tests or test strips to be taken at the provider location so patients who test positive can be prescribed on-the-spot treatment such as oral antiviral medication if necessary[2] This decline may reflect the use and reporting of at-home testing by health center patients. The survey user guide notes that “Testing refers to specimen collection regardless of where the specimen is processed” and instructs health centers to “Report all positive results regardless of where patients were tested.” It may be the case that patients testing themselves at home advise the health center if they test positive but are less likely to report testing to their health center if they test negative.