Alicia Gonzalez's health is fragile, putting her at higher risk of a severe illness should she become infected with the coronavirus. A housekeeper who lives in the Bronx, Gonzalez was diagnosed as pre-diabetic last year, and had a gastric bypass in March. “I was in the surgery on March 10, exactly when everything started,” Gonzalez said.

Her medical lifeline is the Union Community Health Center, which provides an array of medical services, from primary and dental care to physical therapy, to 38,000 people a year across six sites in the Bronx and a 35-foot mobile unit.

But since the pandemic erupted, Union Community has been forced to end on-site visits for all but the most urgent medical needs and substitute what it can with telehealth services.

“My therapist call me, my psychiatrist call me, my primary care call me, and my other doctors call me, yeah everyone calls me, everything is fine. They worry about me,” Gonzalez said.

“We are the working poor,” said Dr. Vanessa Salcedo, Director of Wellness Health Promotion at Union Community. “As we know, we’ve been hearing a lot about essential workers throughout the pandemic, these are our patients.” 

According to the Robert Wood Johnson Foundation, the Bronx is the least healthy county in the state, in part because it has the fewest doctors per resident. That makes clinics like Union Community so essential.

“We have the highest rates of diabetes, of obesity, of hypertension, of chronic disease of all of New York state, so we know this is a medically vulnerable population,” Salcedo said.

But in March, when Union Community was forced to cancel non-essential, on-site services, it went from helping 700 patients a day to fewer than 100.

“So when you think about the revenue impact of losing 80-plus percent of all your revenue, almost within a few days. Devastating,” said Dr. Douglas York, CEO of Union Community. 

Even with its expansion of telehealth since then, Union Community still only serves about half the number of patients each day than it did before the pandemic.

“Community Health Centers across New York State are really struggling financially at a time when they’re needed most,” said Community Health Care Association of New York State President and CEO Rose Dugan. There are more than 70 community health centers with more than 800 sites, according to the organization. 

“Without patients coming in, they’ve quickly pivoted to providing care via telehealth and telephone, but that alone is not enough to pay the bills,” Dugan said.

Congress has provided more than $100 billion dollars to hospitals and clinics to compensate for lost revenue and higher costs but Union Community says the $1.8 million it received is not nearly enough.

“Even with the pivot toward telephone or telemedicine visits, the shortfall is still tremendous,” York said. “If we get into the position where this goes on for a long period of time and there isn’t continued financial safety net provider funds, we have to start cutting services and when you start cutting services, all that does is start hurting patients,” he explained.

That means Union Community could become one more victim of the pandemic, forced to cut services to an already  underserved community, putting New Yorkers like Alicia Gonzalez at even greater risk.

“I don’t want to think about that,” Gonzalez said. “I don’t know what I’m going to do without them.”