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Caring for Agricultural Workers During the COVID-19 Pandemic

The Weitzman COVID ECHO presentation from December 2, 2020

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Caring for Agricultural Workers During the COVID-19 Pandemic

  2. 2. CME Credit • Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to sponsor continuing medical education for physicians. The Bridgeport Hospital Yale New Haven Health designates this live activity for a maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only credits commensurate with the extent of their participation in the various activities. • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to provide continuing medical education for physicians. • The content of this activity is not related to products or services of an ACCME- defined commercial interest; therefore, no one in control of content has a relevant financial relationship to disclose and there is no potential for conflicts of interest.
  4. 4. COVID-19 in the United States 13,714,024 cases on 12/1/20 up from 10,392,702 cases on 11/11/20 270,532 deaths
  5. 5. COVID-19 in the United States
  6. 6. COVID-19 in the United States
  7. 7. COVID-19 around the World
  8. 8. COVID-19 around the World
  9. 9. News headlines Pfizer-BioNTech and Moderna Vaccine Candidates under FDA review DECEMBER 10th -Could potentially start distributing coronavirus vaccines Dec 11th -both highly ~95% effective in preventing COVID-19 -Both have good safety profiles: no serious safety concerns observed
  10. 10. Resources • Nuvance health ~1700 articles reviewed: • CDC: • WHO: • Johns Hopkins: • Others
  11. 11. CARING FOR AGRICULTURAL WORKERS DURING THE COVID-19 PANDEMIC Jeannie McIntosh, MSN, APRN, FNP-C CHC Center for Key Populations 2 December 2020
  12. 12. BACKGROUND • How the COVID-19 pandemic has impacted farms and migrant and seasonal agricultural workers (MSAWs) • About the CT River Valley Farmworker Health Program (CRVFHP) • Unique challenges in providing primary care and COVID-19 outreach to this patient population • Role of the community health worker (CHW) CRVFHP
  13. 13. IMPACT OF COVID-19 ON FARMS AND MSAWs • There have been more than 250,000 covid cases among farmworkers in US, but this number may significantly underestimate cases among migrant and seasonal agricultural workers (MSAWs). [1] • Large-scale covid outbreaks have occurred at farms across the country. The largest to date was at Foster Farms, a poultry farm in CA, where 392 workers tested positive and 8 died. [2] • H2-A visa holders are required to get tested and quarantine for 14 days upon arrival to US. However, a large percentage of MSAWs (up to 49% of horticulture workers, for example) are here without visas so may not have quarantined upon arrival. • As of September, only eight states had issued mandatory regulations for protecting agricultural workers from exposure to COVID-19. Twenty states currently have non- enforceable recommendations. • Covid has had a massive impact on our agriculture industry – US farmers and ranchers are estimated to lose approx. $20 billion in revenue in 2020.
  14. 14. Covid outbreaks on farms Cumulative covid cases on farms FOOD AND ENVIRONMENT REPORTING NETWORK (FERN)
  15. 15. ABOUT CRVFHP • Founded in 1997 and directed by the Mass League of Community Health Centers • A voucher program funded by HRSA and the Bureau of Primary Health Care (BPHC) • Covers primary health care for qualified MSAWs and their families along the Connecticut River Valley in MA and CT • Services included: medical and dental care, medications, outreach and transportation, some specialty care through MOUs with local hospitals and clinics • Care is offered to seasonal farmworkers during peak growing season and to greenhouse workers year-round • MSAW countries of origin: Jamaica and Caribbean, Mexico and Central America, West Africa, Southeast Asia, South America • Crops: shade tobacco (used to wrap cigars), apples, other fruits and vegetables, flowers, x-mas trees • CHC, Inc. is one of the 9 clinics contracted to provide care through this voucher program • Our program is embedded within CHC’s Center For Key Populations • CHC’s CRVFHP core team: - Director of CKP - Family nurse practitioner - Community based services manager - Registered nurse - Outreach worker / clinical champion - Health advocate
  16. 16. UNIQUE CHALLENGES IN PROVIDING CARE TO MSAWS• Primary medical care - Seasonal ag workers have very long work shifts, often 7 days per week - Reluctance to report symptoms of illness for fear of missing out on work - Language and cultural differences - Limitations on what is covered under voucher program - Lack of transportation and reliable phone access - Need to establish trust and rapport in a short time • Covid-specific medical care and counseling - Communal living spaces - Working in close proximity - Limited access to sinks and bathrooms when working in field - Difficulty wearing a mask when doing farm or greenhouse work - MSAWs may fear getting tested, feel pressured by employer not to get tested, or have limited access to testing in spare time - Tech access or tech literacy barriers - Rural health systems less equipped to handle large outbreaks - Coordinating with local consulate officials from different countries where rules around testing, quarantine and travel vary
  17. 17. ROLE OF THE COMMUNITY HEALTH WORKER Joelle Isidor, MD, CRVFHP Outreach Worker • Advertise our services to farm owners and ag workers • Schedule appointments • Deliver supplies and medications • Transport patients for appointments, labs, imaging • Have language skills and cultural knowledge of MSAW countries of origin • Provide health education and convey personal medical information in an accessible and culturally appropriate way • Facilitate communication between farm owners, ag workers and medical team • Help connect the different contracted FQHCs to share resources • Build trust with the ag workers • They are essentially the glue that holds the program together!
  18. 18. MEDICAL CARE FOR MSAWs: OUR EXPERIENCE THIS GROWING SEASON • Covid-19 prevention efforts • Maintaining access to primary care services • Agency response to outbreaks
  19. 19. COVID-19 PREVENTION EFFORTS Joelle Isidor, CRVFHP Outreach Worker • DELIVERY OF SUPPLIES - Masks - Hand sanitizer - Protective eyewear - Food and other goods for workers in quarantine or isolation • PREVENTATIVE EDUCATION - Hand hygiene - Physical distancing - Health risks associated with covid • FLU VACCINE CLINICS – to reduce risk of influenza co-infection
  20. 20. MAINTAINING ACCESS TO PRIMARY CARE SERVICES• TELEHEALTH - Cell phones and iPads distributed by CRVFHP - Phone or video visits available 6 days per week during regular clinic office hours (any provider) - 24-hour nursing triage line • FARM-BASED OUTREACH CLINICS - Sunday afternoon/evening 1-2 x per month - Care provided in tents for privacy - Outreach worker, 1 provider + 2 providers in training (NP resident and fellow), nurse, MA • SITE-BASED VISITS AS NEEDED - Nurse visits for EKG, STI treatment, BP check - Provider visits if face-to-face exam needed based on tele health assessment • VITALS MONITORING SUPPLIES – delivered to farms (BP monitors, pulse oximeters) to allow for V/S assessment during tele health visits
  21. 21. AGENCY RESPONSE TO OUTBREAKS Kasey Harding, MPH Director of the Center for Key Populations • MASS TESTING AT FARMS - Rapid response at onset of outbreak - Leveraging mobile testing supply units, workflow and team members already experienced in large- scale testing events sponsored by state - Returning to retest those who initially tested negative - Results conveyed via texts, phone calls, outreach worker visiting farms • COUNSELING AND EDUCATION - Consulting with local DPH, CRVFHP staff, and CHC clinical leadership to come up with plan - Advising farm owners on how to quarantine and isolate workers in close communal living situations, ex. moving those who test negative to separate barracks or nearby off-site location - Nurse triage and tele health provider visits utilized for counseling symptomatic patients on supportive care measures and ED precautions - Return-to-work guidance - Measures to prevent repeat outbreaks (or additional spread of existing outbreak) LESSONS LEARNED FROM MULNITE FARM OUTBREAK: - Coordinating with DPH - Handling media attention
  22. 22. NEXT STEPS?... VACCINATION CLINICS • Currently doing flu vaccine clinics at the greenhouses and farms • Setting the stage for future covid-19 vaccine outreach clinics? MIGRANT CLINICIAN NETWORK’S HEALTH NETWORK • A program that provides bridge case management, medical records transfer, and follow-up services for mobile patients. • Founded in 1995. Thousands of patients served. • Used to track LTBI treatment completion and chronic disease continuity of care. • Potential utility in tracking covid cases and connecting MSAWs to testing resources + medical care?
  23. 23. LEARN MORE • Brown Institute for Media Innovation. “Documenting Covid-19: The Migrant Farm Project.” • Centers for Disease Control and Prevention (CDC). “Covid-19 Guidelines for Agriculture Workers and Employers.” agricultural-workers.html • CT River Valley Farmworker Health Program (CRVFHP). • Migrant Clinicians Network (MCN). • National Center for Farmworker Health, Inc. (NCFH). “COVID-19 in Rural America: Impact on Farms & Agricultural Workers.” • Pennsylvania Action Coalition. “Examining the Impact of Covid on Community Health Centers, Part 2.” covid-on-community-health-centers-part-2.html
  24. 24. THANK YOU! Kasey Harding, MPH Joelle Isidor, MD Jeannie McIntosh, APRN
  25. 25. Thank You! To learn more about The Path Forward series To view previous COVID-19 sessions: