Table 1.

Impact of COVID-19 on CHC health system and patients based on interviews with chief medical officers and directors^a

Levels of impact and recommendations	Examples of impact and recommendations
CHC health system impact
Economic	CHCs face revenue loss because of clinic closures within the CHC systems, especially dental facilities; patient visits have decreased 50%-70%: no elective or preventive services, few pediatric visits (well-child visits postponed, immunizations for children younger than aged 2 years available), most labs deferred; most chronic disease management visits are deferred; telehealth (largely by phone) represents 80%-85% of consultations.
Staffing	Staff reductions include furloughs, layoffs, and reduction in hours. Telehealth services have changed staff routines. Most CHC systems were able to quickly establish effective telehealth services, covered under emergency plan funds. Physical distancing measures impact clinical staff functions. Staff anxiety and fear related to contamination have been addressed through education (morning clinical team question-and-answer sessions) and clear procedures for use of PPE.
CRC screening practice (workflow)	Lab staff is available to process FITs at most CHCs (although CHCs are not ordering FIT tests routinely). Colonoscopies currently performed only for symptomatic and emergency patients. Community gastroenterologists inquiring about restarting CHC referrals.
CRC screening funding	Preventive services (including CRC screening) are considered elective procedures and not performed.
Markers of readiness for reinitiating in-person CRC screening	Most CMOs shared their support for reinitiating in-person CRC screening, providing the following practices were in place: adequate PPE supply; sufficient COVID-19 testing capacity (viral and antibody testing); lifting of stay-at-home orders; permission to do elective procedures; sufficient staff to handle previsit screening and assessments.
Patient-level impact
Anticipated patient hesitancy for preventive services and clinic visits	Patients will prioritize immediate concerns over disease prevention. Patients will be hesitant to leave home.
Recommended additions and modifications to patient CRC screening materials and process	Recommended modifications for CRC screening because of COVID-19 include the following: use newly created COVID-19 information where applicable and review and update existing CRC screening guidelines accounting for COVID-19 impacts. Telehealth is a huge silver lining; patients are grateful they don’t have to travel to clinic and wait around in the clinic. Telehealth funding postpandemic is a concern (but telehealth benefits during the pandemic are evidence of success).

^aCHC = community health center; CMO = chief medical officer; COVID-19 = 2019 novel coronavirus disease; CRC = colorectal cancer; FIT = fecal immunochemical test; PPE = personal protective equipment.