On May 3rd, 2020 we conducted an interview with Jonathan Santos-Ramos, the Director of Community Engagement and Strategic Initiatives at Callen-Lorde Community Health Center in New York City. Callen-Lorde is a health center serving the LGBTQ community in New York City. In the interview, Jonathan discussed with us how Callen-Lorde has responded to the COVID-19 pandemic, how community health centers face unique challenges, and how LGBTQ-specific healthcare is essential.
The transcript with accompanying audio can be found here:
Eleanor: The date is May 3rd, 2020, purpose of the interview, just about Callen-Lorde and the response to the pandemic. And then can you give your name and your location and where you work.
Jonathan: Okay. So I am Jonathan Santos-Ramos and my pronouns are he/him and I am the Director of Community Engagement and Strategic Initiatives for Callen-Lorde Community Health Center in New York City.
Eleanor: Okay, great. Thank you. Can you just give a brief overview of Callen-Lorde, like locations of the sites, the mission, and then like what services you provide.
Jonathan: Yep. So our mission is to provide sensitive and quality healthcare specifically targeted to the LGBTQ plus communities, in all their diversity including allies. Pretty much anyone who is seeking sensitive quality health care. As well as doing advocacy, health education, research. Our oldest site is in Chelsea on 18th Street. We have a behavioral health practice that is located on 17th street, also in Chelsea. We have a site in the South Bronx, and next week we'll be opening our Brooklyn site right at the base of the Manhattan bridge.
Eleanor: Okay. Exciting. Why do you think a clinic specifically for LGBTQ health care is important.
Jonathan: So Callen-Lorde started in the late sixties with a group of medical providers who were queer identified and recognized that there was not adequate quality health care specific to LGBTQ needs. And so they were a volunteer group and really sort of came together to folks from the community to serve their community. And since then has evolved into what we are today. LGBTQ specific health is extremely important because unfortunately our current sort of general medical system doesn't really support the nuances of queer health.
Specifically around trans care or the insensitivity that we saw in the HIV epidemic, right. That stigma, and unfortunately, those experiences are still very much alive today. So the bulk of the patients who seek our care have either not found care that was inclusive of all their identities or have unfortunately experienced some sort of trauma in the medical field or with medical professionals. So they really come to us as we provide sort of trauma informed care, recognizing that the folks who come through the door have so many levels of trauma that may have happened to them.
LGBTQ specific health is extremely important because unfortunately our current sort of general medical system doesn't really support the nuances of queer health.
And that's part of that sensitivity piece, really letting them drive their care. I feel like a lot of times medical care is, "I'm the doctor, you are the patient, and so this is what you need to do," without taking into account all the many factors that contribute to health.
We know social determinants of health is kind of like the hot topic right now, and we know that our communities have a lot of these determinants that are contributing to their health disparities. We exist to provide that holistic care and really look at all the pieces of you in order to come up with the best care plan as possible.
Eleanor: So you've mentioned that patient driven care is obviously really important. What are some of the main specific ways that Callen-Lorde approaches patients to combat the way that the larger medical community can be insensitive?
Jonathan: Absolutely. It runs the gamut, right? It goes from our front desk with pronouns matter--and we have a pronouns matter campaign and a video on our YouTube channel--where we let our patients fill out a sticker that they can identify their pronouns so that we're using pronouns appropriately.
We don't assume pronouns. We usually ask pronouns. We start with pronouns. That is something that is not prevalent in most medical care. Something that is extremely important because patients are seen and feel seen through their identity and not necessarily through their expression and the binary that the rest of the world, especially the medical world, uses. We don't, for instance go by sex at birth, we go with body parts, right? Or family genetic history or anything that is across the board. Not about how they are presenting, but about how they identify.
We also allow and reflect the language that our patients use in how they describe their body parts. That unfortunately does not happen in most medical settings. And all of that, specifically around our patients of trans experience- the relationship to the body is a lot of times very disconnected. So if we're not allowing them to identify and they don't feel comfortable talking about their body parts, then we're missing a huge opportunity to address things that might be going on with them. On the other side, with our HIV patients, although someone may be newly infected and their viral load is through the roof, if they don't have housing or a stable routine to take their meds every day, we need to address that housing first and not, you know, the getting them on meds day one.
So it's really about taking the whole person as much as possible and then taking it piece by piece, but allowing the patient to be like, "housing's more important than my HIV today" and going there first.
We also allow and reflect the language that our patients use in how they describe their body parts... if we're not allowing them to identify and they don't feel comfortable talking about their body parts, then we're missing a huge opportunity to address things that might be going on with them.
Eleanor: Yeah. What were some of the regular respons- well, actually, let me start with, how has the daily function of those things that you're describing changed since the pandemic started, but also specifically since distancing has started and the closing of locations.
Jonathan: Yeah. So our response to the pandemic and trying to keep our patients safe is, we immediately transitioned to almost all telephonic visits. All of our medical providers were available to check in with their patient panels through telephone. Now through telehealth, now that we have the platform, we've grown very fast in six weeks in response, to try to give our patients as much as possible.
We have onsite pharmacy, so a lot of our engagement was making sure that folks were getting delivery so that they wouldn't risk going on a subway to fill their prescription. So we have closed all of our sites except for the 18th Street site to keep things very, very contained.
We bought over a hundred laptops for our staff to be able to work from home and give them secure access to patient records. We engaged a company to do a telephonic system that would allow our staff to essentially log into their work phone. So when they were calling from either their house phone or their mobile number, it comes up as a Callen-Lorde number when you call your patient. So we were also protecting the staff's privacy. And that way our behavioral health has maintained about 85 to 90% of their productivity and their patient visit volum because they've been able to video chat with their patients in this way. We essentially told all patients, "Don't come in. We got you. We'll figure it out. Do not risk yourself." But stayed open at the one 18th Street location to be able to serve patients who don't have the technology to do that stuff from home.
Next week, as I mentioned before, we're gonna open three days a week in our Bronx location. We are, at our Bronx location, one of the poorest zip codes in the country, and so not everyone has that technology to be able to access their providers. We made a decision that we still don't want folks to go out, but we also don't want folks going without care or without their medication. And one of the things that we have done at 18th Street and we'll be replicating in the Bronx and later in Brooklyn is, there is a greeter at the door. If you don't already have a mask, they hand you a mask.
Then, you know, you walk two steps. And right there is one of our RNs who will triage you and assess kind of why you're coming in. If it's symptom related, you're automatically put into an isolation room where our staff, in full PPE gear, will come in and provide services. If it's something like a prescription renewal, there's med support there who will triage that and help you get your meds. We are taking every precaution to protect our patients and our staff. Because we do want to recognize that staff are also dealing with this, and not discounting the anxiety that comes with having to go into work.
One of the things that we've done is partner with the Department of Homeless Services to run a 175 bed hotel for folks in the shelter system that have either tested positive or are experiencing symptoms that need to be isolated for two weeks, and we're providing their medical care while they are residing at the hotel. We've sort of cut down our physical delivery of care and rethinking it in a way: ramping up our telehealth and our telephonic access and partnering with organizations where folks are most disenfranchised and need care in a very different way that we've never done before.
One of the things that we've done is partner with the Department of Homeless Services to run a 175 bed hotel for folks in the shelter system that have either tested positive or are experiencing symptoms that need to be isolated for two weeks
Eleanor: What would you say the main compromises have been in terms of provision of care? Obviously, prescriptions seem to be able to kind of still happen as easily as they could before. But what would you say the main lacking area is?
Jonathan: Yeah, so because we are who we are, folks aren't coming to us just for medical need. Many of our patients are seeking community. And I think that is the biggest piece, right? For instance, our Bronx site is our smallest site. Folks know what nurse they're going to see. They know their provider. Especially coming from past traumatic experiences, when you end up loving your medical provider, they become family to you and extremely important in your life.
Folks aren't coming to us just for medical need. Many of our patients are seeking community... For instance, our Bronx site is our smallest site. Folks know what nurse they're going to see. They know their provider. Especially coming from past traumatic experiences, when you end up loving your medical provider, they become family to you and extremely important in your life.
Right now we are trying to make sure that not many people are exposed and taking the subway to come see us. What that does is that kind of cuts off a piece of their community that they're used to accessing. Not all medical emergencies are actual medical emergencies. Sometimes they just need to be in front of a person and talk out what might be going on with them. So I feel like that's the biggest. The second is that we have our HOTT program, our adolescent health program, which is health outreach to teens. We have now a lot of young folks who are in not so friendly environments that are now isolated with people that don't necessarily accept their identities. The trauma in that alone is something that we're going to be dealing with for a very long time.
Eleanor: Yeah. I mean, you've kind of already given a little bit of an answer, but what would you say the patient response has been to all of the adjustments? I mean, have you heard feedback from a lot of patients? Is there an increase in calls to the center and an increase in anxiety?
Jonathan: Oh, absolutely. So as I mentioned, our behavioral health has been functioning at 85 to 90%, which was not the rate that they were seeing. Out of all visits scheduled, their no show rate was anywhere from like 30 to 40%, so that would be 60 to 70% of all scheduled appointments they were actually seeing. And now seeing it at 85 to 90, that alone tells you how folks are kind of handling this, right. They need that outlet and are committed to getting that support in a way that they may not have realized they needed before. Our patients are very well-informed and we provide them as much education as possible. And so they've been extremely patient with us, with not coming in even if they've wanted to.
At the same time, at the very beginning, the panic and influx on our pharmacy caused like a week to two week delay in prescription filling. Where we were doing 300 to 500 prescriptions a day, we were seeing 800 to a thousand. Patients were getting, rightfully so, frustrated, and what we found when we started evaluating it was these were prescriptions that probably weren't due for renewal until a month. But the panic of, "Oh my God, I need to get everything now," caused that frustration meter to just like fly. So, although we were able to keep the pharmacy, there was frustration because of volume.
I think that our patients are amazing. The majority of our staff are from the community and our patients recognize that. So if anything, we've gotten messages on our social media or calls asking about a specific nurse and if they're doing okay. Our patients are really just amazing. They've been handling it as best they can.
Eleanor: Yeah. With that being said, how have the staff been responding?
Jonathan: Our staff is amazing. And very much because they're part of the community, they're closely tied to the mission. And so going into our 18th Street office and working at the hotel that I mentioned with the partnership of the Department of Homeless Services, for the last six weeks have been volunteer based only.
And we have had more volunteers than we have had availability for shifts. Which is like really amazing in a different way, right. It just shows our commitment to the folks that we're serving. When it came to the hotel and we put that out that we're going to be having possibly 175 beds of homeless folks experiencing COVID, there was no delay in signing up, from day one. The staff is just, you know, they do what they do in taking care, and has been our history of taking care of our communities. For a project that we didn't know what was going to happen, didn't know what we were walking into, they were like, "I'll be there and we'll figure it out." And we have. So our staff really are quite special.
Eleanor: What would you say the main challenges were in terms of daily operations at Callen-Lorde before extenuating circumstances? Was it issues with something coming from the state, from the federal level, anything?
Jonathan: Well, I mean, you know, it's always very interesting the way that state and federal interact. New York state is the most regulated state when it comes to health centers and healthcare, and is one of the most liberal with expansion of Medicaid and insurance for all. So in sort of that marrying it's like, who do you listen to?
And we always have to listen to the more strict because we receive federal and state funds. So if we go with the most strict, then it covers sort of the more lenient. And in this case it's been New York state, and we've been really adhering to anything that's coming out of Cuomo's office.
Because their response has been a lot more active than our federal response. But many times their messaging is in conflict. And so it's kind of dizzying to try to figure out which one to listen to or how to implement just daily business.
Because our funding is sort of local, cities, state, federal, they're all dealing with our grants, for instance, very differently. Some are like, "we'll just pay it out and just tell us the staff and the expenses that you have and we'll reimburse you.
Don't worry about doing what you said you could do that you can't now do." And some have been like, "we're only, after the shutdown on March 20th, we're only gonna pay you for any efforts that went to essential work." Thankfully, as a federally qualified health center, all of our work is essential.
So that sort of marries, but it's the disconnect between the different entities that can cause a lot of confusion. A lot of our first few weeks were, what does this mean? And trying to sort of interpret policy that's usually not very clear.
We always have to listen to the more strict because we receive federal and state funds. So if we go with the most strict, then it covers sort of the more lenient. And in this case it's been New York state, and we've been really adhering to anything that's coming out of Cuomo's office.
Eleanor: What would be like a typical- before the pandemic started what would be a typical issue that you would come up with in terms of federal versus state?
Jonathan: You know, there's always I feel a tension between the two. For instance, you know, preexposure prophylaxis: PrEP, right? There's different guidelines for city and state, and so as the state's largest PrEP provider, outside of the Department of Health, that affects a big chunk of our operations or even HIV regimen.
We follow the strictest guidelines, right? But sometimes those don't match. When it comes to, for instance, who we are in being an out provider in our current federal system, that's a risk. Especially with the vilifying of trans folks and us being very loud and proud about our trans siblings. That puts us at a risk nationally, but sometimes paints us as a hero locally. So there's always a tension between the two, especially under this current administration, that is really a lot of times hard navigate.
Eleanor: Are you getting consistent, regular information and directions from the government? And if so, is it coming from the state level, the federal level, how are they relaying that, and how are you relaying that information to patients?
Jonathan: That's a great question. So, I mean, it's really been with our local and national partners. We're part of several different organizations or coalitions. For instance, CHCANYS, which is the Community Health Centers Association of New York State, or NAC, which is the National Association of Health Centers, community health centers. We've really, in this time especially, kind of really pulled together and have almost what feels like daily forums.
You know, we're only getting policies released with not much explanation. And policies can be interpreted 50 million ways to Sunday, right? So it's really hard to figure out, like, "Wait, what am I supposed to be doing? Does this mean this or does it mean that?" And a lot of my calls have been, you know, five of us on the same government call, solely so that we can then meet later and see how everyone interpreted the information. And a lot of times we're interpreting it differently. So it's been very, very confusing. There hasn't been much guidance, and we've again sort of just been as conservative as we can in that interpretation to make sure that we're not making ourselves ineligible for certain help later or violating any policy that's being released.
We're only getting policies released with not much explanation... A lot of my calls have been, you know, five of us on the same government call, solely so that we can then meet later and see how everyone interpreted the information. And a lot of times we're interpreting it differently. So it's been very, very confusing.
So as far as our patient education, we've tried to be really general, because we can't give too much detail because we don't fully understand what's happening. And so there's this fine line with wanting to educate folks. I mean, even with the staff, for instance, with the small business loans and the money made available. We went through weeks talking about furloughs and layoffs, and thankfully in the second round last week, we were able to get the payroll protection money.
And then we were like, "Okay, so we were preparing you for furloughs, but just kidding. We're good for eight weeks and we can keep our staff whole." And having to say, "And at week eight, we need to start talking about layoffs and furloughs again." So it's just a really weird time where every day feels like completely opposite of the day before.
So as far as our patient education, we've tried to be really general, because we can't give too much detail because we don't fully understand what's happening.
Eleanor: Would you say the primary challenges you're facing now are new, or old issues that have been exacerbated, or a combination of both?
Jonathan: I think it's a combination of both. For some issues, for instance, we've never run a hotel isolation before, we've never partnered with Department of Homeless Services in this way, you know, and so those are very new problems. And we're happy to figure that out. If you think about us stepping into the hotel and this isolation stuff, what's come up on the daily staff level is just a magnified problem of homelessness in New York City. So they're old problems in a new world.
And very similar to what we're trying to do in response to providing care to our patients. For instance, previous to the pandemic, telehealth reimbursement is about a fourth of what an in person visit looks like. We can't survive with one fourth of what our revenue was. Public health and federally qualified health center service provision is not a moneymaker in any way, shape, or form. And so anytime you cut that down, it threatens our viability.
Thankfully, New York state, again, decided that they would, for all telehealth visits during this period, make all of those reimbursements whole as if they were in person, which was a godsend. But, you know, we went through three weeks of not thinking we were ever going to be reimbursed. And so again, old problems, because reimbursement is always a problem, but in this new world where the context is a little bit different.
Eleanor: Yeah. How have essential services kind of been defined for Callen-Lorde, and who is that coming from?
Jonathan: So we are defining essential services, and constantly redefining what essential services are. Basically our goal has always been to open our doors to a population that does not have the technology or the access to access us otherwise.
So our doors are open and we're not turning anyone away, whether we would deem that "urgent" or not, right. We're asking everyone to call us first before. But if you don't have a phone, you can't, right? What we've been seeing is an increase of folks being released from immigration detention centers or being released from jail, that don't have care. And somehow we pop up on their search or, you know, through word of mouth. So we're actually seeing a chunk of folks who have no access to many things and are looking to establish care.
Very similarly, because trans care is very limited, trans-specific care, we're seeing folks who were accessing trans care at another agency that isn't open. So we're accepting new patients in that way too. And so it's very interesting the way we are trying to stay open.
All that to say, we're loosely defining what essential is. Again, because of what I said earlier, some folks are accessing us because they need community. And all of those things are just as important to help just as much as a prescription is, right. So we want to be available to those folks.
We are defining essential services, and constantly redefining what essential services are. Basically our goal has always been to open our doors to a population that does not have the technology or the access to access us otherwise.
Eleanor: What do you forsee some of the longterm blow back being from all of the adjustments and transitions? I know you mentioned before that, obviously in terms of patient response, there's going to be lasting trauma that you have to deal with. If you could expand on that or other potential long term things that are going to change.
Jonathan: Yeah. I mean, I think that we're going to be changed forever. Unfortunately, we are in many ways ramping back up to a sort of brick and mortar practice and not letting go of our current practices, and preparing for a possible COVID season two in the fall. Right. So I think for us, we are having conversations of what are our new reality is. What's happening January 2021 and what does Callen-Lorde look like? And I think it looks very different than January 2020, in the sense where, you know, we will keep and try to keep as much of our telehealth process as possible.
I think that many times in primary care, which is our main focus for a large chunk of our population, doesn't need to be in person. Many folks who are HIV positive have been monitoring and controlling their HIV and their labs for such a long time that those aren't the highest need folks who need to come in.
And maybe that is a virtual check-in every three to six months, you know. So we're rethinking who actually needs to come to our sites and who doesn't. And that's partially to be able to open more access to folks who aren't in that situation or need more care or need more handholding, because we unfortunately have never really been able to keep up with demand.
So it does give us an opportunity to increase our access for folks seeking our care in that way.
We're rethinking who actually needs to come to our sites and who doesn't. And that's partially to be able to open more access to folks who aren't in that situation or need more care or need more handholding, because we unfortunately have never really been able to keep up with demand.
Eleanor: Branching off of that, do you think that this has emphasized more the importance of in-person care or the possible new opportunities to change the way that you provide care. Or both or neither.
Jonathan: I mean, I think over the last few months, we've learned a lot. We've learned about ourselves. We've learned about our identity in crisis, and we've learned a lot about access in our patient population, right?
So I see it as opportunity, mostly. Because we will, again, be able to transition to a model where our providers are- because New York City real estate, until now is very, very expensive. That's been part of why we haven't been able to keep up with demand. It's very hard to get a health center open in New York state--again, sort of being the most highly regulated in the country--and having the money to open new sites. We were very, very fortunate to get the capital funding to open Brooklyn, but without that city money, that would not have been possible.
This gives us an opportunity to allow our medical providers to stay home, you know, one day a week and provide telehealth for those lower need folks. And if you think of us having about 40 providers, that's 40 days just with one rotation that you have providing access in a different way. And what that allows us to do, is that those are 40 days that we can get more providers to then come on in and be able to provide the in-person. I think after this, there's going to be a huge need of in-person,and I think we have the opportunity of figuring out and defining the difference between in person and maintaining sort of the telehealth model.
Eleanor: How have your daily, personal responsibilities changed with everything?
Jonathan: It's interesting, you know, because before all of this happened I fantasized about what it would be like to work from home. Partially because the commute and the fantasy of not having to rely on New Jersey transit. The reality of it is that the days are longer. Where I may have done 8 to 10 hours in the office previously, I'm doing 12 to 14 at home. And partially, you know, 'cause life goes on. One. The administrative work that it takes to support our current practices, our new hotel adventure--all of that is added to everything else. As I mentioned, the furlough conversations, evaluating our vendor list to make sure that we are pausing any payments to vendors that we're not currently using or using in a reduced amount, entering into new contracts with vendors. For instance, with the new telephonic platform that we're using. Figuring out and being part of the communication meetings to figure out how we keep our staff connected. So there's these added responsibilities on top of just sort of like normal day things that are still happening.
So it's actually lengthened the day. I definitely feel blessed to have a home where I can have a dedicated room for that work, so it doesn't bleed in. A lot of our staff are really struggling with- there's no difference, or rather the line is really blurred if there at all, between personal and professional.
Because if you're working in the same space that you're eating or sleeping, the time kind of goes away. So what we're noticing is that some folks are emailing at 10 at night or 6 in the morning. For myself, there's days that I haven't been able to sleep, and so I wake up at 3:30/4:00. Why not get the day started, right? So working from home definitely takes that sort of stricter boundary of what work and what life, you know, personal life is. So in that sense it's been really hard.
You don't realize how much you actually miss working with folks. I share an office with four other people and previous to this happening, I'm like, "If I have conference calls all day, I'm just gonna stay home 'cause I can't hear in there 'cause there's just too much going on." These days I want that noise back. It's really interesting when you think of the dichotomy between the two, and realizing how much you had when you were able to be there physically.
Eleanor: Yeah. I mean, this is kind of along the same lines, but what has your personal response been, or that of your coworkers who you're talking to you on a daily basis?
Jonathan: I mean, I think that I've been a lot more conscious about need, both emotional and actual physical need. Personally, checking in with those family and friends who may be immunocompromised. If I'm going to the supermarket, you know, "What do you need? I'll pick it up while I'm there and I'll drop it off on your doorstep," or whatever the case may be. I think that a lot of my coworkers are in that same boat of really, again, sort of extending the way that we provide to the community at work: being of service a lot more in our personal communities, in our familial communities.
So that's definitely been a recognized change. I'm more conscious about like, "What do you need? Where can we go?" You know or really staying connected in the way of talking to folks more often. Checking in to make sure that their mental health is- that they're dealing with mental health issues that are coming up in a way where they feel like they have an outlet.
I think that volunteering to go to the hotel and provide administrative support, or volunteering to buy the staff lunch or dinner. I think that there's been many ways in which we have come together as a community to really take care of each other.
So I think that especially during these times, in what I've seen in myself and my colleagues, it's like magnified in a way that's kind of really beautiful, actually.
Eleanor: How much have you been commuting into the city for the past two months, and when you have, what is it being like there?
Jonathan: So we've had several staff who have gotten sick with COVID and have had to be out for weeks at a time. So I've covered for several of my colleagues on the senior team, either running our 18th Street clinical operations or stepping into the hotel as needed. Even to provide- to pick up medical supplies from our 18th Street location and bring them up to the hotel, or medications because we still are using our pharmacy for the residents who are coming in who don't have insurance. So we're just covering those meds for them. So sometimes there's meds like insulin that need to be picked up because somebody needs an insulin shot. I've been going in roughly about one to two times a week to do different things. It was more often when I was running 18th Street operations for about two and a half weeks, but then has been- has gone down.
It all depends kind of what's in front of us. This past week or two we switched from having the furlough conversations to really making sure that we're applying for every grant or foundation to help keep us afloat. So for the last two weeks, I haven't gotten in because the days have been filled with getting those applications in and/or coming up with creative ways to find funding.
And there's sort of the endless webinars about someone else's interpretation of certain policy. Those really keep you home. So depending on sort of need, but it hasn't been consistent.
Eleanor: Yeah. Do you think that Callen-Lorde's ability to kind of function and continue to provide services, or the challenges that Callen-Lorde is facing, have been more extreme or worse than, maybe, a more standard clinic?
Jonathan: I mean, that's hard to say, because I don't know what other folks are dealing with. I do know that we are, as far as our community partners and our sibling health centers- they furloughed pretty early, and they let go of staff pretty early. And we stayed committed to figuring it out. We were in a better financial situation at the beginning of this than some of them, so we were blessed to have that opportunity. If I'm looking at it from that sense, I think health centers who had to lay off staff had it a lot harder than we did.
Being who we are and being so resilient and having this "go get 'em, fight" core to our identity as an organization, I feel put us in a better position to respond in the way that we did. I wouldn't be able to say that we had it better or worse. I would think that we had it better because of who we are.
Being who we are and being so resilient and having this "go get 'em, fight" core to our identity as an organization, I feel put us in a better position to respond in the way that we did.
Eleanor: Yeah. This is also, maybe- I mean, I feel like you can have an answer to this. Do you think that there is a kind of connection between the unique response that the queer and trans community has had because of the experience of AIDS and the way that that has changed how the community can react?
Jonathan: Asbolutely. Oh, absolutely. I think that our community through- I mean, I call it muscle memory, right? We've been here before in certain senses of our current situation. We know how to care for folks who no one else wants to care for.
Easy example is the isolation hotel. The Department of Homeless Services had approached a whole bunch of health centers and organizations to be like, "Help us with this initiative." And many of them said no, because they didn't have staff that wanted to go and be exposed. Where we're like, we're used to treating folks that no one else wants to touch.
So I think that there's a definite fight or flight response that happens. And I think that queer communities are uniquely positioned to take care of each other and to take care of folks in a way, because of that muscle memory. Absolutely.
We've been here before in certain senses of our current situation. We know how to care for folks who no one else wants to care for... we're used to treating folks that no one else wants to touch.
Eleanor: I mean, this is kind of just a basic, broad question, but why do you think queer and trans communities are particularly affected by the pandemic?
Jonathan: I think that we- it's partially connected to the trauma that I was mentioning before. I think that our communities are going to come out of this with a significant amount of trauma, more than their counterparts. And what we do know about COVID is that it's directly connected to socioeconomics.
So our trans patients of color right now are really sort of doubly impacted. Many of our patients of trans experience, who because of their trans identities have not been able to get stable jobs, are even more impacted by this. Many of them who were in sex trade can't work and don't have the backup. So I think that our communities will come out of this with a significant amount of bruises than, I would say, their heterosexual counterparts.
Eleanor: I feel like that's all I need. That's awesome. Thank you so much.