Safety Net Hospitals as Community Anchors in COVID 19
The delivery of medical care in the United States has changed dramatically as a result of the coronavirus disease 2019 (COVID 19) pandemic. As providers, we planned and prepared for the surge of patients, counted ventilators, inventoried personal protective equipment, and set up staffing models to support an exhausted workforce. Elective surgeries were canceled and clinics were closed to in person visits, in an effort to prioritize patient safety and allocate resources toward the management of COVID 19 patients. Beyond direct clinical care, some safety net hospitals functioned as community anchors prior to the pandemic, providing services such as support groups, food pharmacies, exercise classes, and linkage to other resources. Many of these in person initiatives were also suspended due to safety concerns. These actions threatened the ability of hospitals, such as Zuckerberg San Francisco General (ZSFG) to fulfill the multifaceted roles they had played in the community prior to the pandemic. On the surface, it appeared that the comprehensive services safety net hospitals had provided to vulnerable populations would have to be put on hold. Simultaneously, medical student education across the globe was transformed (1) In response to increased demand on clinicians and lack of personal protective equipment, clinical rotations were suspended for many medical students, jeopardizing graduation and entry into the workforce at a time of great need for competent new physicians. This action resulted in a need to reenvision the way that medical students engage with a rapidly changing clinical landscape. In response, the University of California, San Francisco immediately pivoted to assess and recruit available resources to create a COVID 19 elective. Education and clinical leaders focused on identifying opportunities for medical students, temporarily suspended from clinical rotations, to leverage their capacity to provide meaningful support to health systems impacted by COVID 19 (2) Taking a site based approach to organization of the elective opportunities, our team began to work on faculty outreach and development of projects at ZSFG. As San Francisco's main safety net hospital and level 1 trauma center, ZSFG serves an incredible diversity of patients, caring for tech executives and individuals experiencing homelessness together, regardless of insurance, immigration status, or ability to pay. Prior to the pandemic, the spirit of ZSFG was felt simply walking through the hallway, from the Zumba music heard emanating from the multipurpose room to the crescendo ambulance wails of a trauma activation, and the warm elevator greetings of staff who have been working together for decades. The bustle of the hallway stands in contrast to Frida Kahlo's serene self portrait which hangs on the wall above, given to the hospital in thanks for her treatment. The collective empathy and compassion that made Ward 86 famous for its care of HIV infected individuals is still present today. Our experience developing this elective has provided an illustration of how this safety net hospital has innovated ways to continue functioning as a community anchor, going beyond direct patient care to address the social and systemic vulnerabilities of its patient population. In reaching out to faculty for elective proposals, we cast a wide net, recognizing that demands placed on many clinicians with increased responsibilities could limit bandwidth for an additional education role. To our surprise, the response was swift and strong. As we sifted through the project proposals saturating our inboxes and met with faculty to discuss potential ideas for student involvement, we were struck not only by
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