March 30, 2020

Honorable Lina Hidalgo 
Harris County Judge 
1001 Preston, Suite 911 
Houston, Texas 77002

Mayor Sylvestor Turner
Houston City Hall
901 Bagby Street
Houston, Texas 7702
 

Re: COVID-19 Response
 
Dear Judge Hidalgo and Mayor Turner,
 
We applaud you and your teams in Harris County for your tireless efforts to keep our community safe during this unprecedented public health crisis. We know you are working around the clock to contain this disease and to disseminate information as it evolves. 
 
As physicians, epidemiologists, public health specialists, and members of Doctors for Change working on the frontlines in our county’s largest publicly funded healthcare system, we urge attention to our medically underserved patients who often lack of access to health care and health information and are especially vulnerable during the COVID-19 pandemic. Doctors for Change would like to partner with the County in advising on the solutions below.

Access to Health Information 
Lack of consistent access to the Internet and health insurance limits the ability of around 30% of Harris County residents to receive the latest COVID-19 information online or through their providers. This includes information about social services (emergency housing, food, child care, and other resources). Consistent messaging, delivered through various media outlets, not just print materials, is imperative as we move through each phase of this pandemic. 
 
Innovation in Information Delivery 
Greater dissemination of health information is possible by repurposing nonessential economic activities for public health purposes. Census 2020 canvassing has been postponed to August. Local elections are being rescheduled to November. A rich, talented, and yet untapped resource of organizers and newly unemployed adults can fuel a public health economy directed by the county health department for outreach to our medically underserved communities. The idea is to implement a promotoras de salud / lay health worker model. In addition, consider leveraging County contracts with local telecommunications companies to increase access to the internet, and use direct in-language phone and text messaging to amplify reach. 

Addressing Health Literacy
Ensuring that material on COVID-19 is available to those with limited or low health literacy will protect our vulnerable community members. Online screening, call-center communications, and fact sheets should use simpler language (in multiple languages) and graphics to communicate availability of testing (at low or no cost), appropriate self care and “stay at home” procedures and behaviors.

Multidisciplinary Medically Underserved COVID-19 Task Force
Finally, we propose a small and specific COVID-19 task force to address the needs of the medically underserved residents of Harris County. A multidisciplinary team of community, government, private sector, and academic leaders dedicated to these efforts will reduce your workload and ensure we manage this pandemic equitably in Harris County.  While the need is urgent now, we know that the response and lessons we learn as we go will inform how Houston and Harris County respond to health crises in the future. This task force can be leveraged once the pandemic ends to ensure that we are prepared to confront future threats efficiently and equitably. 
 
Please let us know how we can continue to support you in this challenging time.  
 
Sincerely,
 
Doctors for Change
Amelia Averyt MD, MPH 
Dona Kim Murphey, MD PhD
Elizabeth Chiao, MD, MPH
Monisha Arya, MD, MPH
Judy Levison, MD, MPH
Padma Swamy, MD
Areana Quiñones, MPH
 
Central American Minors Working Group
Padma Swamy, MD, MPH
Sarah Howell, MSW, LCSW