We provide daily coronavirus updates on KRCB radio 91. Tune in at 9 a.m. and 6:44 p.m. for the latest local news. Here's our update for Friday, April 24.

It’s been another tough week of sheltering at home – with new information on how early coronavirus came to the United States and the Bay Area – and unsound advice about disinfectants and other dangerous or unproven treatments.

And yet there is good news: Congress came together this week to allocate half a trillion dollars where it’s most needed, including for hospitals and testing.

With all that going on, we’ve got a special treat for you on Sunday afternoon. Because the Santa Rosa Symphony has canceled all its in-person activities, they are partnering with us to broadcast a program from last season for the first time, featuring a symphony that everyone knows and loves.

The concert was performed in October 2018. Francesco Lecce-Chong and the orchestra were celebrating his first appearance with the Symphony as its music director.

Francesco talked with news director Steve Mencher via Zoom about activities he’s leading remotely to bring music into our homes as we wait out the pandemic. Listen here:

Join them Sunday afternoon at 3 p.m. for performances of Celebration for Orchestra by Ellen Taafe Zwilich*, the Violin Concerto in D major by Brahms, Sonoma Strong, by Paul Dooley, and the Symphony Number 5 in C minor by Beethoven.

By Camille Escovedo

The last time this many people filed for unemployment in the U.S. — over 26 million as of April 27 — was during the Great Depression, experts say. Over a million Californians have filed for unemployment in March, and the layoffs have not let up. 

“It’s something I wouldn’t have thought of that I’d be doing, so yeah, it’s a little weird when your employer says, ‘OK, yeah, you should file for unemployment,’” said Josephine, who is — or, was — a kitchen manager and teaching assistant at a preschool in Santa Rosa. 

She asked us not to use her real name. The school shuttered, she’s been furloughed, and now she emails with managers and coworkers to talk about payroll and how they’re doing.

“But it doesn’t actually feel like I’m not employed,” she said. “It's just we’re in this big waiting game and if I need money to support myself during this time, and unemployment’s going to be the way to get it…”

Josephine said staff were told paid sick and vacation hours could be used to stand in for a paycheck. And to mark themselves as “temporarily unemployed” if they filed a claim. 

“I tried filing for unemployment, but the online process is a bit confusing,” she said. “I keep trying to find the button to like, OK, file a claim, and then it takes you to another page that’s like, OK, here’s how to file a claim, but I haven’t found the actual document that I’m supposed to fill out.”

Josephine may not be the most representative of laid-off workers. She’s got bills, but no monthly rent. But local organizations are working to reach those struggling during COVID-19. Mara Ventura, executive director of North Bay Jobs with Justice, focuses on those falling through the cracks.

“The first thing we did was ensure that folks could call us to get information about how or what they might be eligible for and walk them through the paperwork if they needed that. And we provide that in Spanish and in English,” she said. 

Their website lists info about new qualifications for unemployment benefits, including reduced hours due to the outbreak. There are also resources on state disability insurance, the Family and Medical Leave Act and paid sick leave.

“... Because people should not be having to worry about medical debt at a time like this and deciding between going into a hospital or clinic to get care and not, because at this point, that’s not just about the workers, it’s about a huge public health risk,” Ventura said. 

North Bay Jobs with Justice recently co-founded Sonoma County United in Crisis, a coalition that calls on local governments to adopt policies to protect tenants, immigrants, seniors, homeless people and workers during the pandemic. 

“But they also need to know that they’re not going to be evicted and they’re not going to come out of the COVID crisis owing thousands of dollars to their landlords,” Ventura said. “And they also need to know that their sheriff isn’t going to turn them over to ICE.” 

North Bay Jobs with Justice helped launch UndocuFund in 2017 during the Tubbs Fire, to aid immigrants who, if undocumented, were ineligible for assistance through the Federal Emergency Management Agency, or FEMA. 

UndocuFund reactivated in the wake of coronavirus to provide disaster relief funds for undocumented people in Sonoma County who won’t receive federal stimulus checks through the CARES Act. 

“They’re going through the same thing that many other millions of workers are in terms of losing work, but they will not be eligible for so many of the programs that other workers will be able to get a hold of,” Ventura said. 

Coping with the coronavirus pandemic is a communal experience, but job loss means different things for different people. So many applied for aid that UndocuFund has closed its waitlist for now. Meanwhile, other groups rise to meet the county’s needs. 

More information about Sonoma County COVID-19 resources can be found at norcalpublicmedia.org.  

By Kristen Hwang for CalMatters

In a matter of weeks, Dr. William Goral, a private practice ear, nose and throat specialist in San Bernardino County, will be out of business.

His small, solo clinic, which has served patients throughout the Inland Empire for 30 years, postponed about 80% of patient visits due to coronavirus restrictions. That’s not enough revenue to pay rent, utilities or staff. 

“We are going into the red even having laid off two-thirds of my employees,” Goral said.

At private practices and small clinics across the state, independent physicians are worried their businesses won’t survive the current crisis, forcing them to either close their doors or sell their practices, which could lead to higher patient costs. In either case, experts worry that will leave the health care system vastly diminished at a time when the state is facing skyrocketing costs and a shortage of doctors.

(Image: Dr. George Scott in one of several examination rooms in his Manteca clinic. Scott’s private OB/GYN practice is moving to a smaller clinic space in the midst of the coronavirus pandemic due to a rent increase. Photo by Anne Wernikoff for CalMatters)

About one in three Californians get care from private practice physicians and specialists, according to the California Medical Association, which represents roughly 50,000 doctors across the state. In a recent survey, nearly 76% of members reported being extremely worried or very worried about finances.

Empty clinics triggered a cash crunch for doctors after Gov. Gavin Newsom issued a shelter-in-place order last month. That’s because the statewide lockdown forced a majority of medical procedures, from hip replacements to annual check ups, to be canceled or delayed unless they are deemed an emergency.

A catastrophe for private practices

On Wednesday, the governor announced plans to resume some delayed medical care such as heart valve replacements, angioplasty and and tumor removals, but he warned the state remains far from reopening.

And though the federal government is providing aid, most say it’s not nearly enough.

“The whole situation is catastrophic for the entire profession in terms of economics,” said Dr. Thomas LaGrelius, a family medicine doctor in Torrance, Calif. and president of the American College of Private Physicians.

LaGrelius currently is only able to conduct about three in-person patient consults per day and has tried to switch as many appointments as possible to online video conferences. Unlike other doctors who received emergency grants this week from the U.S. Department of Health and Human Services, LaGrelius’ clinic has yet to get any relief from the federal Coronavirus Aid, Relief and Economic Security Act, or CARES Act.

The federal department, which is doling out $100 billion to doctors based on the amount of patients they serve who are on Medicare, gave him a test deposit of $0 and told him a grant would come later.

And while grants are certainly welcome, they’re a “drop in the bucket,” said Debbie Rood, business manager for her husband’s obstetrics and gynecology practice in Manteca. Rood’s husband Dr. George Scott said they received about $2,000 since most women over the age of 65 don’t see a gynecologist regularly. 

His private practice’s finances are complicated by the fact that insurance companies won’t reimburse him until after patients give birth, leaving him and his staff performing unpaid labor for months. At the same time, their rent tripled, forcing them to downsize to a smaller clinic.

Taking out a second mortgage

Scott and Rood are determined to keep the business running but they may need to take a second mortgage on their home. They are also concerned about the long-term implications the economic crisis will have on access to care. 

“If you lose all of your primary care doctors and your (obstetricians) because you can’t make a living,” Rood said, “where are patients going to go?”

It’s a question with a complicated answer, said James Robinson, professor of health economics at UC Berkeley. The economic fallout of the pandemic will lead to the closure of many private practices, but the implications are less clear.

Consolidating practices

Increasingly, in the past decade, independent doctors and private community hospitals have been swallowed by sprawling health care delivery systems through mergers and buyouts. Nearly 60% of Californians received care from an integrated healthcare system in 2018, which organizes doctors, hospitals, and sometimes insurance companies into one coordinated system, according to Let’s Get Healthy California, a state task force that monitors key health indicators including access to care.

Because small businesses like independent physicians typically don’t have the financial reserves to ride out severe economic downturns, the current pandemic will hasten the consolidation of healthcare, Robinson said.

“I think that it’s going to drive them into the arms of health plan places like Kaiser,” Robinson said.

The loss of private practices isn’t necessarily a bad thing, experts say. Consolidated health care can lead to better communication between doctors, more efficient use of testing and scans, and more cost-effective treatment, he added.

(Image: Debbie Rood and Dr. George Scott in their Manteca clinic. Rood says making sure Scott stays healthy during the coronavirus pandemic is a priority. Photo by Anne Wernikoff for CalMatters)

The problem is many of California’s rural counties, which often face provider shortages to begin with, still rely on private physicians and community health clinics. Forty of the state’s 58 counties had below-average access to consolidated health care in 2018, with as little as 10% of the population in Del Norte enrolled in a managed health care plan. 

Mergers raise costs on patients

A large body of evidence shows that hospital mergers and physician buyouts have increased insurance prices throughout the state. 

In areas with high hospital consolidation and high proportions of hospital-owned physician practices, health insurance premiums cost up to 12% more than in areas with average levels of consolidation, according to research published in Health Affairs, a peer-reviewed health policy journal.

“There was an uptick in merger activity right after 2008,” said Daniel Arnold, co-author of the paper and research director at the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare at UC Berkeley. “I think you will see something similar here.”

Rood said she’s scared to death of what will happen to patients should her husband, Scott, become ill from coronavirus or should their private practice be forced out of business. Already, with only five obstetricians and gynecologists in their area and one planning to leave in June, Scott said there aren’t enough OB-GYNs to take emergency calls at the local hospital.

Like many other doctors and business owners, Rood and Scott applied to the Small Business Administration’s Paycheck Protection Program, a $350 billion emergency fund created by Congress to avert business closures and layoffs during the COVID-19 pandemic.

Last hope hangs on second relief package

Their bank, however, took 11 days to send the application to the first-come, first-serve relief program. The day after they submitted, the Small Business Administration announced it had run out of money.

Now, with Congress approving a second $484-billion relief package with $75 billion set aside for physicians and hospitals, independent physicians like Scott and Goral are hoping to save their life’s work.

Goral, the ear, nose and throat specialist, was unsuccessful in obtaining help in the first round of federal funding, but he hopes the second round of funding will buy time until patients return. Still, his position is precarious. Each passing day pushes his business further into debt and he fears he’ll close before ever seeing any money.

“If we have to shut our doors and we don’t have a practice anymore, then the opportunity has been missed,” Goral said.

Kristen Hwang is a freelance reporter pursuing joint master’s degrees in public health and journalism at UC Berkeley.

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.