This story was updated at 5:09 p.m.

As several states across the country impose restrictions or close doors for abortion providers’ doors, clinics in the D.C. region are still finding ways to stay open in the middle of the pandemic.

Much of the care at the clinics is time-sensitive and essential, says Dr. Laura Meyers, the president and CEO of Planned Parenthood of Metropolitan Washington, D.C.

“People’s sexual and reproductive health care needs don’t change because there’s a pandemic,” says Meyers. “People still have sex during a pandemic.”

Planned Parenthood and other local reproductive health clinics are adjusting their services to focus exclusively on time-sensitive care, including abortions, testing and treatment for sexually transmitted diseases, or problems with an IUD contraceptive. They’re also postponing elective procedures and routine check-ups, or moving them online.

“Our message out there is, ‘We’re here for you. Our doors are open, whether they are virtual doors, telephonic doors or in-person,’” Meyer says.

Some clinics are concerned that patients aren’t getting that message.

“When everything first started happening … we would get [calls]: ‘Are you still open? Are you closed? Are you seeing patients?’” says Allison, a front desk and billing specialist at a clinic in Montgomery County.

DCist is using the first names of Allison, and several other women in this story, because they were concerned for their own safety, and the safety of their workplaces.

Some clinic leaders are bracing for more patients seeking care when stay-at-home orders begin to lift, says Dr. Sara Imershein, a retired doctor who usually sees patients seeking abortions at the Falls Church Healthcare Center. (Imershein is currently not going to the center because she’s in a higher-risk group for having a severe COVID-19 case.)

“We’re worried about a surge of later abortions in the coming weeks and months,” Imershein says. “We’re worried that people aren’t even seeking abortion because they don’t know that it is available, or they get mixed messages from the various states that have been trying to outlaw abortion.”

‘Where’s Patient A, Where’s Patient B?’ 

Clinics are also reworking their schedules to control the number of patients being seen at any given time.

In the case of Allison’s clinic in Montgomery County, that has also meant cutting back the number of days they see patients in person from five days a week to three. They’re working longer hours each day in the office as a result.

The choreography for seeing patients in person now is complex, Allison says, as she tries to keep an eye on social distancing measures inside the clinic.

“I’m always thinking about like, ‘Where is this patient? Where’s patient A, where’s patient B?’” she explains.

Patients spend a lot of time filling out forms and receiving counseling on the procedure from the safety of their cars. They’re also required to bring masks to wear inside the clinic.

When they do come inside, patients sit in cordoned-off portions of the waiting room, which are wiped down with disinfectant between patients. Staff wear personal protective equipment—masks, gloves, gowns and other face coverings—at all times. Visitors accompanying patients are not allowed inside.

Clinics are also taking patient temperatures and asking screening questions to gauge possible exposure to COVID-19.

Rosemary Codding of the Falls Church Healthcare Center says her staff are now focused on getting patients in and out of the clinic as efficiently as possible to minimize risk.

“The data really showed that a 15 minute encounter was a lot safer than a 30 minute encounter. And so we worked to see how we could make that happen for our patients and our staff alike,” she says.

Codding notes that the center’s efforts to minimize the time abortion patients spend in the office have been hampered by Virginia law, which currently requires an ultrasound and a 24-hour wait period before patients can receive the abortion procedure. Virginia Governor Ralph Northam signed legislation last month that will roll back both of those requirements starting in July.

One aspect that hasn’t changed despite the pandemic: protests outside the clinics.

Volunteer clinic escorts who accompany patients have mostly chosen to stay home. Megan, a longtime volunteer with the Washington Area Clinic Defense Task Force, says the organization stopped escorting at seven of the eight clinics it works with. The group couldn’t see a way to continue providing the service while maintaining the recommended six feet of distance from patients and protesters alike.

“Particularly in D.C., the law is that the sidewalk and the land up to about a foot from their building is public property,” she says. “It was physically impossible for us to escort patients six feet away from the [protesters], who would not be obeying the six-feet rule.”

“I’m really sad and frustrated about it,” she says.

‘I’m Always On Edge’

Medical staff are also at higher risk for exposure to COVID-19. So far, the clinics reached for this story didn’t report any major staffing changes.

At Allison’s practice, a few nurses are temporarily absent as they care for coronavirus patients at their other jobs. In Falls Church, Codding says a few staff members have had trouble catching public transportation to work, or have chosen to take a leave of absence for family or health reasons.

For those who are still working, Codding worries about the stress of the pandemic compounding the stress her staff already face in providing abortions.

“It is adding and piling on this stress and this uncertainty,” she says. “The way you actually view your coworkers, as well as your patient as possibly somebody that might be asymptomatic and could pass on a virus to you — that’s got to add a lot of stress.”

Allison says she’s feeling the strain.

“I’m always on edge because I have a family at home,” she says. “Every day I’m cleaning, I’m wiping down everything. I take my shoes off outside. [My shoes] stay outside until I go back out. I take a shower when I get home.”

Where possible, clinics are trying to save their patients a trip to the clinic entirely. That means training staff on telehealth or shifting consultations to the phone. Planned Parenthood’s Meyers says the pandemic has pushed the organization to implement telehealth in a more widespread way than before—which has meant some adjustments for staff.

“You have to figure out the technology and the technology exists. Then you have to train your staff on how to use that technology to provide care,” Meyers says. “And obviously, you need to have protocols in place in terms of screening and also how treatment proceeds, too.”

Rising Costs For Protective Gear 

Like other medical providers, reproductive health clinics need more personal protective gear for their staff than they normally do. They’re competing with other medical practices for limited supplies of masks, gloves, gowns and more, often ordering from suppliers they’ve never worked with or splitting bulk orders with other clinics to try to drive down ballooning costs.

Codding at the Falls Church Healthcare Center says her organization started planning for a possible pandemic in late December. The clinic was a pandemic center and vaccine distribution site for Fairfax County during H1N1 in 2009, which Codding says gave them a leg up on how to prepare for a pandemic.

“We started looking at supplies that we knew that we might need, which were consistent with our experience for H1N1,” she says.

But all those extra supplies are costly. Codding says the center’s expenses have tripled since February, and she’s applying for support from the Small Business Administration’s Economic Injury Disaster Loan program.

But Codding is keeping her optimism about the clinic’s future alive.

“I’m not worried. We’ve been in existence since 2002,” she says. “We’ve had a lot of rough roads.”

This story was updated to correct the name of Planned Parenthood of Metropolitan Washington, D.C.