For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

When Dr. Sheila Ramgopal woke up on March 15, the COVID-19 warning signs were there. A dry cough. A sore throat. Some tightness in their chest, and a temperature slightly over 100 degrees.

“Not even a fever in my mind,” Ramgopal, medical director of Pittsburgh’s Allegheny Reproductive Health Center, told Rewire.News. But the symptoms met the criteria to be tested for COVID-19. All that was missing was a known exposure to someone who had tested positive for COVID-19.

“I see patients from all over central and western Pennsylvania and Ohio and West Virginia, it’s hard to know [where I might have been exposed],” Ramgopal said.

Ramgopal, who described their symptoms as “super mild,” called the state department of health and the Wolff Center at the University of Pittsburgh Medical Center to ask to be tested. They were told instead to quarantine at home for 14 days if they suspected they might have COVID-19. But as a doctor providing abortion care, which is not widely available in their area, “obviously, that was not possible,” they said, without trying to find out if they actually posed a risk to patients.

As Ramgopal awaited their test results, they were confronting the reality faced by abortion providers across the country, as the COVID-19 pandemic takes a drastic toll on services and the accessibility of abortion care. With confirmed cases in all 50 states, abortion providers are facing a complex interplay of questions about how to balance their own health, the need to physically distance, and the potential of COVID-19 to limit patients’ ability to travel for abortion services—all of which jeopardize the future of the independent clinics that provide 60 percent of abortions in the United States.

“I feel very powerless and I feel guilty, truly guilty for not being able to provide direct patient care in a really critical time,” Ramgopal told Rewire.News last week.

A recent report by the Guttmacher Institute warned of an “extreme strain” on reproductive health-care workers’ ability to serve patients in the midst of the COVID-19 outbreak. “These are truly unprecedented times,”  Nikki Madsen, executive director of the Abortion Care Network, the national association for independent abortion providers, told Rewire.News in an email. “We are feeling anxiety of the unknown. … The challenges that independent abortion clinics and their patients have had to contend with all along remain true and will likely be amplified.”

In Atlanta, Kwajelyn Jackson, executive director of the Feminist Women’s Health Center, said she and her staff have rescheduled and delayed all elective wellness services to prioritize abortion care, which is particularly time-sensitive. “That’s not a simple decision to make,” Jackson said. “We don’t want to prevent people from getting other kinds of health care … but in order to prolong our ability to provide abortions, we want to make sure our staff are not encountering too many people at once.”

Atlanta’s Feminist Women’s Health Center has staggered appointments and instructed non-clinical workers to work from home. “Our priority is going to be ensuring access to everyone who needs it and keeping people safe and healthy,” Jackson told Rewire.News.

Then there is the question of how these clinics, like other independent businesses, will remain open and can ensure their staff have a workplace to return to once the country has weathered the social and economic upheaval unleashed by COVID-19.

“We are likely going to have to dip into our reserves and … really reallocate our budget to ensure that people can get paid appropriately,” Jackson said. “I’m not going to pretend that this is not taking an emotional toll on me.”  The center’s development team, she said, is considering how future fundraising efforts can frame the potentially devastating impact of the coronavirus crisis on the clinic’s ability to survive.

“We’re monitoring the best circumstances to keep our doors open,” Jackson said.

“People are facing real financial pressures right now,” Madsen said. “And that can be a real challenge for fundraising.”

For Ramgopal’s clinic, the COVID-19 crisis has hit in the middle of a fundraising push for the local abortion fund, coinciding with the National Network of Abortion Funds’ annual fundraising campaign.

As clinics and providers grapple with their new professional reality, telehealth services have seen a surge in usage. Ramgopal, for example, was able to provide virtual consults while waiting for their test results, and 40 percent of their clinic’s staff started working from home.

But while telemedicine can increase patients’ access to reproductive health care, including medication abortion, obtaining an abortion via telemedicine remains prohibited in 18 states. And the Food and Drug Administration has refused to remove its restrictions on telemedicine abortions, Vice reported.

For Madsen, the COVID-19 “pandemic [is] …highlighting just how harmful abortion restrictions can be. That’s true of abortion-specific telemedicine bans, but also of other medically unnecessary restrictions like forced waiting periods, bans on insurance coverage for abortion, physician-only laws, and parental consent and notification laws. … Those barriers have the potential to become increasingly insurmountable now.”

And with a national lockdown and potential domestic travel restrictions looming, access to abortion could become even more fraught. “Abortion is not elective. People are going to … need abortions and [other forms of reproductive care],” Ramgopal said. “If we have travel bans, it’s going to create much worse issues and much more burden on our health-care system and on those people’s communities and their families.”

“There is never an appropriate time to have unnecessary restrictions on abortion,” said Erin Matson, an organizer and co-founder of the direct action group Reproaction, “but the time to lift them is now.”

Meanwhile, Ramgopal is ready to return to clinical work; after several days at home, their test came back negative.