Thomi Clinton says she is exhausted.
Clinton, CEO of the Transgender Health and Wellness Center in Cathedral City, California, said she has been working 70-hour weeks providing services to the LGBTQ community, which has been hit especially hard as the Covid-19 pandemic rapidly spreads across the U.S.
She said she's seen a rise in transgender people seeking the center's help after they have lost their homes or jobs and have had to go back to sex work to make ends meet.
The social and economic disparities are hitting the transgender community "very hard," Clinton said in a phone interview with CNBC, adding transgender people already faced extra obstacles before the pandemic. "I've also noticed a growth in mental health issues, basically suicidal thoughts and attempt."
Doctors are concerned the pandemic, which has shuttered businesses and schools and left people without jobs, may hit the LGBTQ community harder than most others.
Public data has already shown that the Covid pandemic, which killed more than 1 million people worldwide in less than nine months, has disproportionately impacted Black, Latino and Indigenous Americans.
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According to the U.S. Gay and Lesbian Medical Association, the LGBTQ community, a diverse group of people that includes a variety of socioeconomic and ethnic backgrounds, tends to face higher rates of cardiovascular diseases, obesity and other health problems that research suggests can make a coronavirus infection more severe. They also experience higher rates of illicit drug use, homelessness, isolation, anxiety, depression and suicide and often face barriers to health care, medical experts say.
"All the issues that existed prior to the pandemic still exist but are even worse. They've been amplified by the pandemic," said Dr. Scott Nass, GLMA's president.
But doctors and health experts are unsure how severe the impact on the LGBTQ community is because data is so limited. Most state health officials responsible for collecting data on coronavirus cases often report information such as race, age and sex but not other details like sexual orientation and gender identity, health advocates and experts point out.
"In many places across the world and U.S., we don't have good data collection," said Dr. Jesse Ehrenfeld, the American Medical Association's former board chair. "Because LGBTQ people are often invisible when it comes to data collection in a variety of contexts, including health care, that has really limited our ability to get out information about what's going on."
Doctors fear the impact on LGBTQ people could be substantial when considering the social, economic and health risk factors the community already faces.
Dr. Sarah Ketchen Lipson, a professor at Boston University's School of Public Health, said the pandemic is likely putting significant stress on young LGBTQ people, particularly those heading to college with a smaller group of friends and social distancing measures.
"The college years, like age 18 to 24, are a really key time for gender identity development and general psychosocial development," she said in a phone interview. "And many young people find or have a stronger sense of community when they arrive at the campus, and that's particularly true for sexual and gender minorities."
"One thing I'm really worried about for that population is how the pandemic is making it much more difficult for students to find a sense of community on campus," she added.
Lipson, co-principal investigator of the Healthy Minds Study, a national survey on mental health among college students, said the pandemic has also limited LGBTQ students' access to mental health services and gender-affirming services, like hormone replacement therapy.
"This is a key time for higher education to not be cutting back on the availability of mental health services, and schools obviously have to make really difficult decisions in terms of their budgets," she said. "Schools may end up paying for that in a much bigger way if they are not tending to their students' mental health needs."
Dr. Barbara Taylor, who treats HV patients and is a professor of infectious diseases in San Antonio, said there has been a drop nationwide in people getting tested for HIV and other sexually transmitted diseases since many outreach programs were forced to suspend services because of the pandemic. The result could lead to a rise in people who don't realize they have HIV, a virus that disproportionately impacts gay and bisexual men.
Taylor, a provider within University Health System, said many clients are "very nervous" about coming into a health-care setting where they might get exposed to Covid. She said marginalized patients, like those she treats, already face barriers to care such as lack of health insurance, lack of transportation and stable housing. She added data on the impact on LGBTQ people is "just not there."
"This is a structural thing. Everything about this pandemic has highlighted existing structural inequities. This pandemic is highlighting inequities in the LGBTQ community just like it's highlighting inequities in communities of color," she said. "Covid just shines a spotlight on the injustices in our system."
Ehrenfeld, a professor at the Medical College of Wisconsin, said he is also worried about a rise in domestic abuse, which sexual and gender minorities are more likely to experience than their heterosexual counterparts. Domestic abuse is on the rise, studies have shown, as more people have to stay at home.
"We know that LGBTQ people are often more likely to be homeless, but there is another component of domestic abuse that should be discussed," he added.
He said there are great resources for LGBTQ people struggling at this time, including in his own state, where online support groups have been formed for transgender people.
GLMA's Nass echoed the need for resources for LGBTQ people. He said the organization has renewed its call for health services, federal agencies and programs to be open to all communities, including LGBTQ.
"It's a huge first step for a lot of organizations, especially those who have not seen this as a priority in the past,'" he said.
Clinton of the Transgender Health and Wellness Center said she's been focusing on keeping the LGBTQ connected through Facebook groups and private Zoom chats that allow young people in the community to come together while staying safe.
"LGBTQ kids are struggling right now," she said.
Editor's note: If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255.
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