Uncertainties are everywhere… but there are more talks and debates circulating about rural America and how it will be impacted by the spread of the virus. More than half of the counties in America have no hospital ICU beds… I’m worried! Everyone is talking about the big cities but we have some big hurdles to clear as well. With fewer hospitals and fewer medical workers, there’s certainly some worry and unique challenges rural residents and doctors will be facing. According to a 2018 GAO report, 64 rural hospitals closed between 2013 and 2017, which is more than twice the number of closures in the preceding five-year period. Since 2005, 162 rural hospitals have shuttered! Most hospitals closed because of financial problems, and 38% of rural hospitals are unprofitable. In February, The Chartis Group released a study showing that more than 450 rural hospitals are vulnerable to closure

It’s estimated that about 15% of the American population lives in rural areas. Generally speaking, rural Americans are older and many argue their health is a bit more fragile. Smoking, diabetes, high blood pressure and being overweight are all more prevalent in rural areas. Keep in mind, being older as well as having underlying health conditions have increased mortality rates, meaning the older and higher-risk populations are at greater risk. 

Another variable that adds to the rural complication is exposure to large amounts of dust, chemicals, and outside irritants. It’s hard to remember a spring that someone in the family wasn’t battling a sinus infection or some other type of respiratory complication associated with mowing, planting, or working in heavy dust, pollen, ragweed, etc… This will obviously have many of us freaking out. As soon as someone in the house starts coughing and hacking we will more than likely begin jumping to conclusions and forecasting out the what-ifs. 

Large farming operations comprised mostly of Hispanic workers add to the mix as many lack comprehensive health care benefits. According to the Department of Labor’s most recent agricultural workers survey, just 47% report having health coverage, compared to 91.5% of the general population. Meaning, with little to no paid sick leave, farmworkers are heavily disincentivized from seeing a doctor or taking time off in the case of illness.

Why have many hospitals closed? Rural areas have fewer commercial payers than more urban markets, which means these hospitals have a higher volume of state-funded healthcare with lower reimbursement rates. As the U.S. population ages and struggles with chronic conditions, these issues are more extreme in rural areas. Remote locations have a harder time recruiting full-time physicians, especially in specialties such as orthopedics or neurology. While rural patients still need these services, rural hospitals are often only able to offer them once a week or once a month with alternating coverage for subspecialties. It leads to a lack of access to care for patients, burned-out physicians and loss of revenue for organizations. Keep in mind, the typical rural hospital employs about 300 people, serves a community of about 60,000. So, when the only hospital in a county closes, it creates a potentially big problem, especially in a situation like we are facing now with coronavirus. This is sad, but over the last 15 years, the difference in mortality between rural and urban areas has tripled. 

Look inside the numbers fro Alaska… Alaska has reported almost 100 cases and its first Covid-19-related death. Experts from the CDC estimate 40 to 70 percent of the state’s 737,500 people may eventually contract Covid-19, meaning at least 295,000 Alaskans could get sick. Based on initial reports, 20 percent, or 59,000 people, will need hospital care. Alaska only has 1,500 general hospital beds. And even if as few as five percent of Covid-19 patients become critically ill (a conservative estimate), that’s a minimum of 14,750 people needing ICU beds. And Theobald estimates that Alaska only has around 200. If that many people get sick over the next one to three months, only one in 25 people who need intensive care will be able to get it. Even if you halved the number of Alaskans infected with Covid-19 to 20 percent, the system will still be over capacity — by thousands of people.

Keeping transmission rates low in rural America might also be challenging as many doubt the seriousness of the issue and what they are seeing in the media. Another problem for some in rural America is getting their hands on accurate and trustworthy information. I know it’s hard to believe, but many rural Americans still do not have good access to broadband services. Interestingly, this is leading to a ton of misinformation in many isolated areas. Meaning telehealth and other web-based healthcare is probably not an option. They will have to travel and see the doc’s in person and go to the pharmacy in person as delivery is not an option. In addition, many in rural America will need to work to keep our nation’s food system flowing. Talk about “hazard pay” the farmer and those in agriculture that are sacrificing to keep our food supply running should be given some “hazard pay”. 

Stay safe and understand some of the additional risk factors we are facing in rural America. We have fewer healthcare facilities, fever healthcare workers, we are older with more underlying conditions, we have less access to delivery services and a host of other work-related risks that might add to the mix. I’m not wanting to add to the fears but I do want my friends and readers to be smart and think clearly about our family’s future. We will get past this! (Source: HealthLeaderThe CounterForbes, Vox)

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