COVID-19 growing faster in rural areas

Just because you’re rural doesn’t mean you’re safe from COVID-19, a University of Minnesota health researcher told a nationwide audience of journalists on Tuesday.

Almost all rural counties in the United States, 86 percent of them, have had at least one COVID-19 infection, while about one-third of rural counties have had a COVID-19 death, Dr. Carrie Henning-Smith said. Henning-Smith is the deputy director of the University of Minnesota Rural Health Research Center.

“COVID-19 took longer to hit rural areas,” Henning-Smith said. “We first heard a lot about it in Seattle and New York and New Jersey and New Orleans. That’s no longer true.”

She cited a Kaiser Family Foundation report from last week that the rates of COVID-19-related infections and deaths were going up faster in rural counties than in urban ones over the past two weeks.

For two weeks ending April 27, rural counties saw a 125% increase in coronavirus cases (from 51 to 115 cases per 100,000 people) and a 169% increase in deaths (from 1.6 to 4.4 deaths per 100,000 people), according to that study.

During that same time period, metro counties saw a 68% increase in cases (from 195 cases per 100,000 people to 328) and a 113% increase in deaths (from 8.0 deaths per 100,000 people to 17.0).

Coronavirus is poised to hammer the rural health care system, which Henning-Smith said was stressed long before the coronavirus appeared. Since 2010, 128 rural hospitals have closed, eight of them in 2020 alone, while the virus has set many of them teetering on the edge of collapse, Henning-Smith said.

Rural health care systems also face a major shortage of healthcare workers, she said, while people living in rural areas tend to be older, with more underlying health concerns and disability, and less likely to have health insurance than their urban counterparts. Rural residents also are more likely to have less access to broadband internet, finding it difficult to work from home or order groceries online, and also be unemployed.

“Altogether, this puts rural residents at higher risk of COVID-19,” she said.

Alomere expects to lose $5M per month

While many of those conditions hold true for Douglas County, Alomere Health was actually in a stronger position than many other rural hospital systems leading up to COVID-19, said CEO Carl Vaagenes.

While the average hospital operates with roughly 100 days cash on hand, which means the amount it has to pay monthly expenses without any new money coming in, Alomere has 180 days cash on hand, he said.

However, revenue has plummeted for Alomere since March 19, when Gov. Tim Walz halted many business activities, including elective surgeries, Vaagenes said.

Caseloads have dropped from 50 to 90% in all areas, except for labor and delivery, and its April revenue dropped by half, about $7 million.

“We are projecting to lose approximately $5 (million) per month based on current volumes,” he said.

Elective surgeries can begin again after Sunday, May 10, and surgeons are planning to contact patients who have been waiting for procedures, he said.

Like other health care organizations, it encountered difficulties getting personal protective equipment for its workers, several of its committees and what he called “tremendous community support” have left Alomere with a strong PPE supply.

Testing availability continues to be limited.

Another local strength is how the healthcare system, nonprofits, local government and businesses have been collaborating to prepare for the virus, said Ann Stehn, Horizon Public Health administrator.

“It truly is a situation in which everyone understands that we are interconnected and our success lies in our ability to work together to serve our community,” she said.

Bright spots

Henning-Smith said there are some bright spots in how rural areas are managing the coronavirus.

For instance, the Virginia Rural Health Association helped small rural clinics create a buying pool to increase their chances of buying personal protective and other equipment.

In Texas, a 300-square mile school district provided broadband access to every household by adding boosters around their rural schools at a cost of just $30 per household per year.

“Rural areas are smaller and sometimes that can be an advantage,” she said, adding that they can be more nimble and innovative.

Rural health care systems need stable funding, long-term fixes, and more health care providers, Henning-Smith said. She said she would like to see Medicaid expanded and health insurance available to all rural residents who need it, as well as broadband for all rural residents who want it.

She said rural residents can address the loneliness they might feel from social distancing by adopting some old ways.

“We might need to see a resurgence of people calling each other on the phone,” she said. “Sending letters might be a safe way to communicate.”