Most major media outlets to date have focused their attention on the spread of COVID-19 in metropolitan areas like New York City, where the devastating impact of this pandemic is undeniably overwhelming. Nearly a quarter of all recorded U.S. COVID-19 deaths have been in New York City yet, a growing and less noticeable crisis is surfacing in the heart of rural America.
Rural communities play a vital role in the health of the nation
One in five Americans live in rural areas. Rural areas are a crucial source of water, food, energy, and natural resources. At a time when 1 in 5 families are experiencing food insecurity, we need to remember that farms supply safe food to America’s grocery stores and food pantries. Despite the importance of rural communities to the nation’s overall health, the health of rural Americans is often overlooked in federal policy. Even when it is discussed, it’s viewed through a homogeneous lens. Glaringly absent from the dominant narrative about rural America, and rural health research, is the experiences of black, Native American and Latinx populations, as well as immigrants, LGBTQ individuals and people with disabilities.
Rural America has a higher proportion of people who are at high risk or increased vulnerability to the virus.
Individuals in rural communities are older and sicker than people in major metro areas. According to one recent analysis, more rural Americans live in poverty, and have higher rates of obesity, cigarette smoking and physical inactivity compared to their metro counterparts. And according to the CDC, these are the very individuals who are at high risk for developing serious illness and complications from COVID-19, so rural Americans are more likely to require hospitalization and intensive care while hospitalized from the virus.
As COVID-19 hits rural communities, the virus has the potential to spread more quickly.
The number of COVID-19 cases in rural America is steadily climbing. The primary way COVID-19 spreads is person to person, and factories and farms are not workplaces where people can easily stay six feet apart. A large portion of the rural workforce does not have the ability to work remotely, which enables the virus to spread more quickly. One recent analysis found that the COVID-19 growth rate is now higher in rural areas than metro areas. In the two-week period between April 13 and April 27, non-metro counties saw a 125% increase in coronavirus cases, whereas metro counties saw a 68% increase in cases.
Every indicator demonstrates that the rural healthcare system will be hard pressed to respond to a COVID-19 outbreak.
Nearly half of all rural hospitals were operating at a loss before the COVID-19 outbreak. Since 2010, at least 130 rural hospitals have closed, and multiple studies have found that states that didn’t expand Medicaid have seen more hospital closures. As a result of the pandemic, rural hospitals are even more economically strapped. Hospitals typically stay afloat by providing imaging, lab tests, physical therapy and outpatient procedures but these sources of revenue have dried up with elective procedures being cancelled to stop the spread of the virus. Hospitals are also experiencing higher staffing needs and supply costs, while at the same time dealing with price gauging due to the pandemic. There is deep concern that cash-strapped rural hospitals won’t be able to overcome the financial strain, especially given the median rural hospital’s operating margin is 0.7 percent. And even if rural hospitals keeps operating, they might not be able to meet a surge of gravely ill COVID-19 patients because they have fewer intensive care (ICU) beds per capita than metro areas. Rural Americans are accustomed to provider shortages and long drive times to medical care, but during the pandemic, an extra 20 minute drive could mean life or death.
COVID-19 in rural America may compound the impact on people of color.
People of color, particularly African Americans, have been disproportionately burdened by COVID-19 deaths. Although rural communities often are less racially and ethnically diverse than metropolitan areas, troubling health care disparities persist in rural America and there is no evidence to suggest that rural America will escape the inequities of COVID-19 deaths we have seen thus far.
Federal funding won’t be enough to salvage the rural health care system.
The Paycheck Protection and Health Care Enhancement Act allocated $225 million for COVID-19 testing and related expenses to rural health clinics. Subsequently, on May 1st the Department of Health and Human Services (HHS) announced they would be releasing $10 billion from the CARES Act Provider Relief Fund to rural providers at hospitals and clinics. This was welcome news given that many rural hospitals are operating on razor thin margins but the funds likely will not be enough.
As the pandemic unfolds, there is deep concern for rural America, and politicizing public health only makes matters worse. As Governors of states with large rural populations start to roll-back “shelter in place” orders, they should remember that infectious diseases don’t respect geographical boundaries. Even if a rural community has not yet been hit by COVID-19, once the virus enters the community, it could look like a moth to a flame.