That was the message from speakers on an online media briefing hosted by the Infectious Disease Society of America this week, which featured a discussion about the coronavirus in rural America.
“You might think those [rural] communities have been spared from this disease, but they haven’t,” said Andrew Pavia, chief of the division of Pediatric Infectious Diseases at the University of Utah School of Medicine. “We’re going to see a different epidemiology in rural states without the very graphic high peak that you see in cities. We’re probably going to see a long, sustained outbreak, which means we’re probably going to be fighting this for weeks and months to come,” he said.
There are a multitude of reasons why the rural communities aren’t out of the woods and may, indeed, suffer more as the coronavirus gets a stranglehold: Rural communities tend to be more close-knit and often congregate for events; residents in these rural communities are more apt to work in industries, such as meat packing, where working side by side in a warehouse-type atmosphere is the norm; and the resources for sick people are fewer.
“What we’re seeing is a lot of the disease in small communities that don’t have the kind of medical care they have in big cities,” Pavia said. “The hospitals are smaller and have had chronic shortages of physicians for decades now. There are also shortages of ICU beds.”
Many residents of these communities are older, and many are on the lower socioeconomic scale and don’t get the medical care they need, which results in an abundance of diabetes, obesity and other underlying health conditions. That makes them more susceptible to serious consequences from the coronavirus.
In Utah, there is a big Native American population, including the Navajo Nation, which has been hit hard by the virus. “The rates of infection are quite high, and tragically, the death rate for those infected has been quite high,” Pavia said.
In many of these regions, very few people have been tested. “Does that mean there’s no disease? Absolutely not,” Pavia said. “It means we don’t have a good spotlight on what’s going on in those communities.”
Angela Hewlett is an associate professor in the Department of Internal Medicine at the University of Nebraska Medical Center. She said the coronavirus hit Nebraska first in Omaha, its biggest city, but is now shifting to the smaller, rural counties and the numbers there are multiplying.
“Nebraska as a whole looks pretty good when you look at the numbers,” Hewlett said. “It looks like we don’t have a lot of positive cases. But if you break it down by county, it’s a completely different picture that emerges, and it’s alarming.”
She said living in rural America has its advantages, including the fact that people tend to be more spread out. But again, the working environments can be such that people are forced to congregate.
“The industries located in these communities are very different in that they are often industries in which people don’t have to ability to telecommute, they need to actually go to work and are viewed as essential functions.”
And once there is an outbreak, the smaller hospitals are ill-equipped to care for the large numbers of sick people who may be coming from multiple counties and may need treatment in an ICU, which is the case for many patients with the coronavirus.
“They also have limited testing capabilities,” Hewlett said. “It’s difficult to obtain a test and the turnaround time is very long. They have to be taken to a central lab somewhere and it makes it difficult to make decisions positive or negative when your tests take a long time to come back.”
She said she believes more hot spots will erupt in the coming weeks in rural areas throughout the United States.
