Stay home, rural America: You are the unseen simmering hotspot | Opinion

2020-04-13 | The Patriot-News

April 13--COVID-19 has rapidly swept across the country, creating a dire public health crisis calling for unprecedented changes to our daily lives. In times like these where we must band together for the greater good, we cannot forget parts of the country that are often neglected, specifically rural America. While the cases of COVID in rural America remain relatively low presently, Alaska, Idaho, and several other states have begun to identify community spread.

Rural populations tend to be older with higher rates of multiple chronic conditions, making them more vulnerable to serious outcomes from COVID. This includes millions with diabetes, hypertension and heart disease – all risk factors for the coronavirus. Rural America also faces greater challenges in providing adequate and quality healthcare. The geographic maldistribution of physicians in the U.S. has left rural America with a drought of primary care providers and even fewer specialists. The few medical facilities within reach of rural families are often 30 or more miles away.

Largely due to remoteness, rural America faces barriers related to accessing housing, transportation, food, and water that are safe, healthy, and affordable. Rural industries like mining and farming also bring danger and hazardous practices to rural areas, putting health of communities at greater risk. Additionally, rural America, on average, is poorer and less educated. This creates conditions for poor health literacy, and poor health literacy perpetuates poor health outcomes. The effects of these circumstances are clear in reports that rural residents have higher age-adjusted death rates compared to their urban counterparts. These circumstances also place an already at-risk population in further jeopardy during health crises like COVID.

The U.S. COVID curve from the Institute for Health Metrics and Evaluation (IHME) is still experiencing upward trajectory, and it is likely that the worst has yet to come. Despite the current death toll and severity of this reality, there is still no medicine nor vaccine for the virus. There are also not enough hospital beds, ventilators, or medical supplies. Even in the absence of a vaccine or treatment, the most ideal strategy would be to test all potentially infected individuals and quarantine them, but we do not have enough test kits.

As a result, we have resorted to social distancing and isolation as the main methods of prevention. Fortunately for rural areas, social distancing is often a normal way of life. Neighbors live miles apart, separated by wide-open fields. Once the spread of the virus proliferates, the hospitals, which are already resource-limited and understaffed, will become overwhelmed, and concerns of capacity will actualize. Urban residents might also evacuate cities and decide to shelter in rural communities, leading to overcrowding in rural areas. And although neighbors may live great distances apart in rural areas, they still gather in groups and crowds in community settings. This makes it imperative to enforce social distancing rules even in rural communities.

Pennsylvania, for instance, has set an example for the few remaining states that have yet to issue stay-at-home orders. Pennsylvania contains 67 total counties, a majority of which occupy rural areas. The state initially issued stay-at-home orders for only a few counties, but the list slowly grew, and as of April 1st, all 67 counties had the stay-at-home order.

While current models reported by IHME may not accurately predict the levels of spread in rural areas, it is hard to deny that overall projections look pretty grim – projections which assume social distancing through May 2020. Many states still do not have stay-at-home orders, and compliance with social distancing is not where it should be, despite reinforcement across the country. We have learned from the past several weeks how the slow implementation of social distancing caused significant delay in controlling the spread of the virus, and we do not want to repeat mistakes when it involves the health of our country.

Social distancing can’t be emphasized enough in rural areas where the virus could have severe implications, as these areas inherently face more struggles from a health perspective. And these areas have not yet felt the brunt of the virus, so they remain vulnerable. Hospitals and communities in rural areas should prepare now, setting up shelters, satellite clinics, and triage systems as early as possible so they can mitigate future damage, efforts and costs. Most importantly, social distancing must be enforced in rural areas to avoid potentially disastrous health consequences.

The power of social distancing has been illustrated over the past weeks, but we need to make sure that it becomes a universal practice, at least for the time being, so that we, collectively, can avoid paying a tremendous price. The notion that “the best offense is a great defense� could not be more reflective of our current reality and the roles we must play in it.

Sarah Hyun is a graduate of Lehigh University, Bethlehem, PA, and is currently a public health graduate student at Columbia University Mailman School of Public Health in New York City.