Coronavirus in rural America (Part III: More on health)

A few days ago, the Washington Post published an important story by Dan Keating and Laris Karklis comparing flu deaths in rural America to what we might expect from COVID-19 as it spreads to rural places.  The points are mostly that rural America has a higher proportion of elderly and vulnerable populations and less well resourced health care.  Still, not all rural places/regions are "created equal," just as the same is true among urban areas.  Here's an excerpt from the story:

Covid-19 may pose the greatest risk to Americans in rural areas if deaths from the coronavirus pandemic are similar to those from the standard flu. Other concentrations of sick and old people may also be at risk. 

With more than 100 Americans already dead, scientists project the future by measuring the people at greatest risk and deaths from similar threats. 

Biostatistician and infectious disease specialist Nicholas Reich from the University of Massachusetts is participating in the White House Coronavirus Task Force modeling efforts. He said the death rates from flu for people over 50 could be a good indicator of vulnerability for covid-19. He said flu death rates are “probably not a perfect measure but a good place to start.”

The story also offers some interesting comparisons among urban places, and then among rural ones, including this information about the flu:

Rural and small city areas in Iowa and Missouri, around the Missouri River and Mississippi River, have had high death rates. Kansas, Nebraska, the Dakotas, Indiana and New England show rates higher than any of the big cities. 

The push for social distancing and isolation make dense crowds and public transportation in big cities seem like the deadliest environment. 

The pattern of flu deaths over the past five years, however, shows that big metro areas are not hot spots for high flu death rates. Most of the deaths are among the large population in big cities, but the risk for any individual person goes up dramatically where homes are sparse. 

Very rural areas have a 60 percent higher death rate from flu than the big metro areas, according to analysis of CDC death records.

See the story in WaPo to look at the infographics.

And here is today's National Public Radio story on the threat of rural hospital closures, reported by Lauren Weber.  The lede follows:

Rural hospitals may not be able to keep their doors open as the coronavirus pandemic saps their cash, their CEOs warn, just as communities most need them. 

As the coronavirus sweeps across the United States, all hospitals are facing cancellations of doctor visits and procedures by a terrified populace — profitable services that usually help fund hospitals. Meanwhile, the institutions also find themselves needing to pay higher prices for personal protective equipment such as face masks and other gear that's in short supply. 

* * * 

The American Hospital Association ... on Thursday [asked] Congress for $100 billion for all hospitals to offset coronavirus costs, citing rural hospitals' inability to withstand huge losses for long.

Alan Morgan, head of the National Rural Health Association, which represents 21,000 health care providers and hospitals, is quoted:

If we're not able to address the short-term cash needs of rural hospitals, we're going to see hundreds of rural hospitals close before this crisis ends. This is not hyperbole.

A March 17 story from In These Times/Pew Charitable Trust's Stateline is here, and an excerpt (focusing on West Texas) follows:

If you’re exhibiting coronavirus symptoms and meet the criteria, you should get tested.

But if you live in rural Presidio County, on the western end of the Texas-Mexico border, be prepared to travel. County residents who are severely ill are being told to go to Big Bend Regional Center in Alpine, Texas, which is nearly 90 miles away from the city of Presidio. The hospital will stabilize those patients before sending them nearly 200 miles to El Paso, according to a hospital spokeswoman.

Patients in the region seeking test results should be prepared to wait. The 25-bed hospital in Alpine takes samples and sends them to the nearest testing site, also in El Paso. Those tests are reported in a day or two. Three local clinics also have a handful of coronavirus tests, but those are taken by a courier to El Paso on weekdays, and then flown across the state to a lab in Dallas. The turnaround time is three to four days, said Dr. Adrian Billings, with Preventative Care Health Services in Alpine. 

“People who live out here in West Texas, we’re used to it,” said Gary Mitschke, emergency management coordinator of Presidio County. “If you don’t have 100 miles — well, you really haven’t gotten anywhere.” 

As in the rest of the country, most of Texas’ coronavirus cases have been in its largest cities, including Austin, Dallas, Houston and San Antonio. But the virus is moving toward less populated areas.  

Another recent Legal Ruralism post (collecting sources) about rural health care challenges in the era of coronavirus is here.  A New York Times story about the significance of population density to spread, specifically in the NYC context, is here.