Coronavirus in rural America (Part LXXIV): Cases in my home county spike by 55 (out of 7,700 residents) in a single day

Jasper School employees May 2020 

My mom sent me a text message yesterday afternoon telling me that 50 folks at the Newton County nursing home had tested positive for the coronavirus.  I wasn't sure of her source, but today, the Arkansas Democrat-Gazette's main coronavirus story, which mentioned 990 new cases in the state, included this about Newton County, population 7,753:  "an increase of 55 in Newton County, representing a fivefold increase in the sparsely populated county."  According to the New York Times Tracker, the number of cases in the county went from 2.1 per 100,000 residents two weeks ago to 111 in 100,000 today.  This confuses me since the 111 figure would suggest a county population of 50,000, but perhaps I'm missing something here. 

Screenshot of New York Times coronavirus tracker 8 pm Pacific time, July 25, 2020
The northern part of Newton County is shown in red, just above the text box.

The story quotes Jan Larson, mayor of Jasper, the county seat:

It’s frightening.  We’re almost in shock to be honest with you.

The story then quotes Arkansas governor Asa Hutchinson, who said the cases were

demographically elderly.  So we’re trying to determine if that’s a nursing home environment or some other facility.  

The report moves on to quote Health Department spokeswoman Danyelle McNeill:

We’re aware of roughly 50-60 cases [at the Newton County Nursing Home in Jasper] 

The Democrat-Gazette story continues:  

A Health Department report listed just three cases among residents, and four among staff members, on Friday. 

McNeill said the new cases had not yet been added to the totals in the report.
Rachel Bunch, executive director of the Arkansas Health Care Association, said the home “has received several positive tests for residents and staff.” 

Bunch wrote in an email: 

Newton County Nursing Home is doing everything they can to manage the situation and will continue to remain diligent in implementing containment measures.  As we know, the elderly are at the most risk for this disease.

The story notes that a nursing home staff member tested positive for the coronavirus in late March, at a time when there were only four cases in the county. 

The Arkansas Department of Health's map is shown here and in the screenshot below.  It is not as helpful as it might be because it depicts total cases as a raw number, not as a function of population density.  Thus Newton County appears in pale blue, two degrees more pale than the hardest hit counties shown in the darkest blue.

Newton County is in northwest Arkansas, three counties east of Oklahoma
and two counties south of Missouri. The pale blue doesn't look bad on a map
like this, but Friday's numbers mean the rate of infection is three quarters
of a hundredth,  which is a high rate of infection 
according to my infectious disease expert consultant. 

Back to the Democrat-Gazette story, which quotes Mayor Larson re: the governor's mask-wearing mandate:

We’re wearing masks  I did go into Harps [the grocery store in Jasper, previously Bob's AG] yesterday and I only saw one man not wearing a mask. … We’ve been doing well. People have stayed home, worn their masks.

As for Governor Hutchinson (R), he said that "the new cases in the county illustrate the virus’s reach."  I will add that if it has reached Newton County, it has reached the most remote parts of the state.  Hutchinson drives home the point after weeks of delaying the implementation of a mask order:

Everybody has to be mindful there’s not any area of the state’s that’s exempt.

The comments of Mayor Larson and Governor Hutchinson remind me of some photos my mom has sent me.  At the age of 76, she still works as non-certified personnel at the Jasper School.  She was going in a few days a week in May to be part of a team that accepted students' final homework assignments and shut down the building for the summer.  When I repeatedly admonished her then to wear a mask, she said everyone at the school was required to follow the CDC guidelines and wear masks and gloves.  They were also letting homework submitted by students sit for a few before touching it.  Yet when Mom sent me photos of what was happening at the school (which I solicited for use on the blog), no one pictured (in photo at top or the one below) was wearing a mask.

Picking up food for distribution to children who qualify for free lunches,
about 70% in this district.

My college friend, Bill Bowden, was one of the journalists who reported this COVID-19 story for the Democrat-Gazette, and he was kind enough to share some additional information about the outbreak in Newton County:

The Newton County Nursing Home is licensed for 70 beds.

At 2:45 p.m. on Friday, the Arkansas Department of Health’s website still listed Newton County with 18 total cases and seven active positive cases. Eleven people had recovered and 654 had tested negative.

An hour later, the updated website showed Newton County with 73 total cases, 61 active positive cases and 12 recoveries. A total of 676 people have tested negative in Newton County. There have been no deaths reported in Newton County because of covid-19.

Here's a post from early April about the coronavirus in Newton County, back when there was only a single reported case and the nearby Buffalo National River park was being closed as a result of the pandemic.

Back to the matter of masks, the Newton County Times published this interestingly equivocal statement by the Newton County Sheriff on July 22, 2020:

The [Governor's] mandate says that persons violating this mandate can be cited and, if convicted, receive a fine of $100.00, up to $500.00. However, first-time violators shall receive a verbal or written warning. Violators under 18 shall not be cited but only receive warnings. People cannot be jailed or detained for longer than it takes to issue a citation. It also says the mandate shall not prohibit law enforcement officers or local officials from enforcing trespassing laws or other applicable laws in removing violators at the request of businesses or other property owners. 

Sheriff Wheeler said "I feel like our citizens know when they should and should not wear masks and whether or not they fall into one of the categories that would exempt them from the mandate. If you see someone not wearing a mask, they may very well fall into one of the exempt categories and may not be required to wear one. Businesses may require patrons to wear a mask and, if customers refuse, the business is welcome to call us. But, citizens in public not wearing a mask may very well have a legitimate, exempted reason not to be. Please keep that in mind. We definitely don't want to cite citizens for this mandate and feel confident that the citizens and visitors of Newton County can make their own decision as to whether or not they fall under the mandate."

Finally, the Newton County Times this week also ran a press release from U.S. Senator John Bozeman (R) about CARES Act Funding to help rural hospitals. Here's an excerpt from the piece, titled "Covid-19 shows importance of rural health":

Unfortunately, COVID-19 is putting us in danger of an even larger urban-rural divide in the ability to access quality health care services. Hundreds of rural hospitals across the country could close as a result of the crisis. This means tens of thousands of rural patients could lose access to their nearest emergency room.

There was already a quiet storm brewing prior to the COVID-19 crisis. Nearly half of rural America’s hospitals had been operating at a loss and closure rates were escalating dramatically, hitting a record high last year. Closures in 2020 are on pace to eclipse that number.

These already financially-strapped hospitals now face catastrophic cash shortages as the inability to provide non-emergency care has led to an even larger loss of revenue. Many have furloughed staff, instituted massive cuts or are shuttering their doors.

My colleagues and I are working to address this fragile situation and ensure that the health care needs of rural America are not lost in the rush to tamp down urban hotspots. I recently joined a bipartisan, bicameral effort with over 45 of my colleagues to ask the Department of Health and Human Services (HHS) to dedicate a larger share of the Provider Relief Fund specifically for rural health providers.

Created by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Provider Relief Fund was allocated $175 billion to distribute to hospitals and healthcare providers on the front lines of the coronavirus response. At the time of our inquiry, only $10 billion of that total amount has been disbursed specifically to rural health care providers.

* * *

We asked HHS Secretary Alex Azar to allocate at least 20 percent of the remaining funds to rural hospitals and providers. Priority should be granted to facilities significantly affected by COVID-19 preparation as well as those providing care for a disproportionally high percentage of Medicare and Medicaid patients or populations with above average senior populations or co-morbidities. Likewise, providers in areas with limited access to health infrastructure and high numbers of uninsured patients also deserve this particular consideration.

I note that Arkansas is one of few southern states that did expand Medicaid under the Affordable Care Act, effective January 1, 2014.  This has no doubt helped the state's rural hospitals, as has been the case in other states that expanded Medicaid.  Undermining that expansion, however, is the fact that the State then imposed a work requirement for Medicaid, a requirement that has been struck down by a federal judge.