American countryside suffering from chronic poverty struggle to deal with Covid-19

In late October, Kerri Chandler was sitting at a conference room table in Grand Rapids, Minnesota, wearing a mask and 10 feet away from me. For the past nine months, she has been doing the enviable job of preparing the surrounding counties for Covid-19. Three hours from the Twin Cities, the area almost avoided the initial outbreak of the virus. But last month, the number of cases began to increase surprisingly. “I feel like I’m going to wobble until the end of the year,” she told me.

On November 9, Itasca County, with a population of 45,000, announced that it had recorded an additional 205 Covid diagnoses over the past seven days, an increase of 22%, for a total of 1,109. In response, county authorities have suspended contact tracing and relocated limited resources to protect the most vulnerable populations. Chandler, manager of public health in Itasca County, has issued a harsh warning to residents. “If you’re in a group environment, assume someone has a Covid.”

Similar scenes are being developed in rural areas across the country. Three of the four regional counties in the United States are in the White House. Coronavirus Although the Task Force defines it as a “red zone” where the virus spreads out of control, the 10 counties with the highest number of cases per resident are all non-metropolitan areas with less than 50,000 people.

To some extent, wearing masks and resistance to social distance have influenced these occurrences. But the Covid explosion in rural areas is not a simple moral story. In most of these areas, viruses have been vulnerable for decades, exacerbating chronic problems that cannot be resolved by public awareness campaigns.

Chandler said: “My observation so far is that the vulnerabilities that occurred before Covid are only getting worse.”

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In Minnesota, the 21 most unhealthy counties are all rural. In Aitaska, adult smoking, obesity, lack of physical activity, heavy drinking and drunk driving mortality rates are above national and national averages. A similar pattern emerges from coast to coast. Mortality rates for the five leading causes of death: heart disease, cancer, stroke, unintended injury, and chronic lower respiratory tract disease are all high in rural areas. Therefore, there are also common indicators of mental illness, such as suicide rates and drug overdose.

There is more than one cause behind these dark statistics, but several factors clearly contribute. For one thing, rural Americans tend to be older than average and poorer, less likely to get decent medical care in the first place. Poverty across less populated areas contributes to social isolation, substance abuse and mental illness.

These problems are exacerbated only by the apparent inequality of the US healthcare system. Rural hospitals have struggled to float for years to treat older people who have a payment option of government insurance, low reimbursement rates, and unattractive to health care providers. Federal and state programs aimed at supporting these facilities have had limited success. Since 2005, 175 regional hospitals have been closed and 19 have been closed last year alone.

These closures can be devastating to isolated communities. They have been shown to significantly increase mortality in people in need of urgent help, contributing to a serious shortage of beds in the intensive care unit. Also, even if beds are available, there may not be a doctor. In rural areas, there are about 53 doctors in urban areas, while in rural areas there are only about 40 doctors per 100,000 on average.

In short, the American countryside is a very bad place for a pandemic to spread.

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Initially, at least in Itasca County Coronavirus. The Grand Aitasca Clinic and Hospital in Grand Rapids has upgraded a series of facilities before the county’s first incident passed through the door. We improved air circulation and divided the lobby to isolate Covid patients from uninfected patients.for Coronavirus For patients with more critical needs, the plan was to send the patient to a nearby Duluth facility with more competence and expertise.

The plan has been jeopardized by the surge in national incidents over the past two months. In the neighboring state of North Dakota, the hospital is at full capacity and has very few staff, so the governor is recalling Covid-19-positive nurses. So far, the situation in Minnesota isn’t that serious, but things aren’t going in the right direction.

One of the thorny problems is that while the prolonged chronic health problems of the Minnesota countryside remained unresolved during Covid, many people were afraid of getting infected and delayed seeking treatment. Now they are appearing at the wrong moment. Dr. Jon Pryor, who oversees the medical facility at Essentia Health, a network of hospitals and clinics, told me that his company’s Duluth facility has filled up in the last few weeks, but most are not Covid, such as high blood pressure and diabetes. I am a patient with a problem. ..

“It’s been about three or four weeks since the Duluth facility began to fill up,” Grand Itasca’s president and chief executive officer, Jean McDonnell, told me. “If you can’t transfer to Duluth, you need to keep the patient here, or if the patient is less important, you need to send it to Minneapolis-Cent. Paul Area.”

The problem is that if the Twin Cities ICU bed is not an option and is almost full, Grand Itasca needs to implement a surge plan that requires the patient to use the space available, including the corridor.

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In the midst of a pandemic, it’s not the perfect moment to tackle the underlying problems that plague local health care. But nonetheless, some lessons learned during the crisis, which can mitigate what is likely to be the coming severe winter of infection, and perhaps provide a blueprint for future systemic changes. I can.

Pryor told me that the outbreak forced the health systems in the region (many of whom were competitors) to work together in ways that were not possible in January. In the early days of the crisis, they called for information sharing every day. This allows heterogeneous systems to work more closely with patient management and the widespread impact of pandemics. Chandler said a similar spirit of cooperation led the effort in Itasca County.

However, infrastructure remains a serious issue. For example, like many in the American countryside, Minnesota faces a shortage of ICU beds. The time to build them is not during the crisis, but before the next crisis. Essentia Health is urging Congress to create a $ 1 billion fund to upgrade hospital rooms under construction to ICU-enabled units. Normally, these rooms act as regular medical beds, but in times of crisis the hospital could simply “switch on,” Pryor said.

There is also a shortage of staff. For decades, federal and state programs have sought to attract healthcare professionals to rural areas. At best, they stopped the bigger shortage and emphasized the need to rely on distant hospitals. But one bright spot during the pandemic is the increasing use of telemedicine. Increasing access to such technologies should be a priority for policy makers. First, we need to invest more in local broadband and step up efforts to turn public libraries and other government facilities into telemedicine hubs.

But after all, rural health care cannot be improved without addressing the chronic poverty and social isolation that are causing many problems in the first place. To change these facts, we need to increase economic development and investment, among other things, to attract employers and healthcare providers.

In the meantime, rural Americans will need to cover up and socially distance themselves. That is not a satisfying answer. But until vaccines are widely available, these struggling areas may be the best you can expect. “Are you okay now? We are,” Pryor said. “But this will be a long and harsh winter. Is it okay tomorrow? I don’t know.”