March 22, 2020
Protecting Rural Communities
against Coronavirus Transmission and Mortality
Rural communities of Kentucky and other states are not
immune to COVID-19, or the coronavirus. The
first known case of coronavirus in Kentucky was in Cynthiana, a town with a population
of only 6,400 persons, and cases of coronavirus have been identified in several
other rural communities. The older age
compositions and inadequate hospital infrastructures of rural communities place
them at extremely high risk for serious cases of coronavirus and
mortality.
Failure to strictly engage in social-distancing will result
in continued spread of coronavirus amongst rural (and urban citizens). Of even more concern, anecdotal evidence
shows that too many rural citizens and hospital personnel are not heeding
federal and state recommendations to reduce coronavirus transmission. It has been observed multiple times that
health care workers who have been exposed are not being quarantined and tested
appropriately by these rural and community hospitals despite requests from the health
care employees. Financial and staffing
concerns should not supersede appropriate care and protocols put in place to
slow the progression of this contagious and deadly disease. Single lapses can cost lives, and our efforts
are wasted unless they are collectively implementing in rural, community, and
urban areas. Lack of compliance with
recommended practices will ultimately burden our healthcare systems at every
level with massive amounts of people seeking hospital care.
The cruel reality is that very few rural hospitals have
intensive care units (ICUs) and ventilators necessary to treat serious cases of
coronavirus. Rather, the majority of
rural hospitals in Kentucky and other states are critical access hospitals
(CAHs), which are intended to provide only emergency and short-term acute
care. The federal government relaxed
regulations for CAHs last week, allowing them to expand bed capacity and
lengths of stay. However, an inadequate
supply of health care personnel in rural areas severely limits the abilities of
critical access and other rural hospitals to deliver intensive care and respiratory
services for patients with coronavirus.
Transferring patients from rural to urban hospitals is not a realistic
option because many urban hospitals are already facing short supplies of ICUs
and ventilators.
Government officials and health care leaders must immediately
take the following actions to lessen the transmission of coronavirus among
rural (and urban) citizens and shore up the rural (and urban) hospital capacity:
1.
Public
service announcements (PSAs).
Kentucky and other states desperately need to better communicate the
risk of coronavirus and rationale for social distancing to rural citizens. We have observed no such informational PSAs
in Kentucky. Alabama has an excellent
PSA that could be easily adapted. We
additionally should have more short PSAs to illustrate best practices of social
distancing, Do it Yourself (DIY) homemade hand sanitizer, handling of outside
packages (e.g., mail and other home deliveries), and homemade masks, etc.
2. Coordinated coronavirus testing. Testing should be centralized at
designated sites. A site may be a designated
hospital, clinic, health department, or drive through testing area. Centralization will reduce coronavirus
exposure among health care personnel in multiple emergency departments and
clinics serving a given town or city. Of
course, governments, health care leaders, and the media must assure that
citizen know where to go for testing.
3. Coordinated hospital expansion, especially
ICUs and ventilator. State
government and the hospital industry must carefully coordinate the expansion of
hospital capacity, especially ICUs and ventilators. The supply of ICUs and ventilators must be
accurately and continually assessed and then reported in a transparent fashion
to hospital administrators, clinicians, and the general public.
Lastly, we must emphasize that action must be immediate. We cannot wait for the usual convening of
taskforces that take months to make decisions.
Government and hospital leaders must act faster than the rate of
coronavirus transmission.
Ty Borders, PhD
Foundation for a Healthy Kentucky Endowed Chair in Rural
Health Policy
Department of Health Management and Policy
University of Kentucky
Sam C. Tyagi, MD, FACS, FSVS, RPVI
Assistant Professor of Vascular and Endovascular Surgery
Department of Surgery
University of Kentucky
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