May 4, 2020 — Rural communities are facing their first wave of coronavirus cases, lagging behind many cities that have hit their peak. Rural residents are often older, sicker, and poorer than urban residents and have less access to medical care, making them particularly vulnerable to COVID-19.
About 8 in 10 rural counties have confirmed cases, with 52,480 — representing 5.2% of the total cases — and 1,965 deaths — representing 4% of all U.S. fatalities — as of April 27, according to the University of Iowa’s Rural Policy Research Institute.
The coronavirus has spread in South Dakota via an outbreak at a Sioux Falls meatpacking plant that infected more than 300 workers. In Idaho and Colorado, the virus spread from popular ski resorts. In rural southwest Georgia, a large funeral started an outbreak. A religious revival event in early March in a western town in the Navajo Nation that shares borders with Arizona, New Mexico, and Utah appears to have been a “super spreader” event, responsible for many infections.
Many rural communities were already facing problems of access to health care and greater rates of health care problems. Add the coronavirus pandemic, and America’s rural areas are suffering.
Rural Hospitals Dwindling
People in rural areas who get sick with COVID-19 have fewer hospitals to treat them. Since 2005, 170 rural hospitals have closed, including 10 this year alone, according to the University of South Carolina Rural Health Research Program.
The Centers for Medicare and Medicaid Services (CMS) has designated at least 1,350 of the estimated 2,000 rural hospitals nationwide as “critical access hospitals” that have 25 or fewer beds and are more than 35 miles, or 15 miles by mountainous terrain or secondary roads, from the next nearest hospital.
“These hospitals are designed for primary care and surgery, not pandemics. Most of the care is outpatient — people are coming for diagnostic testing, broken bones, and immunizations. If they need intensive care, they are transferred to larger facilities,” says Alan Morgan, CEO of the National Rural Health Association (NRHA) in Washington, D.C.
The critical access hospitals are trying not to ventilate sicker patients until they can transfer them to the larger regional hospitals with intensive care units and more ventilators, says Morgan. In addition, in rural counties, there are regional shortages of nasal swab test kits and a lack of personal protection equipment in reserve.
One in five U.S. rural hospitals are at a high risk of closing unless their financial situation improves, according to a 2019 analysis of publicly available data.
In addition, rural hospitals rely on Medicare and Medicaid patients, who make up 60% to 70% of their patients, compared to 30% in urban hospitals, says Morgan. “Rural hospitals have been providing too much uncompensated care. That is why we’ve seen so many close in the Southeast and more recently in the Midwest and Plains. They were in a precarious financial position before the pandemic.”
When county hospitals close, there are ripple effects in the community. Patients have to travel farther to get to the nearest hospital, which is a barrier to routine primary care as well as emergency room and inpatient care, says Carrie Henning-Smith, PhD, deputy director of the Rural Health Research Center at the University of Minnesota in Minneapolis.
When a rural hospital closes, mortality rates increase by 6%, according to a paper published last year by the National Bureau of Economic Research.
There is also the economic impact — rural hospitals are often the biggest employers in town. “When they close, jobs disappear and workers leave town and take their tax dollars with them. That means fewer people supporting the town financially,” says Henning-Smith.
Revenue Lost to Pandemic
The pandemic has pushed some cash-strapped hospitals out of business.