The Current

'Volatile stew' of factors could see COVID-19 spike in rural United States: expert

As the U.S. reopens and COVID-19 cases rise in southwestern states, rural health expert Carrie Henning-Smith says hospitals in those areas may be ill equipped to cope.

Rural hospitals may be poorly equipped to deal with outbreaks: Carrie Henning-Smith

Protesters against COVID-19 lockdown measures in Frisco, Texas, in April. The southwestern U.S. is seeing a rise in cases. (Jeremy Lock/Reuters)
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There's a "volatile stew" of factors in rural areas of the U.S., that could lead to an explosion of COVID-19 cases, says an expert on the health of those communities.

"Part of it is the demographics of rural communities — they are older on average than urban communities, they have more underlying health conditions, fewer economic resources," said Carrie Henning-Smith, deputy director of the University of Minnesota Rural Health Research Centre.

She told The Current's Matt Galloway that those communities are also "less likely to have health insurance and they're less likely to have good access to health care." 

On top of that, rural areas are more likely to have the places that have become COVID-19 hotspots: prisons, meat-packing plants and long-term care facilities, she said.

"All of those are creating this really volatile stew in rural areas, just at the moment that we're reopening our states and economies."

A customer gets her hair done last month at Passions Salon during the phased reopening in Cave Creek, Ariz. (Nicole Neri/Reuters)

COVID-19 cases are rising in nearly half of U.S. states, according to an Associated Press analysis this week. The analysis found that the epicentre of the pandemic in the U.S. is moving away from the northeastern states and into the south and west.

Texas-based physician Dr. Peter Hotez says that the country's southwest did a good job of "implementing aggressive social distancing" in March and April, to avoid the high volume of cases that were happening in New York.

"That was great, but the models also told us that we had to stay in that situation throughout the month of May, maintain that social distancing," said Hotez, co-director of the Center for Vaccine Development at Texas Children's Hospital.

He said nobody was willing to do that, and now — weeks after states began to reopen — "we're starting to see a very steep rise in the number of cases."

"And not just number of cases, which you could argue is due to increased testing, but also increase in hospitalizations and ICU admissions." 

Henning-Smith said rural hospitals may be poorly equipped to deal with a spike in cases, due to shortages in both funding and staffing.

"Many rural hospitals operate just on the edge," she said.

"There is a disproportionate lack of ICU beds and ventilators and the type of special resources that we need to be able to serve folks in rural communities."

U.S. President Donald Trump said he will release guidelines to reopen the economy on Wednesday as frustrated Americans defied stay home orders to protest the ongoing COVID-19 shutdown. 2:05

Protests contributed to re-opening

Hotez said pressure to revive the economy was pushing the drive to reopen, as well as armed protests from Americans who resent "what they call government interference: social distancing, contact tracing, vaccines."

"Even though they're a small group, they prevailed, and we opened up the economy and now we're in the situation that we're in," he said.

Henning-Smith said political divisions were also playing a role in shaping public behaviour, including the wearing of masks.

"I'm afraid that wearing a mask, which is simply good practice and based on good science, has instead become a political signal of which side you affiliate with," Henning-Smith said.

Dr. Theresa Tam, Canada's chief public health officer, is now recommending that Canadians wear masks in public as an "added layer of protection" whenever physical distancing is not possible. 2:27

She said some political leaders (usually but not always Democrats) are telling the public to wear masks, while others (usually but not always Republicans) are dismissing them.

"The concern has been that wearing a mask makes people fearful and makes people worried about the virus rather than worried about how we can support our economy," she said.

But she argued "they're not two different issues. We can't have a good functioning economy without having a healthy population." 

"And we can't have a good functioning economy while we have a virus still ravaging the population."

Hotez said opening up the economy is one thing, but sustaining the recovery will require the U.S. "to build up our public health system — it's not too late."

"If the numbers really continue to go up by next week, we're going to have to re-instigate aggressive social distancing," he said.

"It's going to be important to save lives." 


Written by Padraig Moran. Produced by Julie Crysler, Paul MacInnis and Rachel Levy-McLaughlin.

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