www.nytimes.com

As the coronavirus outbreak spreads into rural parts of the United States, more people who live far from a hospital are increasingly likely to need one. That poses challenges for communities where hospitals are scarce and I.C.U. beds are in short supply — even a relatively small outbreak there could overwhelm medical resources, with potentially grim consequences for public health.

Research shows people are less likely to seek health care, even emergency care, when they need to travel farther to get it, especially when they are more than about 30 minutes from a hospital.

“We already know that people in rural regions who are located farther from health care use care less and generally have worse outcomes,” said Dr. Paul Delamater, a researcher on health care access at the University of North Carolina.

And that’s under normal circumstances. In a pandemic, the problem is twofold. Without a hospital nearby, those who are sick may not seek care at all, leaving them to suffer and to risk spreading the infection to others.

But if a large outbreak does occur and too many people need treatment, rural hospitals could easily be overwhelmed and be forced to send patients traveling even farther from their homes for care.

“I would imagine things are only going to get worse, not better,” Dr. Delamater said.

Read more: Coronavirus Was Slow to Spread to Rural America. Not Anymore.

Dozens of rural hospitals have closed in the last decade, many of them in the Southeast. In the West, there have been fewer closures, but hospitals are more dispersed and many are designated “critical access hospitals,” with 25 or fewer inpatient beds. That means fewer beds, farther apart for the sick, whether those with coronavirus or those needing other treatment.

The problem of distance is further compounded by demographics. Rural populations generally tend to be older and have higher rates of underlying health conditions, making them most at risk of hospitalization from the coronavirus.


People living outside a 30-minute drive from the nearest hospital

Rank

State

All ages

Rank

State

65 and older

1

California

794,000

1

California

151,000

2

Florida

551,000

2

Washington

112,000

3

Arizona

541,000

3

Florida

111,000

4

Washington

537,000

4

Arizona

106,000

5

Missouri

347,000

5

Oregon

82,000

6

Texas

347,000

6

Missouri

75,000

7

Colorado

343,000

7

Texas

75,000

8

New York

331,000

8

Virginia

69,000

9

Oregon

326,000

9

New York

66,000

10

Virginia

325,000

10

North Carolina

63,000


By The New York Times·Source: 2014-18 American Community Survey

Alpine County, which straddles the Sierra Nevada in Northern California, is one of more than 700 counties nationwide with no hospital at all. The closest is in South Lake Tahoe, a 30- to 40-minute drive for most residents, according to Nichole Williamson, the county’s director for Health and Human Services.

Just one person in the county has tested positive for coronavirus so far, but if the outbreak were to grow, Ms. Williamson said, there would not be much they could do. A shortage of medical personnel means that setting up a temporary hospital would not be an option. “We have plenty of buildings we could use,” she said, “but we don’t have the staff to open up an alternate care site.”

Ms. Williamson said that if an outbreak occurred in Alpine County, she would expect people would need to be sent to a bigger hospital in Reno, Nev., about an hour and 15 minutes away.

In some cities where hospitals are overwhelmed, more people have been found dead at home. Evidence is also building that people who might have otherwise gone in for conditions unrelated to the coronavirus are avoiding hospitals for fear of contracting the virus.

So far, those outcomes are a risk but not yet a reality in most rural areas. In some counties with the largest populations living far from hospitals, local officials said they had not heard of anyone failing to get the medical treatment they needed.

In Whatcom County, Wash., for example, 38,000 people live 30 or more minutes from St. Joseph Medical Center in Bellingham. Cindy Hollinsworth, an expert in communicable diseases at the county health department, said that even though many residents did not live within that range, all lived within a 40-minute drive and had access to emergency medical services.

Read more: Covid-19 Arrived in Seattle. Where It Went From There Stunned the Scientists.

A spokesman for San Bernardino County, Calif., where there are 24 hospitals but 61,000 residents still live outside the 30-minute range, said the current public health concern there was a shortage of tests for the virus, not hospital beds.

But some areas of the country with large populations living far from hospitals are showing cause for concern. Rural communities in three states where the coronavirus has spread — Arizona, Florida and Washington — are already experiencing strain on their local medical facilities.

Outbreak in Navajo Nation

Across Arizona’s remote landscape, about half a million people live more than a 30-minute drive from the nearest hospital. Access is especially difficult in Native American tribal areas, where coronavirus cases are growing quickly.

An outbreak that began in mid-March had reached 350 infections just in Navajo County as of Thursday morning, with a higher rate of cases per capita than most states.


People living outside a 30-minute drive from the nearest hospital





Critical access

hospitals

Critical access

hospitals

Critical access hospitals

Critical access

hospitals


By The New York Times

Anne Newland, who operates primary care clinics across Northern Arizona, said smaller tribal clinics were already reaching capacity and transferring patients who needed intensive care to facilities in Flagstaff and Phoenix.

“In Navajo County, they’re trying to get patients who need a ventilator out,” she said. “Patients from these highly affected areas are able to be transferred down to the valley, but that’s an expense.”

Patient transfers can cost up to $20,000, an overwhelming burden for smaller facilities. “Covid-19 is just a condition that’s challenging everybody,” Dr. Newland said.

She also worries that given the severity of the outbreak, people will be hesitant to travel long distances to hospitals at all.

“It’s not just the distance, it’s that people are afraid,” she said. “And sometimes they need to see their doctor or go into the E.R., and they shouldn’t avoid that.”

Fear Among Florida Farmworkers

In rural Florida, hospital access is the most limited in the farm towns of the panhandle and north of the Everglades.


People living outside a 30-minute drive from the nearest hospital





Critical access

hospitals

Critical access

hospitals

Critical access hospitals

Critical access

hospitals


By The New York Times

The lack of a nearby hospital in Immokalee, a migrant farming town of 24,000 in South Florida, creates health care challenges under normal circumstances and is causing greater concern as the coronavirus pandemic unfolds. As of Friday, 34 confirmed cases had surfaced in the town.

Workers there produce most of the state’s tomato supply. They have called for a field hospital to be set up in town through the Coalition of Immokalee Workers, a labor advocacy and human rights group.

“We’re about 40 minutes to an hour to a hospital, so that’s going to be very limiting,” said Lupe Gonzalo, a farm worker and staff member of the coalition.

Farm workers are deemed essential workers, but they lack protective equipment, and for many workers social distancing is impractical.

“The buses they ride on to go to the farms are packed, sometimes with over 40 or 50 people,” Mrs. Gonzalo said. “The workers live in confined spaces — maybe 10 to 15 people in a trailer. So if one person gets sick, many people will get sick.”

Empty Hospitals in Washington State

In Washington State, rural hospitals are seeing problems with too few patients rather than too many. Nonurgent procedures are suspended, and people with chronic conditions are avoiding going…



Source link

Comments

comments

LEAVE A REPLY

Please enter your comment!
Please enter your name here