Covid kills rural Americans at twice the rate of people in urban areas

Rural Americans are dying from Covid at more than twice the rate of their urban counterparts – a divide that health experts say is expected to widen as access to medical care declines for a population that tends to be older, sicker, heavier, poorer and less vaccinated.

As the initial wave of Covid-19 deaths overtook much of rural America, where about 15% of Americans live, non-metropolitan death rates quickly began to overtake those in metropolitan areas as the virus worsened. was spreading nationwide before vaccinations were available, according to data from the Rural Policy Research Institute.

Since the start of the pandemic, about 1 in 434 rural Americans have died from Covid, compared to about 1 in 513 urban Americans, according to institute data. And although vaccines have reduced overall Covid death rates since the winter peak, rural death rates are now more than double those in cities – and are accelerating rapidly.

In rural northeast Texas, Titus Regional Medical Center CEO Terry Scoggin is struggling with a 39% vaccination rate in his community. Eleven patients died from Covid in the first half of September at his 16,000-resident Mount Pleasant hospital. Typically, three or four outpatients die there in an entire month.

“We don’t see death like that,” Scoggin said. “Usually you don’t see your friends and neighbors die. “

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Part of the problem is that Covid incidence rates in September were around 54% higher in rural areas than elsewhere, said Fred Ullrich, research analyst at the University of Iowa’s College of Public Health. who co-wrote the institute’s report. He said the analysis compared rates between non-metropolitan or rural areas and metropolitan or urban areas. In 39 states, he added, rural counties had higher Covid rates than their urban counterparts.

“There is a national disconnect between perception and reality when it comes to Covid in rural America,” said Alan Morgan, head of the National Rural Health Association. “We have turned many rural communities into killing boxes. And there is no movement to address what we see in many of these communities, either among the public or among government officials. “

Yet the high incidence of cases and low vaccination rates do not fully understand why death rates are so much higher in rural areas than elsewhere. Academics and officials describe the higher rates of poor health of rural Americans and their limited options for medical care as a deadly combination. Pressures from the pandemic have compounded the problem by exacerbating staff shortages in hospitals, creating a cycle of deteriorating access to care.

It is the latest example of the deadly coronavirus which is wreaking havoc in some communities than others. Covid has also killed Native Americans, Blacks or Hispanics at disproportionate rates.

Vaccinations are the most effective way to prevent Covid infections from becoming fatal. About 41% of rural America was vaccinated as of Sept. 23, compared to about 53% of urban America, according to an analysis by the Daily Yonder, a newsroom covering rural America. Limited supplies and poor access made vaccines difficult to obtain in remote areas at first, but officials and academics now blame vaccine reluctance, misinformation and politics for low vaccination rates.

In hard-hit southwest Missouri, for example, 26% of Newton County residents were fully immunized as of September 27. in remote areas, according to department administrator Larry Bergner. But he said interest in clichés usually only increases after the death or serious illness of someone in a hesitant person’s social circle.

Additionally, the overload of Covid patients in hospitals has undermined a basic tenet of rural health infrastructure: the ability to transfer patients from rural hospitals to higher levels of specialist care in regional or urban health centers. .

“We literally have email list servers of rural head nurses or rural CEOs sending an SOS to the group, saying, ‘We’ve called 60 or 70 hospitals and we can’t get this patient out. heart attack or stroke or surgical patient and they “are going to get septic and die if it lasts much longer,” said John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals.

Morgan said he couldn’t count the number of people who had told him about the transfer issue.

“It’s crazy, just crazy. It’s unacceptable, ”Morgan said. “From what I see, this mortality gap is accelerating.”

Access to medical care has long plagued swathes of rural America – since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of which are largely rural, do not have hospitals with intensive care unit beds.

Rural Americans before the pandemic had overall death rates 20% higher than those living in urban areas, due to their lower insurance rates, higher poverty rates, and more limited access to care health, according to the Centers for Disease Control and Prevention. 2019 National Center for Health Statistics.

In Ripley County in southeast Missouri, the local hospital closed in 2018. As of September 27, only 24% of residents were fully vaccinated against Covid. Due to a recent case crash, Covid patients are being sent home from emergency rooms in surrounding counties if they are not “seriously ill,” said health department director Tammy Cosgrove.

Endless cycle of burnout

The country’s nursing shortage is particularly severe in rural areas, which have less money than large hospitals to pay the exorbitant fees that travel nursing agencies demand. And as interim nursing agencies offer hospital staff more money to join their teams, many rural nurses are stepping aside. One of Scoggin’s nurses told her she had to take on a travel job – she could pay off all her debts in three months with that kind of money.

And then there’s the exhaustion of working for over a year and a half during the pandemic. Audrey Snyder, the outgoing president of the Rural Nurse Organization, said she had lost count of the number of nurses who told her they were resigning. These resignations fuel a never-ending cycle: As traveling nursing companies attract more and more nurses, the nurses left behind become more exhausted and end up resigning. While this is true in hospitals of all types, the effects in hard-to-staff rural hospitals can be particularly severe.

Rural health officials fear staff shortages may be exacerbated by health care vaccination mandates promised by President Joe Biden, which they say could spark a wave of resignations hospitals cannot afford. About half of Scoggin’s staff, for example, are not vaccinated.

Snyder warned that nursing shortages and their associated high costs will become unsustainable for rural hospitals operating on very thin margins. She predicted that a new wave of rural hospital closures would further increase the dire death figures.

Staff shortages are already limiting the number of beds hospitals can use, Scoggin said. He estimated that most hospitals in Texas, including his, are operating at about two-thirds of their bed capacity. His emergency room is so overwhelmed that he has had to send a few patients home to be monitored daily by an ambulance team.

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