In a webinar hosted by the Philadelphia College of Osteopathic Medicine Office of Diversity and Community Relations, Assistant Professor Stacie Fairley, PhD, said, “I initially felt protected from COVID-19 because I live in the rural area, but during these past few months this novel coronavirus has had a tremendous impact on Southwest Georgia and other rural communities in our country.”

Virus Shifting From Cities to Rural Areas

Dr. Fairley, who teaches microbiology and immunology at PCOM South Georgia, discussed that while initial hot spots of the disease were centered in dense urban areas, infections have rapidly expanded into suburban and rural settings – in areas with a population between 2,500 and 50,000 according to The Henry J. Kaiser Family Foundation (KFF).

According to USA Today, as of May 4, 2020, 86 percent of all rural counties in the United States had at least one COVID-19 case and about one-third have at least one COVID-19-related death. At the time of her presentation, KFF reported that the county with the most cases per capita - Lincoln County, AR - is a metro county, while the county with the most deaths per capita - Randolph County, GA - is a non-metro county with 278 deaths per 100,000 people.

Challenges for Rural Health Care

She explained that contributing factors include under-resourced health systems, limited access to healthcare due to geographical location, inability to social distance, disproportionate rates of poverty and food insecurity, limited internet access and rural economies largely built on essential workers, farmers and small businesses.

Dr. Fairley said that “rural hospitals were already struggling to prior to COVID-19 both in the areas of finance and resource. Some rural hospitals are underfunded, understaffed and under resourced. Now in the days of COVID-19, there is an increase in demand and price for equipment such as ventilators or personal protective equipment (PPE). These rural hospitals are unable compete with the larger medical facilities when trying to purchase these items. According to The Cecil G. Sheps Center for Health Services Research, over 130 hospitals across the country have closed during the past decade, and this pandemic could result in more rural hospital closures during a time when our country critically needs them.”

She added, “Unlike in past instances of natural disasters, overburdened rural hospitals can't lean on big-city medical centers for help when those organizations are also struggling. This pandemic has truly highlighted the historical issues that have been in rural America and other communities for a long period of time prior to COVID-19.”

Rural Communities Cannot Easily Shut Down

Dr. Fairley explained that some rural community homes are composed of multigenerational families, which makes it difficult to practice social distancing. Residents in rural communities often have a higher prevalence of comorbidities such as diabetes, arthritis, heart disease, etc., thereby making them more vulnerable to COVID-19. Furthermore, many residents are essential workers with no health insurance, limited access to healthcare and face food insecurities. She added, “Many are unable to take time off work if they become sick, which makes them less likely to seek treatment. Even with telemedicine, some lack internet access. Additionally, for some essential workers language barriers prevent them from receiving and understanding information about the virus.”

“Rural America is largely built on essential workers, farmers and small businesses,” Dr. Fairley said. “Rural economies often fare worse during recessions and have a harder time bouncing back.” Statistics from the Center on Rural Innovation show that small businesses provide about 35 percent of employment in rural towns. As an example, Dr. Fairley explained that Smithfield Foods, a meat packing facility in Sioux Falls, SD, closed temporarily due to the pandemic. As reported by The Omaha World-Herald, the business recently had 600 employees who tested positive for COVID-19, and 40 percent of diagnosed cases in South Dakota were linked to this facility. The closure of facilities such as Smithfield could have a cascading effect on this community and the economy.

Economic Relief for Rural Counties

But there is hope on the horizon, according to Dr. Fairley and research provided by BKD and NPR. “The Coronavirus Aid Relief, and Economic Securities Act (CARES) was created to provide assistance and healthcare response for individuals, families and businesses affected by the pandemic,” she said. “The first CARES Act did not specifically allocate funds to rural areas, instead it allocated funds to areas with a population of 50,000 or more, but this next one does.”

Dr. Fairley explained that allocations will be distributed to agricultural producers and rural hospitals. She said the CARES act will also provide funds to rural residents for broadband internet access for telemedicine.

Dr. Fairley said that from a personal standpoint, the pandemic has caused her to make many adjustments.

“It’s not just affecting Moultrie – it’s affecting the world,” she said. “We know we have to sacrifice and adapt.”