COVID Kills Rural Americans, Including Missouri, Twice As Many As Urban Residents | KCUR 89.3
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 shrinks for a population that tends to to be older, sicker, heavier, poorer and less vaccinated.
As the initial wave of COVID-19 deaths swept across much of rural America, where about 15% of Americans live, non-metropolitan death rates quickly began to exceed those in metropolitan areas as the virus spread 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 city-dwellers, 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 urban rates – and are accelerating rapidly.
In rural northeast Texas, the CEO of Titus Regional Medical Center 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 a month.
“We don’t see death like that,” Scoggin said. “Usually you don’t see your friends and neighbors die. “
Part of the problem is that COVID incidence rates in September were about 54% higher in rural areas than elsewhere, said Fred ullrich, a research analyst from the University of Iowa’s College of Public Health who co-authored the institute’s report. He said the analysis compared rates of non-metropolitan, or rural, metropolitan or urban areas and areas. In 39 states, he added, rural counties had higher rates of COVID than their urban counterparts.
“There is a national disconnect between perception and reality when it comes to COVID in rural America,” said Alain morgan, head of the National Association of Rural Health. “We have turned many rural communities into killing boxes. And there is no movement to respond to 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 and Hispanics in disproportionately high rates.
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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 a 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 southwestern Missouri, for example, 26% of Newton County residents were fully vaccinated as of September 27. The health department held raffles and immunization clinics, advertised in the local newspaper, and even carried the vaccine to those who did not have transportation in remote areas, according to the administrator of the Larry Bergner department. 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 mailing lists of rural head nurses or rural CEOs sending out an SOS to the group, saying, ‘We’ve called 60 or 70 hospitals and we can’t get this patient out of the hospital. have a heart attack, stroke or surgery and they “are going to get septic and die if it lasts much longer,” said John Henderson, Chairman and CEO of the Texas Organization of Rural and 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 health care has long plagued swathes of rural America – since 2005, 181 rural hospitals have closed. A KHN 2020 analysis revealed that more than half of American counties, many of them, 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 2019 data from the Centers for Disease. Control and Prevention National Center for Health Statistics.
In Ripley County, southeast Missouri, the local hospital closed in 2018. On September 27, only 24% of residents have been 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.
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 immediate former president of the Rural Nurse Organization, said she had lost count of the number of nurses who told her they were quitting. 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 could be made worse by health care the vaccination mandates promised by President Joe Biden, which they believe could cause 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 slim 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.
Kaiser Santé news is an independent editorial program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communications organization not affiliated with Kaiser Permanente.