Alan Morgan | COVID-19 is straining our ailing rural health systems

The front lines of the war on COVID-19 have expanded and are now reaching into rural America. As infection rates begin to plateau nationally, and states begin to reopen, we, too, must expand our focus and our action to rural communities—areas with limited healthcare infrastructure and populations most at risk for contracting the virus.

At this time, more than 90 percent of the nation’s rural counties have documented cases of COVID-19, with more than 70,000 confirmed cases and 3,000 deaths. COVID-19 is now firmly rooted in rural, but the unknown factor remains how these thousands of small communities will respond in the months ahead.

There are approximately 2,000 rural hospitals in the United States, serving more than 60 million people. On average, these hospitals have only one-month’s cash on-hand, and 10 have already closed in 2020. But these primary care hubs are threatened not only by financial concerns, but the ability to adequately serve and address patient surges when they occur.

And we are seeing these national rural trends playing out before our eyes in North Carolina.

The populations most at risk of contracting the virus and/or having the most negative health outcomes—the elderly, those with chronic health conditions, people of color, those in congregate-living facilities or working in meat processing plants, and the uninsured—are over-represented in rural North Carolina.

Our state’s rural hospitals were already on shaky financial footing before the pandemic, meaning that rural hospitals would be even more vulnerable when COVID-19 patients started showing up and other, more profitable services were suspended. Compound that with high rates of uninsured patients and the volume of uncompensated care, and the financial outlook for rural hospitals is even shakier.

To both weather the storm now and to emerge from this crisis successfully, effective rural testing and contact tracing systems must be in place, rural communities must understand the increased risk to their local populations, and a sustainable funding system must be enacted for rural health systems of care.

But we can’t just stop there. Success in urban America in containing this pandemic will not automatically mean success in small town America. As the nation’s focus moves on to economic recovery, we cannot allow rural America to be left behind in a rush back to normalcy.

We still need to recruit and retain rural health providers, expand telehealth options, and close the health insurance coverage gap. These issues do not get put on the back-burner when an unthinkable public health crisis strikes—they happen concurrently.

COVID-19 is putting unprecedented stress on our nation’s healthcare infrastructure. We are collectively holding our breath and keeping our distance in hopes that our already strained rural systems of care don’t topple—and we can save lives in the process. A short-term fiscal response will relieve the immediate needs of rural systems across our state and nation, but farsighted and sound public policy is needed to ensure that rural people have access to quality healthcare, for today and tomorrow.