On first glance, rural communities may seem to be at an advantage for social distancing to combat COVID-19 infection, and at a reduced risk for spread of the infection. Although the number of people and their proximity to each other is reduced in rural settings, there are other challenges that produce unique risks for rural populations during this national health emergency.
According to the US Census Bureau, compared to urban settings, rural populations are of older age. Approximately 17 percent of the country’s population lives in rural communities, and the average age of rural Americans is 73.3 years old. The COVID-19 virus carries a higher risk of death in persons over 65 years old.
The Centers for Disease Control and Prevention reports that there are higher rates of cigarette smoking, high blood pressure, and obesity in rural communities, leading to higher rates of death from heart disease, cancer, chronic lower respiratory disease, stroke and unintentional injuries. These risks in the rural population may lead to higher rates of COVID-19 infection or worsened outcomes.
Also, many occupations in rural areas don’t provide health insurance or paid time off. This reduces the incentive for workers to stay home if they are sick and makes childcare difficult for workers who only get paid if they are at work. Lack of health insurance also is a barrier to receiving care for someone who is sick. Testing for the COVID-19 virus may occur less frequently in people who do not have insurance to cover those costs, and treatment of infected persons may be costly.
Further, broadband and cellular services are often sporadic in rural areas, with 15 percent of rural adults reporting they never going online. This barrier to communication can reduce the availability of reliable and up-to-date information on the pandemic and public health measures.
Perhaps the most important concern during the present national crisis is the lack of healthcare services in rural settings, including few local doctors and other healthcare personnel, limited or no hospitals or healthcare facilities, and remote locations that are difficult to access for the population.
Many rural settings have no hospital or are limited to a critical access hospital, with 25 beds or less. Many critical access hospitals lack resources to manage life-threatening illnesses or manage acute respiratory failure, a hallmark of severe COVID-19 infection. Critical access hospitals typically have a limited number of ventilators, and few personnel trained to use that equipment or manage complex cases.
Additionally, COVID-19 testing services are limited in America, and many rural communities do not have access to viral testing. This results in the extent of the disease in rural settings being undercounted. If individuals are infected but don’t get tested, they may continue to interact with others in their community and spread the disease unknowingly. The result could be more severe cases among vulnerable groups because those who need treatment won’t seek it immediately.
However, not all is bleak.
The COVID-19 pandemic has unveiled critical access barriers to healthcare present in the rural setting across America. Those barriers cannot be overcome in time to affect the present outbreak, but hopefully changes to rural infrastructure can result from the lessons learned during this pandemic to improve healthcare for the growing American rural population for the future.
Ohio Northern University is a partner in the region, with a mission to serve the community in a variety of ways. The university plays a significant role in improving the quality of life for area residents. The ONU College of Pharmacy’s HealthWise mobile clinic continues to provide services throughout the region and is at the disposal of area health agencies as the COVID-19 pandemic expands. ONU HealthWise Pharmacy has expanded prescription delivery to the entire region to improve access to medications and pharmacist services during this national emergency. The university recognizes the unique challenges for healthcare in the rural setting and stands ready to assist the community as a true partner.
People in this region are accustomed to common sense and coming together for the common good. Those qualities will help us through this crisis.
Steven Martin, PharmD, is dean of the Ohio Northern University Raabe College of Pharmacy and an expert in infectious diseases