Governor Colyer and I are both rural Americans, from families whose roots go back generations in farming country born in small hometown hospitals. When it comes to health care, we know that rural America has experienced its share of unique challenges and triumphs, and it’s why we are bringing special attention to the impact of COVID-19 in rural areas.
The pandemic has killed tens of thousands of Americans and wreaked havoc in large urban centers across our great nation. At the same time, clusters of cases have also been reported in rural areas of Minnesota, Nebraska, Tennessee, and Arkansas, and there is certainly a chance we could see additional rural clusters emerge over the next few months.
As states begin to reopen their economies, it is imperative that local leaders recognize and confront the challenges posed by COVID-19. Now is the time for rural America to act, before the pandemic causes further harm to already fragile communities and health care providers.
For the last three decades, health disparities in rural America have continued to grow. During that time, more than 120 rural hospitals closed and many that remain struggle financially. Rural populations are older and sicker, with higher rates of heart disease, stroke, diabetes, and lung disease that place them at higher risk. Rural nursing homes and tribal facilities are especially vulnerable.
Rural hospitals may not be prepared to handle more than a few coronavirus patients. Further, canceling many elective procedures has worsened already precarious situations, threatening more closures and staff furloughs. As rural communities begin to reopen, they must be prepared for a potential COVID-19 resurgence while balancing the need to bring health services online in a rapid and safe manner.
The federal government is mobilizing unprecedented resources to meet this challenge. Under the leadership of President Trump, HHS has disbursed $10 billion to rural hospitals, rural health clinics, and rural health center sites, in addition to announcing $400 million to Indian health care facilities. HHS has made over $100 billion in advance Medicare payments to help with cash-squeezed budgets and awarded more than $1.3 billion to health centers to help diagnose and treat COVID-19.
Telehealth has been expanded significantly, and telehealth.hhs.gov was launched to help providers learn to implement this new technology. Many rural Americans can now access telehealth services through commonly-used apps such as FaceTime or Skype to receive care. This will have tremendous impact for rural patients by making doctor visits more convenient, removing unnecessary travel and reducing wait times.
States and rural providers are adapting to the pandemic. In Kansas and Illinois, fourth year medical students are graduating early to volunteer in rural hospitals. Doctors have learned that by keeping patients with respiratory distress due to COVID-19 prone on their stomachs, their patients breathe better, and may remove the need for breathing assistance. Hospital volunteers are sewing personal protective equipment (PPE) gowns, and have even used FEMA plastic sheeting to help make them. Nurses and home health workers are helping with contact tracing. And some rural providers are beginning to accept recovering COVID-19 patients so they can receive care closer to home.
Nationally, we are conducting over 300,000 tests per day, and rural communities need to be ready to test as states reopen. Through early identification and contact tracing, communities can stop potential outbreaks before they begin. Having mechanisms in place, such as COVID screening protocols for surgical patients and new inpatients, will provide the assurance patients and providers need to resume elective surgeries. Rural providers should also develop plans for conserving PPE, social distancing, face coverings and hygienic practices, and may even consider preparing alternate care sites for handling new cases, and streamlining coordination with nearby ICUs.
In the midst of the COVID-19 pandemic, more rural hospitals must find ways to make themselves sustainable for the communities they serve. Now is the time for them to develop new models to meet this challenge for the benefit of their communities long-term—a goal we have been working toward as part of President Trump’s emphasis on rural health care.
We are getting smarter in combating this disease every day, and applying what we are learning is vital as we move forward. We both know, as rural Americans ourselves, that commitment and innovation will save lives and strengthen our rural communities.
Eric Hargan is the Deputy Secretary of the U.S. Department of Health and Human Services. Jeff Colyer is a practicing physician, former Governor of Kansas, and Chairman of the National Advisory Committee on Rural Health care.