The path this virus has taken in the last nine months has created a double-tsunami effect on rural healthcare providers. The first wave of infections never really reached rural hospitals yet government (Federal and State) mandates to shut down elective procedures and ambulatory clinic operations across ALL healthcare providers had a devastating financial impact on rural facilities yet, they never experienced anything close to a surge. Yes, CARES Act funds were applied for and distributed to cushion the blow in their bank accounts but remember, care delayed is care denied. There has been no accounting of the morbidity or mortality impact of the delay or canceling of procedures due to our lack of knowledge about the virus and its spread, at that time.
As a side bar, there were a number of hospitals, that were in Chapter 11 protection when Congress appropriated the relief funds, who petitioned the Courts to suspend their filing so they could qualify for CARES Act funds to help pay bills even though a number of them were no longer providing services. Once the funds were received, they again petitioned the Courts for protection.
So, now, the second wave of COVID outbreaks comes and rural America is the epicenter of the viral flood. Once again, these smaller hospitals, who depend upon elective procedures to generate operating capital, are forced to suspend or curtail these services to insure that the necessary facility space, equipment, supplies and staff can be deployed to try to meet the onslaught. Since rural America was “immune” from the first wave, they were certainly caught off-guard, thinking that distance from urban congestion and travel would insulate them, once again. These facilities, in large measure, do not have the infrastructure, staffing, network, or clinical expertise to effectively deal with the patient surge. The demographics of rural cities place many of the cases in high risk categories due to higher levels of co-morbid conditions such as age, obesity, heart and lung problems, diabetes, hypertension which greatly increase the probability of patients needing high level intervention (ventilators) to manage the disease process.
This latest surge only continues to grow. The hope of vaccines cannot come soon enough. However, there is another hurdle to overcome in the immunization fight…TRUST!! Inner city and rural America have had a long-standing distrust of government for the same and different reasons. You can have the most effective vaccine on the planet but it will do no good unless it is injected into the arms of humanity. In the land of the free and the home of the brave, this will be a difficult task. One, I believe, more logistically and influentially difficult than the science, itself.
In spite of all of this, the pandemic will end; either through vaccination, herd immunity, or both. The problem that will endure is the cost of the fight. The devastating numbers of lives lost. The physical and emotional strain on our first responders and medical care teams. The depletion of critical equipment and supply stocks. The crushing blow to our service industries and small businesses. The loss of “community” as we continue to social distance. And, the staggering debt that our country and the world has endured and must find a way to pay for without creating a unwanted and lasting legacy that continues to stifle economic recovery.
Healthcare must emerge from this trial in a more responsive configuration with a focus on wellness and prevention. Certainly, a commitment to population health management, early intervention, and chronic disease reduction will help to reduce the overall cost of healthcare in the U.S. Healthcare will be 20% of our national GDP by 2025. I do not believe this is sustainable and will further erode access to critical healthcare services going forward. Rural America will suffer the most as more hospitals close and access to life sustaining treatment becomes a desperate ambulance ride down a county road to a facility more than 30 miles away.