With nearly all of the 50 states in some form of lockdown to fight the spread of COVID-19, WalletHub today released updated rankings for the Most Aggressive States Against the Coronavirus, as well as accompanying videos.

To identify which states are taking the most aggressive actions to combat coronavirus, WalletHub compared the 50 states and the District of Columbia across 51 key metrics. The data set ranges from tested cases of COVID-19 per capita to school closures, ICU beds, and shelter-in-place policies. Below, you can see highlights from WalletHub’s report, along with a summary of the largest changes in rank from our previous report and a Q&A with WalletHub analysts.

Note: Rankings reflect data available as of 1 p.m. ET on April 6, 2020.

On April 3, CMS Administrator Seema Verma, Deborah Birx, MD, White House Coronavirus Task Force, and officials from the FDA, CDC, and FEMA participated in a call on COVID-19 Flexibilities. Several physician guests on the front lines presented best practices from their COVID-19 experience(s). You can listen to the conversation here.

As the coronavirus spreads across the country, the related anxiety, fear, and depression also threaten the health of Americans. Mental health experts say the combination of rising death tolls and social isolation make it difficult to cope with the pandemic. As the Director of the Office of Rural Mental Health Research, Andrea Beckel-Mitchener explains that rural communities often pursue counseling less often due to the “stigma to seeking help.” Further, rural areas often have less access to mental health care. Telehealth has received growing support recently and can greatly improve mental health care in rural communities. For tips on coping with social distancing and isolation, check out the advice given by Substance Abuse and Mental Health Services Administration.

Politico reports that in a April 2, 2020 news briefing, Dr. Deborah Birx, the White House coronavirus coordinator, announced that rapid point-of-care tests will distributed to areas of the country where current COVID-19 testing is scarcest. “These are new tests, and we have prioritized the groups that we think have the least access to testing now,” Dr. Birx said. “Priority will be given to Indian Health Services and rural areas that do not have access to labs that perform high-volume coronavirus tests.”

With the support from the National Rural Health Association, 41 senators and 81 representatives wrote a letter to HHS Secretary Azar urging the administration to fairly distribute aid to rural hospitals and health clinics. Under the CARES Act, the HHS Secretary has flexibility in how the $100 billion fund will be allocated to struggling providers. The lawmakers requested that funding be provided to rural hospitals quickly, as many are running low on money while preparing for the coronavirus. NRHA is concerned that large health systems (who also need help) will consume the funds due to small rural providers’ inability to compete for the funds. We are advocating for a rural set-aside to be established within these funds to ensure that rural providers can access this important, much-needed funding.

Daily Yonder

By Craig Settles

Rural America already has a shortage of hospital beds. Telehealth could help move some patients to a new type of facility powered by broadband. New temporary regulations in response to COVID-19 will allow the change.

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Daily Yonder

By Bill Bishop, Tim Marema and Jan Pytalski

The novel coronavirus continues to spread across rural America, according to data USA Facts has compiled from state health authorities. Yesterday, April 1, an additional 58 rural counties reported their first Covid-19 cases.

The impact of the novel coronavirus varies across the rural landscape. On average, there were 14.1 cases of COVID-19 for every 100,000 rural residents. That rate is well below the national rate of 55.9 cases per 100,000 residents.

But most of us don’t live in an “average” county. There are 80 rural counties with infection rates above the national average (shown in red in the map). And some rural counties have COVID-19 infection rates among the highest in the country.

Some of the highest rates are in Rocky Mountain ski counties. (The Yonder reported this phenomenon last week.)  Blaine County, Idaho, has a COVID-19 infection rate of 1,164 per 100,000. For comparison, the Bronx in New York City reported a rate of 598.6, the highest tally of any central city area.

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Fred Ullrich, BA; and Keith J. Mueller, PhD

While the majority of confirmed COVID-19 cases in the United States are found in urban centers, rural areas are not free of cases. As of April 1, 2020, there were a total of 234,040 cases and 5,398 deaths identified in counties (data provided by USAFacts.org), with 8,866 cases and 206 deaths (about 3.8 percent of both) reported in non-metropolitan counties.

This RUPRI data brief shows the current nonmetropolitan and metropolitan spread of the disease, and the associated map shows how the disease has spread over time.

Click to down the updated maps, and the “progression” of cases throughout the country.

https://rupri.public-health.uiowa.edu/publications/policybriefs/2020/COVID%20History/

New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Video

CMS Approves Additional State Medicaid Waivers and Amendments to Give States Flexibility to Address Coronavirus Pandemic

CMS approved its 45th Medicaid waiver to the District of Columbia, delivering urgent regulatory relief to ensure the District can quickly and effectively care for their most vulnerable citizens. In light of the urgent and evolving needs of states during the COVID-19 crisis, CMS developed a toolkit to facilitate expedited application and approval of State waivers requests in record time. The waivers support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

CMS also approved an additional state waiver amendment request for Oklahoma to give emergency flexibilities in their programs that care for the elderly and people with disabilities, bringing the total to 18 approvals across 16 states.

Section 1135 Waivers  

1915(c) Appendix K Waivers

 Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients.

Guidance

April 5, 2020

Under her authority as Secretary of the Department of Health to take any disease control measure appropriate to protect the public from the spread of infectious disease, Dr. Rachel Levine today signed an order providing direction for maintaining and cleaning buildings for businesses authorized to maintain in-person operations under her and the governor’s life-sustaining business orders announced March 19.

According to the Building Safety Measures order, “Cleaning, disinfecting, and other maintenance and security services performed by building service employees are critical to protecting the public health by reducing COVID-19 infections in the commonwealth.”

The measures outlined in the order are for owners of buildings of at least 50,000 square feet used for commercial, industrial or other enterprises, including but not limited to facilities for warehousing, manufacturing, commercial offices, airports, grocery stores, universities, colleges, government, hotels, and residential buildings with at least 50 units.

In addition to maintaining pre-existing cleaning protocols, the order outlines these new protocols:

• Clean and disinfect high-touch areas routinely in accordance with CDC guidelines, in spaces that are accessible to customers, tenants, or other individuals.
• Maintain pre-existing cleaning protocols established in the facility for all other areas of the building.
• Ensure that the facility has a sufficient number of employees to perform the above protocols effectively and in a manner that ensures the safety of occupants and employees.
• Ensure that the facility has a sufficient number of security employees to control access, maintain order, and enforce social distancing of at least 6 feet, provided the security employees are otherwise responsible for such enforcement.

The order goes into effect at 12:01 a.m., April 6.

View the full order as a PDF here or on Scribd.