By Christine Vestal
Hard-hit communities in the Midwest and Great Plains are beginning to run short on staff, beds, and ICU rooms.
Read more

By Tim Murphy and Tim Marema
New infections climbed by 16% in rural counties last week, putting 160 more rural counties on the red-zone list.
Read more

Pennsylvania State Veterinarian Dr. Kevin Brightbill announced that Pennsylvania has confirmed its first COVID-19 positive cat.

The 16-year old Cumberland County cat, who lived in a household with multiple individuals who had previously been diagnosed with COVID-19, presented in early October with mild respiratory illness. Unfortunately, as a result of respiratory distress, the cat was humanely euthanized. The case is still under investigation, and a primary cause of death has not yet been confirmed.

The Pennsylvania cat is one of a handful of COVID-19 positive pets from across the United States that died or were euthanized while infected. All pets infected had known prolonged exposure to COVID-19 individuals and none to date appear to have died from COVID-19. Instead, other serious underlying illnesses are attributable to cause of death.

“As Pennsylvanians have spent more time at home throughout the pandemic, our companion animals have undoubtedly been the recipients of extra love and attention,” said Dr. Brightbill. “If you or a loved one becomes diagnosed with COVID-19, take steps to keep your pet healthy, just as you would your family.”

Many of the same recommendations for protecting people apply to animals. To help protect Pennsylvania pets, households with COVID-19 positive individuals should adhere to the following guidelines:

• Avoid contact with pets and other animals, as you would other people.
• Arrange for another household member to care for your pet(s) while you or family members are in isolation.
• Avoid contact such as petting, holding, snuggling, facial contact, and sleeping in the same bed.
• Wear a mask and wash your hands before feeding or tending to your pet if you are unable to find alternative care for them.

Symptoms of COVID-19 in pets includes fever, coughing, difficulty breathing or shortness of breath, lethargy, sneezing, nose or eye discharge, vomiting, or diarrhea. If your pet exhibits symptoms after contact with a person positive for COVID-19, contact your private veterinarian.

At this time, there is no evidence that animals play a significant role in spreading COVID-19 to people. COVID-19 is mainly spread through person-to-person contact.

Pennsylvania Governor Tom Wolf announced a plan to waive liquor license fees to provide financial relief to restaurants and bars, which have faced significant financial impacts during the COVID-19 public health crisis.

“As we enter the anticipated fall resurgence of COVID-19 cases, the very contagious nature of this virus makes gathering indoors publicly at full capacity dangerous. Still, we know that restaurant and bar owners in Pennsylvania are committed to keeping their employees and customers safe and the vast majority of these businesses have followed safety precautions and invested in new procedures and supplies, but COVID continues to hurt this industry,” Gov. Wolf said. “My administration continues to look for innovative ways that we can support the bar and restaurant industry. Eliminating liquor license fees is an important step toward helping bars and restaurants retain the capital they need to weather the storm of COVID-19.”

Governor Wolf is working with the Pennsylvania Liquor Control Board to waive standard licensing fees through 2021 starting January 1, 2021. More than 16,000 Pennsylvania restaurants and bars, clubs, catering clubs and hotels would see $20 million in relief.

The governor was joined by state Representatives Dan Deasy (D-Allegheny), Ed Gainey (D-Allegheny) and Jake Wheatley (D-Allegheny), and Senator Wayne Fontana (D-Allegheny) at LeMont Restaurant in Pittsburgh.

“I’m glad I could work with Governor Wolf to bring help to our bars, restaurants, taverns and social clubs right now. I know this isn’t a solution to the big problems this pandemic presents, and more help is needed,” said Rep. Deasy. “I’m working hard to enact additional measures that can help keep these vital employers in business.”

“This terrible public health crisis has also stricken our economy and our path to recovery will need to be a well thought out and effective one on several fronts. While the COVID-19 pandemic has affected just about every industry, restaurants and bars have been hit particularly hard and we need to provide relief to these small businesses at the heart of our communities,” said Sen. Fontana. “Over the summer, Senate Democrats introduced a comprehensive proposal to provide emergency relief to Pennsylvania’s restaurants and taverns, which have seen significant financial loss due to the COVID-19 pandemic and the resulting shutdown. Under our plan, license renewal and permit fees that are paid by restaurants and taverns would be waived for one year along with other administrative changes to help financially benefit these struggling businesses. I’m pleased that the governor is taking steps to implement some of our goals and am encouraged that this will provide meaningful assistance to so many of these establishments that are struggling.”

As part of his fall legislative agenda, Governor Wolf has called on the General Assembly to provide an additional $225 million in federal Coronavirus Aid, Relief and Economic Security (CARES) Act funding in the form of forgivable loans and grants to small businesses in Pennsylvania through the COVID-19 Relief Statewide Small Business Assistance Program. In addition, the governor proposed $100 million in forgivable loans and grants for the hospitality, leisure and service industries, including restaurants and bars, salons and barber shops.

The governor also supports the federal Real Economic Support That Acknowledges Unique Restaurant Assistance Needed to Survive (RESTAURANTS) Act. The bipartisan bill in Congress provides $120 billion to help independent restaurants with the economic challenges created by the COVID-19 pandemic.

The Technical Assistance and Services Center (TASC), in coordination with the Federal Office of Rural Health Policy (FORHP), are pleased to provide an update of the COVID-19 Funding Sources Impacting Rural Providers guide. This funding resource is intended to support rural health care providers, along with their state and local partners, navigate the availability of federal funds to support the novel coronavirus (COVID-19) pandemic response and recovery efforts. This guide is updated regularly to capture changes in funding sources.

Seven tables, or matrices, are provided for quick reference at the beginning of this resource. The tables can be used to check eligibility of participation in funding sources by provider types: rural prospective payment system (PPS) and critical access hospitals (CAH), rural health clinics (RHC), federally qualified health centers (FQHC), long-term care (LTC) or skilled nursing facilities (SNF), tribal facilities, and emergency medical services (EMS). The tables also provide an at-a-glance view for each provider type sharing the different types of funds that may be accessed from various funding sources dependent on their participation eligibility. Each funding source is described in its own section of this resource with an executive summary followed by further detail on the use of funds, reporting requirements, hyperlinks to the legislation and detailed information.

The guide can be found in COVID-19 Collection located on The National Rural Health Resource Center’s website. This collection consists of trusted and reliable resources, such as the COVID-19 Funding Sources Impacting Rural Providers Guide, along with standing links to additional organizations’ COVID-19 resources, FAQs, webinars, tools, and trainings. The Center aims to help direct the most up-to-date and relevant tools and resources to rural hospitals, clinics, and their communities. This Collection will be updated regularly to help assist with the abundance of circulating information relating to COVID-19.

Time Magazine

When COVID-19 hit the Southwest Georgia Regional Medical Center in Cuthbert, a small rural town in Randolph County, in late March, the facility—which includes a 25-bed hospital, an adjacent nursing home and a family-medicine clinic, was quickly overwhelmed. In just a matter of days, 45 of the 62 nursing home residents tested positive. Negative residents were isolated in the hospital while the severely ill patients from both the nursing home and the local community were transferred to other better-equipped facilities.

“We were trying to get the patients out as fast as possible,” says Steve Whatley, Southwest Georgia Regional’s board chairman. “It was a daily nightmare.”

The scramble was exacerbated by a dire lack of medical necessities. Employees had to diligently conserve personal protective equipment. The hospital had no ventilators. And the nursing home’s air systems had to be retrofitted to create negative-pressure rooms to contain the airborne virus particles. Making matters even worse, one of the county’s only two physicians became ill with a severe respiratory disease unrelated to the coronavirus, while the other had an unexpected surgery requiring eight weeks of recovery time. Nurse practitioners stepped up as Southwest Georgia Regional waited for backup from neighboring health care organizations. More than 30 of 200 employees stopped working out of fear or because they got sick; the state of Georgia provided six nurses and two respiratory therapists as emergency relief. Despite the heroic efforts of the center’s staff, more than a dozen nursing home residents died within eight weeks of the virus’ arrival, though it’s unclear how many were directly due to COVID-19.

The ordeal left Southwest Georgia Regional—which was already struggling to survive—in financial shambles, as costs related to the coronavirus greatly exceeded revenues. It will permanently close on Oct. 22, making it the seventh Georgia hospital to do so since 2010. After Southwest Georgia Regional closes, Randolph County will become the 55th in the state to have no hospital at all. Residents will need to drive 30 minutes west and across the state line to Eufaula, Ala. or 50 minutes east to Albany, Ga. for care.

The middle of a pandemic is a bad time for a hospital to close. Yet Southwest Georgia Regional isn’t unique. Hospitals in St. Paul, Minn., Chicago, Houston and Philadelphia have recently closed or are set to do so soon. And in rural areas of the country, where hospitals often have enough beds for just a few dozen patients, 15 facilities have shuttered this year as of Oct. 20, including 11 since March, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. There may be as many as 18 such closures in 2020, topping last year’s record high. The hospitals in the worst financial shape generally have one thing in common: they serve the country’s most vulnerable people, who rely on Medicare and Medicaid or who are poor and uninsured.

Read more.

This afternoon, HHS through HRSA announced the latest Provider Relief Fund (PRF) application period had been expanded to include provider applicants such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received PRF distributions. Further, HHS also updated its September 19, 2020, Frequently Asked Questions (FAQ) document clarifying purposes of relief payments and loss revenues.

Appalachia reached two grim milestones last week when the Region recorded 500,000 confirmed COVID-19 cases and 10,000 covid-related deaths. From March 6, 2020, COVID-19 cases increased at a gradual pace. In the past few months, the number of confirmed cases increased faster, and has continued to increase every day since October 2. This week, Appalachia set a new record high for the seven-day rolling average of new daily cases with 5,062 on October 20th. The seven-day average of new daily cases was 4,425 a week ago and 3,805 two weeks ago.

The seven-day rolling average of new daily deaths stands at 68 per day, up from 60 a week ago and 53 two weeks ago. As of 11:30am today, October 22, 2020, there were 545,567 cumulative cases throughout Appalachia and 10,666 cumulative deaths in 383 of Appalachia’s 420 counties.

For more information on the coronavirus in Appalachia, visit here.

Stateline, Pew

The nation’s pandemic hotspots have shifted to rural communities, overwhelming small hospitals that are running out of beds or lack the intensive care units for more than one or two seriously ill patients.

And in much of the Midwest and Great Plains, hospital workers are catching the virus at home and in their communities, seriously reducing already slim benches of doctors, nurses and other professionals needed to keep rural hospitals running.

Nationwide, positive coronavirus cases started rising in mid-September as children and college students returned to school, more businesses reopened and more people started resuming daily activities outside of their homes. Wisconsin and other less populous states became the new hotspots.

This week, per capita rates of COVID-19 were highest in North Dakota, followed by South Dakota, Montana, Wisconsin, Nebraska, Idaho, Utah, Wyoming, Iowa, Arkansas and Illinois. Hospitalization rates also were rising in those states and others.

Health care experts expect that a seasonal spike in flu and pneumonia, combined with a steady rise in COVID-19 cases, will swamp many health care systems, particularly in rural areas.

Wisconsin recently opened a 530-bed field hospital on state fairgrounds in Milwaukee that was set up in the early days of the pandemic but sat unused until now. Last week, 50 beds were readied for patients, and the staff was working on transfers with hospitals that were hitting their capacity limits. The number of hospitalized COVID-19 patients in the state tripled in the last 30 days.

In Oklahoma City and the surrounding area, no ICU beds were available last week, according to the University of Oklahoma. The lack of beds required medical professionals in those already understaffed hospitals to spend hours on the phone arranging patient transfers to other Oklahoma hospitals.

Fewer than 20 ICU beds were available in the entire state of North Dakota, according to state data. That meant patients had to be transferred hundreds of miles, in some cases to South Dakota and Montana.

Read more.