The Senate passed a $484 billion deal for small businesses and hospitals today after cash for sorely needed loans dried up last week. Congress and the Administration have agreed on a $484 billion COVID-19 relief package to provide funding to small businesses and hospitals and for testing. The proposal includes $310 billion for the Paycheck Protection Program, which was depleted. Read full story.
Rural Cases Increase by a Third over the Last Week
The broad trend is that rural counties are adding cases at a slightly faster rate than urban counties, although the number of rural cases remains only about 6% of the U.S. total.
That’s slightly faster than the metropolitan growth rate of about 23%. The growth continues a familiar trend as the rural infection rate inches up relative to the metropolitan rate.
As the rural infection rate climbs relative to the metropolitan rate, rural cases are becoming a slightly larger percentage of the nation’s overall Covid-19 cases. On Monday, April 13, rural cases constituted 4.1% of all Covid-19 cases in the U.S. On Sunday, April 19, they were 4.7% The growth is small but steady.
Seventy-nine rural counties had their first case of Covid-19 from April 13 to 19. There are still 410 rural counties, out of about 2,000, that do not have a case of the virus.
Beyond these large trends, the spread of the virus is an ever-growing collection of local events, in most cases unique to specific people and places.
The largest increase in rural cases during the last week occurred in Marion County, Ohio, where an outbreak at a state prison caused the case count to rocket from 91 to 1,743. Marion, with a population of about 65,000, now has the highest number of cases in the state.
In the Midwest, outbreaks seem tied to meat-processing plants. Marshall County, Iowa, the site of a Swift pork plant, saw its cases increase from 37 to 118 last week. Ford County, Kansas, increased from 16 to 127 cases. In Dodge City, the county seat, National Beef closed its plant from April 16 to April 21 to install safety gear and take other measures. Cargill also confirmed cases of coronavirus at its plant.
Parts of Indian Country are being hit hard. McKinley County, New Mexico, added 172 cases of Covid-19 last week, nearly doubling the number it had on April 13. The county’s population is 75% Native American and includes parts of the Navajo Nation and Pueblo of Zuni. Arizona counties in the region also saw dramatic increases. Navajo County, Arizona, grew by more than 100 cases to a total of 459, and Apache County, Arizona, doubled its cases, growing from 89 to 178.
The rural South continued to see significant increases, with a band of counties running from East Texas across Louisana, Mississippi, Alabama, southwest Georgia, and the coastal regions of South Carolina and North Carolina.
Moore County in Texas, however, said its nearly five-fold increase in cases came from better means of testing. An Amarillo television station reports that the county has rapid coroavirus test that can return results in 15 minutes.
“Whenever we first got these tests, we brought them here to Moore County, and then we tested them against our own known … positive and negative patients, and we had 100 percent accuracy,” Steve Agle, the general surgeon at the local hospital, told KFDA television news. The county judge said Moore County is the only one in the state to use the test and report numbers from them.
Rural America Could Be Weeks away from Peak in Coronavirus Cases
Two infectious-disease experts say reopening industries that don’t allow social distancing could cause hotspots.
While larger urban areas may be seeing the number of coronavirus cases slow, cases in rural areas are just beginning, two experts said during a briefing from the Infectious Diseases Society of America Tuesday.
During the 45-minute long briefing, Dr. Angela Hewlett, associate professor, Department of Internal Medicine, University of Nebraska Medical Center, and Dr. Andrew T. Pavia, chief of the Division of Pediatric Infectious Diseases, University of Utah School of Medicine, told reporters that rural communities are beginning to see outbreaks of the coronavirus that differed from those seen in more urban communities, and that the outbreaks in rural America are far from reaching their peak.
Pavia said that disparities between rural communities and urban communities prior to the outbreak of COVID-19 in the U.S. may mean the disease will be a part of rural communities for a long time to come.
“The health disparities between big cities and rural communities means we may see long, sustained outbreaks in rural areas for weeks and months to come,” he said. “The resources in rural communities are just not the same.”
Smaller hospitals with staff that is not as adequately trained, coupled with existing health issues in the community and in some cases poverty conditions, all contribute to how well rural communities are able to contain and combat the disease.
While Hewlett said rural communities are much better at social distancing, the culture of those communities may contribute to outbreaks. From large community gatherings to large industries providing jobs in close quarters to the community, the way rural communities thrive may be a part of how easily it is spread, she said.
The number of cases of the disease in rural communities could continue to rise for weeks, she said. It may be two or three more weeks before many rural communities see their case numbers peak, she said.
In states like South Carolina, Texas, Tennessee and Georgia, where governors are pushing to slowly open up their state’s economies in coming days, how those economies open up could have an impact on the health of rural communities, as well, they said.
If the jobs that start up again are ones that put social distancing and other protective measures in place – like agriculture – things could go well, Pavia said.
But opening up the wrong businesses could cause an uptick in cases and small micro-outbreaks, Hewlett said.
“We have to be really careful about this,” she said. “I agree that this should be a local- or state-level decision, but there is a way to do this right.”
Re-opening industrial sites which supply jobs to rural communities may not be a good idea, Pavia said, because of the close contact workers have with one another. That contact could end up spreading the disease again.
“Opening up industries in rural facilities – I just don’t know how you open those up and open them up safely,” he said.
Both doctors said rural communities need enhanced testing, enhanced contact tracing before they open up again.
Pennsylvania Governor’s Administration Encourages Residents to Support Local Restaurants with CarryoutPA.com
The Pennsylvania Department of Community and Economic Development’s (DCED) Tourism Office encourages Pennsylvanians to support local restaurants by visiting the CarryoutPA website, which offers a comprehensive list of restaurants offering takeout, curbside, or delivery services during the state’s stay-at-home order.
CarryoutPA.com was developed by the Pennsylvania Restaurant and Lodging Association (PRLA) to serve as a go-to resource for dine-out options in support of the commonwealth’s restaurant industry, which accounts for 10 percent of jobs statewide. Pennsylvania restaurants that would like to be added to the registry can register here.
Pennsylvania Department of Agriculture Outlines Updated Farm Labor Requirements, Advocates for Skilled Labor to Ensure Food Supply
The Pennsylvania Department of Agriculture provided farmers who provide housing to their workforce – be it domestic, migrant, or guest H-2A workers – with enhanced requirements for seasonal farm labor to maintain a healthy agriculture workforce to ensure necessary farm labor can continue during COVID-19 mitigation in Pennsylvania. The Wolf Administration continues to advocate for a safe, skilled agriculture workforce to perform essential duties to keep Pennsylvania’s food supply chain strong.
Pennsylvania is home to more than 360 permitted Seasonal Farm Labor Camps with nearly 4,300 workers. The workers in these camps are primarily migrant workers – sourced by their company – or H-2A workers – sourced federally. Even before COVID-19 hit Pennsylvania, the Department of Agriculture’s Bureau of Food safety oversaw the Seasonal Farm Labor Camps where these guest workers reside. The Seasonal Farm Labor Act and regulation sets standards for conditions of work, living quarters, occupancy, camp sanitation, food facilities, fire protection, and safety of farm workers. In addition to these required standards, the department has issued additional requirements for employers to follow to mitigate against COVID-19 for their workforce.
The following are some examples of necessary provisions to maintain the health and safety of seasonal farm workers:
- Per CDC recommendations, there should be a minimum of six feet between beds;
- Beds should be positioned so that workers sleep head-to-toe to limit exposure to respiratory droplets;
- Provide workers with cloth face masks to wear while in housing;
- Ensure bathrooms and other sinks are consistently stocked with soap and drying materials for adequate handwashing;
- Provide hand sanitizer when soap and water are not available;
- Ensure high contact surfaces are cleaned and sanitized on a routine basis with EPA-registered disinfectants;
- Ensure essential supplies for cleaning and sanitizing are available in all living quarters and worksites;
- Designate an individual responsible for maintaining routine cleaning.
In addition to these additional requirements to keep workers from getting sick with COVID-19, the Modified Seasonal Farm Labor Camp Requirements include steps to take if an employee is diagnosed with COVID-19.
CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19
As the United States continues to face the unprecedented public health emergency from the COVID-19 pandemic, the tide is turning and some areas throughout the country are seeing a decline in cases. As states and localities begin to stabilize, CMS is issuing guidance on providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with low and stable incidence of COVID-19. This is part of Phase 1 in the Trump Administration’s Guidelines for Opening Up America Again. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures.
Small Healthcare Provider Quality Improvement: Sourcebook, 2016-2019
This sourcebook provides detailed descriptions of 32 rural quality improvement initiatives funded through the Small Health Care Provider Quality Improvement grant program during the 2016-2019 grant period. Initiatives focused on enhancing chronic disease management, increasing patient and caregiver engagement, improving quality of care, and better health outcomes. Read more here.
Small Area Health Insurance Estimates: 2018
This resource reports on health insurance coverage in the U.S. in 2018 and changes between 2017 and 2018, as well as changes between 2013 and 2018. It includes maps showing county-level uninsured rates. Read more here.
Additional links: Visualizations and Reference Maps
The Opioid Crisis and Community-level Spillovers onto Children’s Education
This article presents a study on the link between the opioid epidemic and children’s educational outcomes. It evaluates community-level resources for handling the opioid crisis and how that correlates with educational outcomes, specifically in rural and underserved areas. Read more here.
Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
This research brief identifies the standardized set of measures used for data collection by the Evidence-Based Tele-Emergency Network Grant Program grantees. It explores ways in which emergency department-based telehealth services can be used in rural hospital emergency departments. Read more here.