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COVID-19 and Rural Health Equity in NH
NH has the fastest growing #covid19 epidemic in the US.
I would like to discuss what this means for rural health equity in NH based on the second phase of our research on COVID-19 and Rural Health Equity in NNE.
https://www.hereruralequity.com/c19vt06
NH has the fastest growing #covid19 epidemic in the US.
I would like to discuss what this means for rural health equity in NH based on the second phase of our research on COVID-19 and Rural Health Equity in NNE.
https://www.hereruralequity.com/c19vt06
NH succeeded in stemming an early #covid19 surge despite its proximity to the spring’s largest global epidemic, and NH cases concentrated in southern regions of the state. NH was able to sustain low infection rates into the summer and early fall.
The first phase of our research on COVID-19 and rural health equity in NH/VT revealed that aggressive state action, coupled with robust regional and community responses, contributed to low infection rates in rural NH. https://www.healthaffairs.org/do/10.1377/hblog20200722.490817/full/
NH has the fastest growing epidemics in the US with a 124% 14-day increase in cases (NYT). State data shows rapid increases in hospitalizations, deaths, and outbreaks. NH exceeded its contact tracing capacity in early November.
https://public.tableau.com/shared/QX2N854CH?:display_count=y&:origin=viz_share_link&:embed=y via @tableaupublic
https://public.tableau.com/shared/QX2N854CH?:display_count=y&:origin=viz_share_link&:embed=y via @tableaupublic
NH hospitals still have open beds; however, @caseymcdermott reported that they are beginning to experience pressures on hospital and ICU bed capacity. In addition, many are experiencing workforce shortages. https://twitter.com/caseymcdermott/status/1337153213762576398?s=20
79% of NH’s #covid19 deaths--the highest in the US--have occurred at nursing homes and the state has seen rapid expansion of outbreaks at long-term care facilities across the state. Prisons and other congregate living settings also face increasing outbreaks.
NH instituted a mask mandate on 11/20. It currently has fewer restrictions in place than neighboring states. It has not restricted bars, restaurants or other activities, and its public health guidance is less stringent than that in other states. https://www.kff.org/coronavirus-covid-19/issue-brief/state-data-and-policy-actions-to-address-coronavirus/
What does this mean for rural health equity? NH is the second oldest state in the US, and rural regions are older. Distinct rural risk factors for transmission include the presence of nursing homes & prisons, reliance on regional centers, and high workforce mobility.
Low early rates of #covid19 infection in rural regions of NH have contributed to low perception of threat in rural NH. This, combined with pandemic fatigue and some resistance to public health measures, has left communities more vulnerable to the introduction of cases.
Rural regions have limited health systems capacity. Even a small number of #covid19 cases can overwhelm rural health systems. https://twitter.com/FutureDocs/status/1333243068946984960?s=20
Rural regions in NH have limited capacity to care for #covid19 patients. NH has only 1.8 ICU beds/10K--one of the lowest rates in the country--and these beds and critical care workforce concentrate in more urban areas. Coos County, the northernmost country of NH, has 3 ICU beds.
Beds are not the biggest constraint though. Rural health systems and long-term care facilities face long standing workforce shortages, and these shortages are most acute in the remote parts of NH. Bed capacity can be increased; however, workforce cannot be expanded quickly.
Rural NH hospitals are part of a larger healthcare landscape and rely on larger hospitals in southern NH for the transfer of critically ill patients. Stretched hospitals may be unable to take not only rural #covid19 patients but also other patients requiring tertiary care.
NH has a strong culture of local control but its state #covid19 response, including its contact tracing, is centralized in Concord. Rapid growth in cases in southern NH impact rural public health responses and health systems in several ways.
Rural regions have seen imported cases from southern NH, and strained NH contact tracing systems have impeded containment of early-stage rural outbreaks and state outbreak responses. Berlin, Colebrook, Stewartstown, and Plymouth also have had outbreaks.
Rural NH health systems are seeing growing numbers of #covid19 cases but are not yet at a crisis point. Health systems report increasing workforce pressures as staff are required to isolate. Many fear that further shortages will debilitate thinly staffed healthcare institutions.
Rural hospitals are also starting to experience difficulty transferring patients requiring care to southern NH hospitals. Some are already sending patients out of state; however, growing surges across the NNE region may further constrain rural transfers in coming weeks.
Rural public networks, local leadership, and health systems have mobilized to respond to outbreaks. Local action has helped to fill the gap in state-led responses but are playing out in absence of the public health measures that were critical to NH’s early #covid19 success.
The impacts of growing rural #covid19 outbreaks go beyond the health sector. Rural schools and businesses have been forced to close, a significant concern in regions with poor broadband coverage. School closures further strain the rural health workforce. https://www.unionleader.com/news/health/coronavirus/coos-county-impacted-by-rising-cases-schools-going-to-remote-learning-restaurants-close/article_72bcb83e-4249-513c-a0c7-92f6672ac2d5.html
What is essential to understand is that many of the public health measures that stemmed #covid19 transmission and protected NH’s health systems in the spring are no longer in place. Adding to concern, NH can no longer rely on neighboring states for excess hospital capacity.
#covid19 is pushing rural health systems across the country to the brink of collapse. Higher compliance with mitigation strategies may be protective in NH; however, this may be insufficient to prevent devastation seen in other settings. https://twitter.com/AnnaKingreports/status/1337814786692661248?s=20
Vaccines are arriving but not fast enough to turn the tide of NH’s epidemic. The first doses of the vaccine may reach nursing homes and health workers this week; however, it will take many more months to achieve widespread immunity to #covid19.
Other states offer a sobering warning. New Mexico, a state praised for its pandemic response, recently took more aggressive action in response to an increase in cases only to see its health system forced to resort to crisis standards of care. https://twitter.com/griffwitte/status/1335217258134708224?s=20
Absent additional action, #NH can anticipate further acceleration of its epidemic and significant loss of lives and livelihoods. Thanksgiving and the coming holiday season may lead to what Dr. Fauci has called a “surge upon a surge.”
We will look back at this moment as one where NH had a key choice. A strong public health response, combined with enhanced support for vulnerable populations, is needed to save lives and enable NH to keep vital components of public life open until vaccine coverage is achieved.
