Rural communities of Kentucky and other states are not immune to COVID-19, or the coronavirus. The first known case of coronavirus in Kentucky was in Cynthiana, a town with a population of only 6,400 persons, and cases of coronavirus have been identified in several other rural communities. The older age compositions and inadequate hospital infrastructures of rural communities place them at extremely high risk for serious cases of coronavirus and mortality.  

Failure to strictly engage in social-distancing will result in continued spread of coronavirus amongst rural (and urban citizens). Of even more concern, anecdotal evidence shows that too many rural citizens and hospital personnel are not heeding federal and state recommendations to reduce coronavirus transmission. It has been observed multiple times that health care workers that have been exposed are not being quarantined and tested appropriately by these rural and community hospitals despite requests from the health care employees. Financial and staffing concerns should not supersede appropriate care and protocols put in place to slow the progression of this contagious and deadly disease. Single lapses can cost lives, and our efforts are wasted unless they are collectively implementing in rural, community, and urban areas. Lack of compliance with recommended practices will ultimately burden our healthcare systems at every level with massive amounts of people seeking hospital care.

The cruel reality is that very few rural hospitals have intensive care units (ICUs) and ventilators necessary to treat serious cases of coronavirus.  Rather, the majority of rural hospitals in Kentucky and other states are critical access hospitals (CAHs), which are intended to provide only emergency and short-term acute care. The federal government relaxed regulations for CAHs last week, allowing them to expand bed capacity and lengths of stay. However, an inadequate supply of health care personnel in rural areas severely limits the abilities of critical access and other rural hospitals to deliver intensive care and respiratory services for patients with coronavirus. Transferring patients from rural to urban hospitals is not a realistic option because many urban hospitals are already facing short supplies of ICUs and ventilators.  

Government officials and health care leaders must immediately take the following actions to lessen the transmission of coronavirus among rural (and urban) citizens and shore up the rural (and urban) hospital capacity: 

• Public service announcements (PSAs). Kentucky and other states desperately need to better communicate the risk of coronavirus and rationale for social distancing to rural citizens.  We have observed no such informational PSAs in Kentucky.  Alabama has an excellent PSA that could be easily adapted.  We additionally should have more short PSAs to illustrate best practices of social distancing, Do it Yourself (DIY) homemade hand sanitizer, handling of outside packages (e.g., mail and other home deliveries), and homemade masks, etc.

• Coordinated coronavirus testing.  Testing should be centralized at designated sites. A site may be a designated hospital, clinic, health department, or drive through testing area. Centralization will reduce coronavirus exposure among health care personnel in multiple emergency departments and clinics serving a given town or city. Of course, governments, health care leaders, and the media must assure that citizen know where to go for testing.

• Coordinated hospital expansion, especially ICUs and ventilator.  State government and the hospital industry must carefully coordinate the expansion of hospital capacity, especially ICUs and ventilators. The supply of ICUs and ventilators must be accurately and continually assessed and then reported in a transparent fashion to hospital administrators, clinicians, and the general public.  

Lastly, we must emphasize that action must be immediate. We cannot wait for the usual convening of task forces that take months to make decisions. Government and hospital leaders must act faster than the rate of coronavirus transmission.  

Ty Borders, PhD, is with theFoundation for a Healthy Kentucky Endowed Chair in Rural Health Policy and the Department of Health Management and Policy at University of Kentucky. He can be emailed at ty.borders@uky.edu. Sam C. Tyagi, MD, FACS, FSVS, RPVI isAssistant Professor of Vascular and Endovascular Surgery in the Department of Surgery at the University of Kentucky. He can be emailed at sam.tyagi@uky.edu.

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