Rural America Could Be the Region Hardest Hit by the COVID-19 Outbreak
By Christopher Curley
The COVID-19 pandemic has already swept through cities and urban centers.
Now, the illness appears to be building like an infectious prairie fire in rural America, as well as in larger towns in the Midwest.
That wasn't the case just a few weeks ago.
"Many rural communities aren't seeing anything. They're simply having to prepare for what they know is coming," Dr. Randall Longenecker, the assistant dean for rural and underserved programs at Heritage College of Osteopathic Medicine at Ohio University, told Healthline in late March. "[But] it will come, no matter what."
Longenecker's prediction appears to be coming true.
In South Dakota, more than 1,300 residents have now tested positive for COVID-19. More than 500 of those cases are employees of the Smithfield Foods meat processing plant in Sioux Falls that was closed until further notice on Wednesday.
A team from the Centers for Disease Control and Prevention (CDC) visited the plant on Thursday. The complex, which employs 3,700 people, is now considered the largest COVID-19 hot spot in the nation.
Smithfield Foods has also announced plans to close pork processing plants in Wisconsin and Missouri.
Despite these increases in infections, there are still five states, four of them in the Midwest, that have no shelter-in-place orders.
There are also three other states that have restrictions in only some of their communities.
Among the states without any sheltering orders is South Dakota, which now has by far the highest number of COVID-19 cases per capita than any Midwestern state.
Nebraska also hasn't instituted any sheltering orders.
In that state, the owner of the Nebraska Crossing mall plans a "soft reopening" of his shopping center next weekend. That complex sits along Interstate 80 between the population centers of Lincoln and Omaha.
All of this has experts worried about what's in store for the middle of the country.
A potential recipe for disaster
Rural areas may end up being among the hardest hit regions due to their demographics and lack of resources.
The 15 percent of people in the United States who live in rural areas are largely a higher-risk population that's particularly vulnerable to serious outcomes with COVID-19.
In addition, many people in rural areas live 30 or more miles away from the nearest hospital.
"Systems that are under stress during routine times will be more stressed during disasters and times of crisis. Sometimes we forget those systems that are at the brink," said Tricia Wachtendorf, PhD, director of the Disaster Research Center at the University of Delaware.
Rural health systems already stretched financially are therefore particularly vulnerable, but so are rural areas that don't have as deep a bench of resources to tap when times get tough.
"When you start thinking about recovery trajectories and impacts, the extent to which there is community functioning before a disaster has strong implications in that recovery trajectory post-disaster," Wachtendorf told Healthline. "That goes right down the spectrum: transportation systems, employment support, hospitals and public health, food security — all the key systems. If those are low pre-disaster, those are going to have substantial effects on what communities experience during the disaster, as well as their post-disaster recovery."
Older and Less Healthy
Rural populations tend to be older and face a higher risk of death from heart disease, cancer, lower respiratory disease, stroke, and unintentional injuries.
Nearly 20 percent of the population in completely rural counties is 65 and older, according to U.S. census data, compared with around 15 percent in mostly urban centers.
Americans living in rural areas also tend to have higher rates of cigarette smoking, high blood pressure, and obesity, compared with their urban counterparts.
Both older age and cigarette smoking are two factors tied to a higher risk of severe illness or death from COVID-19.
Despite these statistics, there's a sense among some experts that some people in rural communities, as well as political leaders in these states, haven't taken the threat of COVID-19 seriously enough.
Initially, "Less dense areas might be at an advantage compared to geographic areas that are more densely populated, and they may also be less connected to some areas where there's a concentrated case," Wachtendorf said in late March.
But once these communities do start to see cases, they might struggle to fill basic public safety and administrative roles, especially if people such as police officers and firefighters get sick and have to self-quarantine.
Despite this potential threat, Mississippi Gov. Tate Reeves, Missouri Gov. Mike Parson, and Alabama Gov. Kay Ivey all rejected calls in late March to issue shelter-in-place orders that are common in other states to try to slow the spread of the disease and help flatten the curve.
Doctors in Tennessee also urged that state's governor in late March to issue a shelter-in-place order.
In addition, Reeves issued an executive order in late March that seemed to exempt most businesses in Mississippi from closures, muddying the public's understanding of how to respond to the crisis.
Neighboring Louisiana saw its COVID-19 cases soar in late March, recording the highest growth rate in the world in the first 2 weeks since its first confirmed case.
But even there, with Louisiana Gov. John Bel Edwards urging residents to stay home, some were defying those recommendations.
In the town of Central, Louisiana, for instance, the Life Tabernacle Church continued to host gatherings of 1,000 people or more as COVID-19 cases mount.
These religious services were held as President Donald Trump suggested that some businesses could reopen and people could "pack" churches on Easter Sunday.
The president backed off that notion and then announced he has extended his administration's guidelines on social or physical distancing until April 30.
Experts say any lack of physical distancing could have ripple effects that overwhelm rural hospitals and disrupt essential services down the line.
"If someone gets sick in those areas or an agency or department gets sick, there may be fewer people within those agencies to continue operations, leaving that particular community more vulnerable," Wachtendorf said.
A lack of hospitals
Medical facilities known as critical access hospitals, which have 25 beds or fewer and are 35 miles away from the closest facility, are among the ones that have closed at the highest rates in the past two decades, even as their closure rate slowed somewhat thanks to provisions in the Affordable Care Act.
"Rural hospitals, on the whole, they're going to see their curve, whether it's flat or not, start a whole lot later, maybe 3 weeks, 6 weeks," Longenecker told Healthline.
In the meantime, however, "Rural hospitals right now are seeing a steep decline in activity, empty beds, and empty practices, so for right now there's a steep loss of revenue."
For those rural hospitals — ones that remain after more than 80 have closed since 2010 and nearly 700 more found themselves on the brink of closure — that loss of revenue illuminates a dangerous teetering in our health system, as administrators try to balance the costs of staying afloat against the predicted flood of eventual COVID-19 cases.
In the meantime, many of these critical access hospitals are operating with bare-bones staff.
"What's happening is the wave hasn't come yet here," said Jane, a travel nurse working at a critical access hospital in Wisconsin. "We're down to two teams working here per day, which is OK most days because procedures keep getting canceled and falling off, but yesterday, we were working our (tails) off and I'm wondering why are we down to a skeleton crew? It's because they're trying to save money for when the s— really hits the fan."
By then, supply shortages and other issues may have already rocked the system, Longenecker said.
"Hopefully some things will be worked out, like the supply of testing and supply of personal protective equipment, or not. They may have already sent them to the city," he said.
"What scares me is that — because there's not confirmed cases up here yet and there's only two in the county. I'm just worried that we're going to get overlooked when it happens, and we're going to be up a creek," she told Healthline. "I think a hospital is not a place you want to be right now unless you absolutely have to be."
Part of the reason rural areas are so vulnerable to the COVID-19 health crisis is that they were vulnerable to begin with.
Rural zip codes lost almost 20 percent of their hospital beds between 2006 and 2017, according to a study from the Economic Innovation Group (EIG), a bipartisan public policy organization.
But that doesn't tell the whole story. Within this study, EIG found that economically distressed rural areas were especially affected.
Put another way, "There are fewer than half as many hospital beds per capita reasonably accessible from the average rural distressed zip code as are from the average rural prosperous one," the report says.
Wachtendorf noted the example of hospital closures funneling people from a wide geographic radius into central, overburdened regional health centers, as well as local clinics that aren't full hospitals, as potential points of strain in the system in a crisis.
Rural areas that rely on farming as a main source of income might also find themselves in a particular bind.
"It's not like you could just take 2 weeks off and think the crops will still be there," Wachtendorf said. "Some of that seasonal work is very much dependent on timing. And it's not just a matter of pushing off that production for 2 weeks or a month. It's either done now or it's not done at all."
Is telemedicine the answer?
One way in which hospitals and doctors are dealing with this ongoing crisis in rural and urban centers is through telemedicine.
Not every patient is a patient with COVID-19, so those who can receive care from their homes and thus stay out of overburdened hospitals are a benefit to the system at large.
"Prior to COVID-19, we were seeing much more of a demand for telehealth in rural areas," said Pamela Ograbisz, DNP, FNP-BC, director of telehealth at LocumTenens.com, a healthcare staffing agency. "In a way, COVID-19 leveled the playing field in healthcare by erasing the boundaries between rural areas and large cities. It doesn't matter where patients are located; they need care.
"Because of this and because clinicians are overwhelmed, demand for telehealth has gone up across the board," Ograbisz told Healthline.
But telemedicine can only go so far, and won't fix the fragmentary nature of the American healthcare system, Longenecker said.
"It's hard, as individualistic as we are as Americans, for us to think about the good of the community or think epidemiologically, which is a very different way of thinking than just thinking about me and my family," he said. "But anything we could do to be less fragmented and to be more systemic (as a healthcare system) would be really, really good."
Many people shop online for everything from clothes to appliances. If they do not like the product, they simply return it. But there's an environmental cost to returns.
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EcoWatch Daily Newsletter
By Dolf Gielen and Morgan Bazilian
John Kerry helped bring the world into the Paris climate agreement and expanded America's reputation as a climate leader. That reputation is now in tatters, and President-elect Joe Biden is asking Kerry to rebuild it again – this time as U.S. climate envoy.
Energy Is at the Center of the Climate Challenge<p>The <a href="https://science2017.globalchange.gov/chapter/1/" target="_blank">effects of climate change</a> are already evident across the globe, from <a href="https://theconversation.com/100-degrees-in-siberia-5-ways-the-extreme-arctic-heat-wave-follows-a-disturbing-pattern-141442" target="_blank">extreme heat waves</a> to <a href="https://science2017.globalchange.gov/chapter/12/" target="_blank">sea level rise</a>. But while the challenge is daunting, there is hope. Solar and wind power have become the <a href="https://www.irena.org/publications/2020/Jun/Renewable-Power-Costs-in-2019" target="_blank">cheapest forms of power generation globally</a>, and technology progress and innovation continue apace to support a transition to clean energy.</p><p>In the U.S. under a Biden administration, long-term national climate legislation will depend on who controls the Senate, and that won't be clear until after two run-off elections in Georgia in January.</p><p>But there is no shortage of <a href="https://www.bloomberg.com/features/2020-biden-climate-change-advice/" target="_blank">ideas for ways Biden</a> could still take action even if his proposals are blocked in Congress. For example, he could use executive orders and direct government agencies to tighten regulations on greenhouse gas emissions; increase research and development in clean energy technologies; and empower states to exceed national standards, <a href="https://www.reuters.com/article/us-autos-emissions-california/defying-trump-california-locks-in-vehicle-emission-deals-with-major-automakers-idUSKCN25D2CH" target="_blank" rel="noopener noreferrer">as California did in the past with auto emission standards</a>. A focus on a just and equitable transition for communities and people affected by the decline of fossil fuels will also be key to creating a sustainable transition.</p><p>The U.S. position as the world's largest oil and gas producer and consumer creates political challenges for any administration. U.S. forays into European energy security are often treated with suspicion. Recently, France blocked <a href="https://www.wsj.com/articles/frances-engie-backs-out-of-u-s-lng-deal-11604435609" target="_blank">a multi-billion dollar contract</a> to buy U.S. liquefied natural gas because of concerns about limited emissions regulations in Texas.</p><p>Strengthening cooperation and partnerships with like-minded countries will be critical to bring about a transition to cleaner energy as well as sustainability in agriculture, forestry, water and other sectors of the global economy.</p>
Creating a Global Sustainable Transition<p>How the world recovers from COVID-19's economic damage could help drive a lasting shift in the global energy mix.</p><p>Nearly one-third of Europe's US$2 trillion economic relief package <a href="https://www.bloomberg.com/news/articles/2020-07-21/eu-approves-biggest-green-stimulus-in-history-with-572-billion-plan" target="_blank" rel="noopener noreferrer">involves investments that are also good for the climate</a>. The European Union is also strengthening its 2030 climate targets, though each country's energy and climate plans will be critical for successfully implementing them. The <a href="https://joebiden.com/clean-energy/" target="_blank" rel="noopener noreferrer">Biden plan</a> – including a $2 trillion commitment to developing sustainable energy and infrastructure – is aligned with a global energy transition, but its implementation is also uncertain.</p><p>Once Biden takes office, Kerry will be joining ongoing <a href="https://www.un.org/en/conferences/energy2021/about#:%7E:text=The%20overarching%20goal%20of%20the,2030%20Agenda%20for%20Sustainable%20Development.&text=Accelerate%20delivery%20of%20United%20Nations,related%20issues%20at%20all%20levels." target="_blank" rel="noopener noreferrer">high-level discussions on the energy transition</a> at the U.N. General Assembly and other gatherings of international leaders. With the U.S. no longer obstructing work on climate issues, the G-7 and G-20 have more potential for progress on energy and climate.</p><p>Lots of technical details still need to be worked out, including international trade frameworks and standards that can help countries lower greenhouse gas emissions enough to keep global warming in check. <a href="https://www.carbonpricingleadership.org/what" target="_blank" rel="noopener noreferrer">Carbon pricing</a> and <a href="https://www.csis.org/analysis/how-can-europe-get-carbon-border-adjustment-right" target="_blank" rel="noopener noreferrer">carbon border adjustment taxes</a>, which create incentive for companies to reduce emissions, may be part of it. A consistent and comprehensive set of national energy transition plans will also be needed.</p><p>The global shift to <a href="https://www.irena.org/publications/2019/Jan/A-New-World-The-Geopolitics-of-the-Energy-Transformation" target="_blank">clean energy will also have geopolitical implications for countries and regions</a>, and this will have a profound impact on wider international relations. Kerry, with his experience as secretary of state in the Obama administration, and Biden's plan to make the climate envoy position part of the National Security Council, may help mend these relations. In doing so, the U.S. may again join the wider community of countries willing to lead.</p>
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By Maria Caffrey
As we approach the holidays I, like most people, have been reflecting on everything 2020 has given us (or taken away) while starting to look ahead to 2021.
We Need More Than Listening<p>By now we have all become sadly accustomed to the current administration sidelining scientists, most prominently Dr. Anthony Fauci, because the facts they provide do not fit with the political rhetoric of the moment.</p><p>I have <a href="https://www.csldf.org/2019/08/22/csldf-helps-climate-scientist-maria-caffrey-fight-for-scientific-integrity/" target="_blank">my own history</a> of filing a scientific integrity complaint with the National Park Service (which falls under the Department of the Interior) after senior ranking employees attempted to censor one of my scientific reports. I know all too well the damage and pain that these actions cause, not just for the individual scientist, but also because these <a href="https://www.ucsusa.org/resources/attacks-on-science" target="_blank" rel="noopener noreferrer">attacks on science</a> over the last few years have undermined sound, evidence-based decision making.</p><p>President-elect Biden has repeatedly said that he will <a href="https://thehill.com/homenews/521638-trump-biden-will-listen-to-the-scientists-if-elected" target="_blank" rel="noopener noreferrer">listen to the scientists</a>. While this is certainly a welcome change, listening can only take us so far. This past week Lauren Kurtz from the <a href="https://www.csldf.org/" target="_blank" rel="noopener noreferrer">Climate Science Legal Defense Fund</a> and my colleague <a href="https://www.ucsusa.org/about/people/gretchen-goldman" target="_blank" rel="noopener noreferrer">Gretchen Goldman</a> published <a href="https://www.scientificamerican.com/article/ten-steps-that-can-restore-scientific-integrity-in-government/" target="_blank" rel="noopener noreferrer">an article</a> listing 10 actions the new administration should implement to show their commitment to strengthening government science:</p><ol><li>Clearly prohibit political interference and censorship.</li><li>Protect scientists' communication rights.</li><li>Acknowledge that attempts to violate scientific integrity, even if ultimately not fruitful, are still violations.</li><li>Protect federal scientists' right to provide information to Congress and other lawmakers.</li><li>Commit to incorporating the best science as part of agency decisions.</li><li>Elevate agency scientific integrity policies to have the full force of law.</li><li>Publicly release anonymized information about scientific integrity complaints and their resolutions at every agency.</li><li>Institute an intra-agency workforce, potentially under the White House <a href="https://www.ucsusa.org/sites/default/files/2020-09/strengthening-science-and-si-at-ostp.pdf" target="_blank" rel="noopener noreferrer">Office of Science and Technology Policy</a>, to coordinate scientific integrity efforts across agencies, foster discussion of policy improvements, and standardize criteria for policies across agencies.</li><li>Strengthen whistleblower protections.</li><li>Ensure that policies cover all actors who will be dealing with science.</li></ol>
Time for Action<p>I have spoken to many scientists, particularly federal scientists, who are eager to turn the page so they can hurry back to the work they had been doing before this administration, but I urge caution in assuming that things can be "normal" again.</p><p>Before Trump, I naively thought the scientific integrity policies established during the <a href="https://obamawhitehouse.archives.gov/blog/2016/12/19/scientific-integrity-policies-update" target="_blank">Obama administration</a> would be sufficient. I never imagined that any administration could so willfully ignore and attack expert advice and evidence that is intended to protect us and our public lands.</p><p>I have personally witnessed how hard our federal scientists work. They put in long hours with minimal pay (far less that what they could get if they worked in private industry) to pursue one simple goal: to make things better for the nation.</p><p>We need stronger scientific integrity policies to protect these people and their work. But more than that, we need stronger scientific integrity laws because they also benefit society.</p>
By Andrea Germanos
Environmental campaigners stressed the need for the incoming Biden White House to put in place permanent protections for Alaska's Bristol Bay after the Trump administration on Wednesday denied a permit for the proposed Pebble Mine that threatened "lasting harm to this phenomenally productive ecosystem" and death to the area's Indigenous culture.
<div id="da98c" class="rm-shortcode" data-rm-shortcode-id="478a197b7c59c92787c92bec92f1ac39"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1331662923710693376" data-partner="rebelmouse"><div style="margin:1em 0">Bristol Bay forever, Pebble mine never. #NoPebbleMine #SaveBristolBay https://t.co/CBQ9zuy8A5</div> — Save Bristol Bay (@Save Bristol Bay)<a href="https://twitter.com/SaveBristolBay/statuses/1331662923710693376">1606328156.0</a></blockquote></div>
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In the midst of a pandemic, sales of cleaning products have skyrocketed, and many feel a need to clean more often. Knowing what to look for when purchasing cleaning supplies can help prevent unwanted and dangerous toxics from entering your home.