Coronavirus Is Spreading Through Rural South’s High-Risk Population – Reopening Economies Will Make It Worse
By Anne Cafer and Meagen Rosenthal
In the rural South, the COVID-19 pandemic is becoming a silent disaster.
As rural residents commute to jobs in cities and transportation hubs, they're being exposed to the virus and bringing it home to a population already at risk.
Chronic diseases that can lead to more severe COVID-19 symptoms are common across the rural South. The population is older and poorer than much of the country, and the health care system has been deteriorating for years as hospitals lose staff and close.
Despite the population's vulnerability, Southern states have been a stronghold of resistance to federal and international recommendations around COVID-19 protective measures. Most of the states' delays and refusals to enact "shelter-at-home" policies were tied to economic arguments.
Now, governors are using the same economic reasons for loosening those restrictions. Georgia Gov. Brian Kemp called for reopening several types of businesses, including hair salons, starting Friday and restaurants and even theaters starting Monday, despite concerns from public health officials. Mississippi is also considering lifting its shelter-at-home orders for economic reasons. When that happens, service workers, once partially protected from exposure, will find themselves at greater risk.
As University of Mississippi sociologists who work with rural communities on a range of resilience issues, especially health, we are concerned about the economic and health consequences of returning to business before the region is prepared to protect its residents.
Rural Commuters on the Urban Front Lines
Rural areas may seem isolated from the coronavirus threat, but in the South, one in 12 rural residents commutes to an urban hub for work. Many of those jobs are on the front lines of health care and service industries, where exposure to other people is hard to avoid.
In much of the South, "shelter-at-home" orders have had loose interpretations of "essential personnel" who are exempted from the order. They include employees in high-exposure jobs – cashiers, fast food workers and registered nurses, all among the largest employment areas for Southern states. Many of these workers are less likely to have sick leave or be able to work from home. And they are paid lower wages, so many still go to work even when they're sick.
These workers have been saved some exposure while restaurants shifted to drive-through operations and social distancing was encouraged. However, if other Southern states follow Georgia's lead and begin lifting their current protections, workers' chances of being exposed to someone infectious with the coronavirus rise.
Mississippi's rural infection numbers stand out in particular: 62% of the state's coronavirus cases as of mid-April were in rural counties, and the state had counted more than 200 deaths. Rural infection rates were higher than in urban areas: 181 cases per 100,000 people compared to 128 in urban counties. The South as a whole had more urban cases, but still a high rural infection rate.
The South Isn’t Prepared for a COVID-19 Surge
Southern states are already scrambling to manage both detection of coronavirus cases and treatment of the disease. Their testing capacity, essential to controlling the pandemic, has been increasing but remains sporadic and well below the national average. Access to care is increasingly difficult.
Mississippi has just over 400 ICU beds in its largest hospital service area, Jackson. Currently, 100 of those are occupied. Conservative estimates predict that needs for rural ICU beds will double to more than 800 in the next six months under moderate coronavirus infection projections.
Ventilators are an even bigger concern. University of Mississippi Medical Center has only about 125 to 150 ventilators in its facilities, and officials estimate 40% to half are in use on any given day.
The rural South's health profile adds to the risk. The region has higher rates of chronic medical conditions that have been found to significantly increase the likelihood that a person infected with the coronavirus will develop severe COVID-19. Among the first 159 people to die from COVID-19 in Mississippi, over half had cardiovascular disease, over 40% had diabetes or high blood pressure, and one-third were obese.
Much of the care for these patients is being delivered through a shrinking rural health care system. Of the 128 rural hospital closures across the country in the last 10 years, over half were in the South. The pandemic has created more financial troubles for rural hospitals as nonessential procedures have been postponed. Every county in Mississippi is considered underserved, meaning residents don't have enough doctors, even if they have access to a health care facility.
Testing and Investing in Health Care Long-Term
In the short term, Southern states need to increase their testing for coronavirus cases. Per capita, the South administered about 20% fewer tests. Many southern states currently rely on pop-up testing at sites temporarily opened in locations where other facilities are not available. Permanent, well-stocked testing centers would help residents know where to go.
In the long-term, these states need to invest in their rural health infrastructure.
Rural hospitals and pharmacies are essential to reducing long-term risk among rural Southerners, particularly those with chronic health conditions. They are also important "economic anchors" for their communities. According to the American Hospital Association statistics, every dollar spent by a hospital supports US$2.30 of additional business activity within the community and hospitals are a top source of private sector jobs.
Anne Cafer is an Assistant Professor of Sociology at University of Mississippi.
Meagen Rosenthal is an Assistant Professor of Pharmacy Administration at University of Mississippi.
Disclosure statement: Anne Cafer receives funding from Carnegie Foundation, Walmart Giving Foundation. Meagen Rosenthal receives funding from Walmart Giving Foundation, Eshleman Institute for Innovation: Discovery Grants Program, Mississippi Department of Health, UNC TraCS Institute (pilot grant).
Reposted with permission from The Conversation.
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By 2030, almost a third of all the energy consumed in the European Union must come from renewable sources, according to binding targets agreed in 2018. Sweden is helping lead the way.
Sweden is a world leader in renewable energy consumption. Swedish Institute/World Bank
Naturally Warm<p>54% of Sweden's power comes from renewables, and is helped by its geography. With plenty of moving water and 63% forest cover, it's no surprise the <a href="https://sweden.se/nature/energy-use-in-sweden/#" target="_blank">two largest renewable power sources</a> are hydropower and biomass. And that biomass is helping support a local energy boom.</p><p>Heating is a key use of energy in a cold country like Sweden. In recent decades, as fuel oil taxes have increased, the country's power companies have turned to renewables, like biomass, to fuel local 'district heating' plants.</p><p>In Sweden these trace their <a href="https://www.sciencedirect.com/science/article/pii/S0360544217304140#fig3" target="_blank">origins back to 1948</a>, when a power station's excess heat was first used to heat nearby buildings: steam is <a href="https://www.sciencedirect.com/topics/engineering/district-heating-system" target="_blank">forced along a network of pipes</a> to wherever it's needed. Today, there are around 500 district heating systems across the country, from major cities to small villages, providing heat to homes and businesses.</p><p>District heating used to be fueled mainly from the <a href="https://www.sciencedirect.com/science/article/pii/S0360544217304140" target="_blank">by-products of power plants</a>, waste-to-energy plants and industrial processes. These days, however, Sweden is bringing more renewable sources into the mix. And as a result of competition, this localized form of power is now the country's<a href="https://www.sciencedirect.com/science/article/pii/S0360544217304140#fig3" target="_blank" rel="noopener noreferrer"> home-heating market leader.</a></p>
Sweden is using smart grids to turn buildings into energy producers. Huang et al/Elsevier
Energy ‘Prosumers’<p>But Sweden doesn't stop at village-level heating solutions. Its new breed of energy-generation takes hyper-local to the next level.</p><p>One example is in the city of Ludivika where 1970s flats <a href="https://www.buildup.eu/sites/default/files/content/transforming-a-residential-building-cluster-into-electricity-prosumers-in-sweden.pdf" target="_blank">have recently been retrofitted with the latest smart energy technology</a>.</p><p>48 family apartments spread across 3 buildings have been given photovoltaic solar panels, thermal energy storage and heat pump systems. A micro energy grid connects it all, and helps charge electric cars overnight.</p><p>The result is a cluster of 'prosumer' buildings, producing rather than consuming enough power for 77% of residents' needs. With <a href="http://www.diva-portal.org/smash/get/diva2:1232060/FULLTEXT01.pdf" target="_blank" rel="noopener noreferrer">high levels of smart meter usage</a>, it's a model that looks set to spread across Sweden.</p>
<div id="d7bf9" class="rm-shortcode" data-rm-shortcode-id="8757b138d5570bec9d6aad18074a429a"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1273556364263071744" data-partner="rebelmouse"><div style="margin:1em 0">Read more about Western Harbour and book a visit: https://t.co/ujSmVs9rNK 🏡🌳🌊 https://t.co/C5PuPziqIM</div> — Smart City Sweden (@Smart City Sweden)<a href="https://twitter.com/SmartCitySweden/statuses/1273556364263071744">1592474473.0</a></blockquote></div>
Scaling Up<p>A recent development by E.ON in Hyllie, a district on the outskirts of Malmö, southern Sweden, <a href="https://www.eonenergy.com/blog/2019/February/sweden-smart-city" target="_blank">has scaled up the smart grid principle</a>. Energy generation comes from local wind, solar, biomass and waste sources.</p><p>Smart grids then balance the power, react to the weather, deploying extra power when it's colder or putting excess into battery storage when it's warm. The system is not only more efficient, but bills have fallen.</p><p>Smart energy developments like those in Hyllie, Ludivika, and renewable-driven district heating, offer a radical alternative to the centralized energy systems many countries rely on today.</p><p>The EU's leaders have a challenge: how to generate 32% of energy from renewables by 2030. Sweden offers a vision of how technology and local solutions can turn a goal into a reality.</p>
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