Struggling rural health care system to get tested by COVID-19 outbreak

Dr. Brent Waters sees a bit of everything at his medical office in Blackshear near the southeast corner of Georgia. Patients come to his clinic for worries ranging from colds and the flu to chronic diseases like diabetes and hypertension as well as bumps, bruises and cuts.

But Waters said lately his office, part of Georgia Physicians South, has been fielding more than 20 calls a day from people concerned they have contracted COVID-19, the disease caused by a new coronavirus.

“One guy came in today, he had gone to Bike Week in Daytona this weekend and his employer wanted him tested even though he wasn’t running a fever, he didn’t have a cough, none of that kind of stuff,” Waters said. “So we told him he didn’t need to get tested, but you know, a lot of them are people that are running fevers, people that have a cough and, you know, some of it, I’m sure is going to come back being coronavirus, but you’re still seeing pneumonia, still seeing a lot of flu.”

Waters said if he still has concerns after speaking to a patient by phone, he’ll have them come to the office and be escorted inside privately for a flu swab. If that comes back negative, he’ll consider performing a test for coronavirus.

As of Monday, patients tested positive in about two dozen Georgia counties including several outside metro areas according to data from the Georgia Department of Public Health. The state agency reported 121 cases Monday. One Georgian has died during this outbreak, a man in Cobb County.

No cases of the disease have been reported yet in Pierce County, where Blackshear sits. Pierce County is considered rural by the 2010 census, with a population density of fewer than 65 people per square mile.

When people come to his office with more serious conditions, the closest emergency room is only 10 miles away in Waycross, Waters said. That’s not bad compared to other rural areas of the state.

Nine of the state’s 159 counties have no physician at all, according to Georgia Health News. Each is in a rural area of the state. Seven rural hospitals have closed since 2010 and about two dozen that remain open are under financial stress in part due to treating a high number of uninsured patients.

Waters said he’s hoping self-isolation will help keep cases low, but he’s concerned about the possibilities if the disease spreads in his area.

“It wouldn’t take a lot of people,” he said. “Waycross has 12 ICU beds, and most of those are usually filled with regular patients, so even if you had 10 cases, it would be a big deal. Handleable, but if it got to be more than that, if you’re talking 25 or 30 or 40 cases, it would get very hard to deal with.”

Many rural hospitals already struggling

Georgia’s rural hospitals have been getting financially squeezed for years, and despite efforts to revive them, many are still in poor shape, said Jimmy Lewis, CEO of a rural hospital association, Hometown Health.

“There’s been a continued erosion, and we’ve got hospitals that are to their court of last resort, and that is doing whatever they can to seek assistance from the local counties and communities to come in and carry the load. And that’s where we’re running out of steam. We’ve run out of steam,” Lewis said.

Lewis told the Georgia Recorder Monday some rural hospitals are already experiencing shortages as the coronavirus spreads.

“What we’re beginning to see is supply chain shortages … whether it be surgical supplies or antiseptic supplies or whatever, the same things that are affecting residences by going to the grocery store and seeing the shelves all empty, that starts to impact what will go on in the rural hospitals,” he said.

Lewis said another challenge for rural hospitals is they tend to run tight crews as it is, so if one team member gets sick, it could have a big ripple effect on performance.

“We rely so much on individual skill sets for the hospital to survive, and if we have one of those skill sets to become infected, suddenly we take away a major part of that rural hospital’s ability to survive … if one of them is infected and quarantined, it puts that person totally out of commission to serve that hospital. And that hospital could be in closure position in very, very short order, and I mean very, very short order,” he said.

Magnifying problems

The challenges Georgia’s rural communities confront with the coronavirus pandemic serve to highlight problems that have been around for a long time, said Laura Colbert, executive  director of Georgians for a Healthy Future, a health care consumer advocacy group.

“Health care has been a top issue for voters and consumers for a number of years now, and I think that we’re seeing exactly what doesn’t work under a magnifying glass,” she said. “So, in Georgia, we’ve got about a 15% uninsured rate. We’ve got many folks above that 15% who have health insurance but are considered underinsured, or even if they don’t fall, technically, within the category of underinsured, many feel like they’re being stretched too thin with premiums and deductibles.”

Rural Georgians are more likely to be uninsured, which makes them more likely to put off visits to the doctor, Colbert said. They also tend to be older and more often have chronic health conditions, which makes them at heightened risk from the coronavirus.

Residents of remote areas also travel longer distances for treatment, and telemedicine is often not an option because of spotty internet coverage.

“I’m not an epidemiologist, and I don’t want to fan the flames of panic, but I think because rural Georgians have those disadvantages already, I do think It makes it harder for rural areas to both prepare and then to respond,” Colbert said.

Pierce County is one of 16 counties under the jurisdiction of the Georgia Department of Public Health’s Southeast Health District.

Only one case of coronavirus has been reported so far in that district, in Charlton County, where Charlton Memorial Hospital closed its doors for good in 2013.

Rebecca Reis, risk communicator for the southeast district, said people who are in those rural areas and have symptoms that might be from coronavirus should first try to see a doctor and then call the health department.

“If you’re not doing well, definitely try to get in touch with a primary care provider,” she said. “If for some reason you can’t get in touch with a primary care provider, we know there are some who are not able to access that, then they can go to the health department, and although we do not have testing in the health department, we will connect them to care.”

Reis added that the 16-county area it represents is still considered low risk for the virus, and that staff are working diligently to keep it that way. She said people can help by practicing good habits such as washing hands, not touching one’s face, staying away from sick people, staying home when sick, covering one’s mouth and disinfecting frequently-touched surfaces.

Waters said he is concerned the ongoing pandemic has the capacity to get out of hand, but he’s hoping good sense and good hygiene will win out.

“As long as people do like they’re supposed to do and stay at home and don’t congregate and that kind of stuff, I think it’ll be fine,” he said. “I think there’s a fine line. I think there’s people that are panicking about it, which I think is unreasonable, and then I think there’s people that are just very lackadaisical about it, and I think needs to be somewhere more in the middle. And if most people stay in the middle, we’ll be fine.”