The COVID-19 pandemic has become a stark reminder of how vulnerable the nation’s healthcare system is to shocks in the demand for healthcare services and supplies.
While the outbreak overwhelming healthcare systems in New York, one of America’s most densely populated areas, has drawn attention to healthcare systems in urban areas, a crisis is also looming in our rural areas. This crisis is perhaps coming sooner rather than later precisely because of urban epidemics.
However, these crises are also a good time to remember that while the virus is a national emergency, the initial response to each new pocket of the outbreak is a local one.
Maine, which likes to call itself Vacation Land, fills with part-time residents and tourists in the warm summer months. In a state full of small towns of only a few thousand, it is easy to spot the part-time residents and the vacationers, and reports have been emerging of New York license plates showing up a few months ahead of schedule.
No doubt, this phenomenon is not unique to Maine, or likely even to small towns in New England. Residents of densely populated outbreak hot spots are likely fleeing the epidemic and seeking shelter in more remote regions where human contact is less intense. Unfortunately, in the absence of official data collection, the magnitude of such moves remains unknown, and planning cannot be done effectively without this information.
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Population swells in rural areas are a critical piece of information right now. New York area hospitals may be overrun, and the same thing can happen with rural hospitals, but with greater speed and greater consequence.
The entire state of Maine, for example, has roughly 300 ICU beds total, with some small hospitals having only a single ventilator or no ventilators at all, a crucial tool in caring for patients with life-threatening respiratory infections. Existing ventilators may not be sufficient to deal with an uptick in need from state residents, let alone shoulder the burden of caring for an influx of out-of-staters.
Many rural hospitals that were in financially precarious positions before the public health emergency have been further destabilized during the public health emergency due to cancellations of elective procedures and empty beds, necessitating reductions in staffing across the country to help control costs in the absence of revenue.
However, as we have seen in hard-hit parts of the country, a COVID-19 outbreak can quickly and unexpectedly swamp local healthcare systems. While healthcare systems around the country have been making efforts to prepare for the COVID-19 pandemic, the response any hospital is capable of is limited by the resources it has.
Rural hospitals that are resource constrained under normal circumstances and not equipped to deal with large volumes of medically complex patients requiring long hospital stays may be even further constrained following this prolonged period of poor cash flow and staff reductions.
Then there are the more persistent challenges of simply ensuring access to basic supplies, like personal protective equipment in the hospitals, of which we have been seeing nationwide shortages. FDA is using its authority to relax certain restrictions and fast-track authorizations for critical products, such as COVID-19 diagnostic tests, ventilators and other medical devices, but shortages continue to be a challenge.
It is also critical to point out that medical emergencies unrelated to COVID-19 continue, and those patients need care as well. At a time when rural hospitals have been closing and access to care in rural America has already been a challenge, COVID-19 is a crisis waiting to happen, and a crisis that may be hastened by a migration of city dwellers to their summer homes that stress healthcare systems that are already vulnerable.
Finally, many of these out-of-staters may fall ill but not require hospitalization. They will not, however, have a primary care physician and pharmacy setup in Maine (or other rural state of destination). As hospitals and primary care practices attempt to rapidly pivot to remote monitoring and telehealth solutions to care for their patients, out-of-staters may not have these existing relationships and may be even more likely to attempt to visit a hospital.
Further, rural communities, especially those with other socioeconomic challenges, may find it especially difficult to convince local residents to use these remote tools as they often require digital savviness, access to home computers and other technologies, an adequate high-speed internet infrastructure and a fundamental trust in healthcare institutions.
America’s response to COVID-19 so far has been largely one of reacting to problems only after they could no longer be easily controlled. The resources of America are already stretched such that we are unlikely to be able to devote resources for a high level of preparedness everywhere.
However, we can try to predict where the next hot spots will be and which health systems will need to be ready—but prediction requires data. It requires data regarding how people are moving and where they are going. This is where companies with location tracking technology already widely used by consumers can help. There is no doubt that these companies are already thinking about how to use these data to model disease spread and making predictions—rural health would be an important focus of their technologies.
There are privacy concerns, as there should be, but data need not be individually identifiable, nor should they need to find their way into the hands of law enforcement.
Rural health preparedness is likely not the only place big data can be meaningfully applied. However, rural healthcare systems, in particular, stand a better chance of being prepared and receiving advance assistance when predictive analytics are made available and powered by near real-time location data.
Views expressed are those of the writer and do not necessarily reflect the position of the broader firm or its clients. Paul Gerrard, M.D., is vice president at McDermott+Consulting.