At the beginning of the COVID-19 pandemic, some studies showed that rural and small town hospitals could be overwhelmed in a surge and potentially unable to provide care to all who might need it.
Today, nearly six months after the first reported COVID-19 cases in Missouri, rural counties are becoming the newest hot spots, but many of these places still lack all the tools needed to fight the virus, according to some public health experts.
Lack of funding and contact tracing measures, as well as ongoing issues with testing, will make it harder for these places to reduce virus spikes that public health advocates say could’ve been avoided.
“Other countries have shown us this did not have to be our inevitable outcome,” says Lynelle Phillips, vice president of the Missouri Public Health Association. “We could’ve had a whole different path here, and we didn’t take action soon enough.”
The residents of Pettis County spent months watching COVID-19 from afar, first in China, then on the coasts, then in Kansas City. And today, this county of 42,000 in central Missouri has a higher seven-day infection rate than Kansas City or Saint Louis.
The once far-off threat has suddenly become personal to the staff at Bothwell Regional Health Center in Sedalia.
“In the case of smaller communities, you’re taking care of neighbors,” says Bothwell CEO Lori Wightman. “And you’re taking care of family members of friends.”
Pettis County is one of five rural or small-town counties in Missouri with higher infection rates in the last week than those in big cities. Other include Dunkin, New Madrid, Shelby and Taney counties.
Wightman says that in many ways, the community and hospital are in better shape than they had once feared.
Improved treatments for COVID-19 have meant fewer deaths and shorter hospitalizations. And because the average age of people testing positive has been trending younger — reaching 43 as of this week — fewer of the cases are as severe.
Missouri has focused its COVID-19 efforts on protecting hospital capacity, and it’s managed to shore up supplies of masks and other protective equipment. But Bert Malone, who’s on the board of the Missouri Public Health Association, says the state missed the most important elements of getting places like Pettis County prepared for the virus.
“The fact of the matter is that the hospitals are on the endpoint of this pandemic,” Malone says. “They are where you go when you are critically ill. The most effective strategy should be put at the front end of preventing disease, preventing individuals so they don’t have to go to the hospital.”
Testing and data reporting continue to be problems in Missouri.
Just a week and a half ago, the state appeared to have the second highest rate of increase in new cases in the country. State officials, however, said the jump was due to a case backlog, and a few days later average new case numbers dropped by about a third.
Then, over the weekend, the state missed reporting for two days after it upgraded its reporting system.
Claire Standley, an infectious disease researcher at Georgetown University, says inconsistencies like these can undermine the public’s understanding of the coronavirus' threat.
“Just because official case counts may vary slightly over time doesn’t mean that the virus is suddenly going away and suddenly coming back and then suddenly going away again. Transmission is being maintained within the community, and it’s just our ability to count those cases that is changing,” Standley says.
Health advocates, meanwhile, say that many Missouri health departments are struggling to report test results and trace contacts in large part because they still have not received the emergency federal CARES funding passed by Congress back in March.
Gov. Parson in May authorized the federal money to be given to county commissions, which were expected to pass it along to local health departments. But that hasn’t always happened, in many cases because of local politics and competition for the funds.
Health departments in at least 50 counties had not received CARES funding as of mid-July, according to survey results released by Missouri’s Department of Health and Senior Services. The department did not respond to inquiries about the current state of CARES funding.
Malone, the public health advocate,says that, today, many health departments are unsure if they will ever get federal emergency funds.
“It’s a heck of a way to run a railroad, if you ask me,” Malone says.
Then there’s the issue of masks.
Missouri has made national news several times this summer after videos surfaced of pool parties and other eye-popping violations of mask and social distancing recommendations.
Gov. Parson, however, has scoffed at the idea of a statewide mask order, insisting it should be a matter of “personal responsibility.”
Many small towns and communities, including Pettis County, have recently approved mask mandates, but only after case numbers hit new highs.
Bothwell CEO Wightman says that so far, her hospital is operating below capacity, and she’s glad that community leaders are taking the virus seriously. But Pettis County is now in uncharted territory, with growing cases numbers and public school officials planning to resume classes at the end of the month.
Wightman thinks it didn’t have to be this way.
“I know that, had we had more people wearing masks earlier, we may have avoided having so many people in our community and so many people in the hospital due to this infection,” Wightman says. “And we wouldn’t have even been having a conversation about, 'Gee, can we even be returning kids to school?’”
