How COVID-19 Is Impacting Rural Population Health

According to research from West Virginia University, COVID-19 patients living in rural areas who end up in an intensive care unit face a greater risk of dying, impacting population health.

While the first wave of COVID-19 greatly affected those living in urban areas, researchers saw more cases and deaths in rural populations in the most recent surge.

“This is the first study coming out of Appalachia,” said Sunil Sharma, study lead and chief of West Virginia University’s pulmonary, critical care, and sleep medicine section.

“We were surprised that nobody had made that effort to look at what our community needs are. And if you don’t work in a hospital, I think sometimes there’s this sense of comfort in thinking, ‘Maybe things are not as bad in rural areas,’ but they are. They’re worse than in urban areas.”

The researchers examined data from 81 patients transferred from critical access hospitals and rural facilities to an ICU for more specialized care. Of the 81 patients, 50 were mechanically ventilated due to acute respiratory distress syndrome (ARDS) from COVID-19. The control group included 31 patients who were also ventilated due to ARDS for non-COVID-19 reasons.

“We were so overwhelmed with COVID-19 that we had no cases of ARDS other than COVID-19,” Sharma said. “So, we took ARDS patients from a pre-COVID era as a control group with a very similar amount of lung damage from ARDS.”

The data indicated that 54 percent of rural COVID-19 patients in the sample died within 30 days of being admitted to the ICU, while 30 percent of patients in urban populations died. The research team also found that rural patients with COVID-linked ARDS were more likely to die than their pre-COVID-19 counterparts.

“The COVID group with ARDS had a much higher mortality rate,” Sharma said. “Sixty-eight percent of those people died within 30 days. In the control group, only 42 percent did, even though that group wasn’t any less sick than the COVID group.”

The study results also indicated that if rural COVID-19 patients are intubated, their risk of death spikes if they are over 70 years of age or intubated for more than five days. According to researchers, insights such as this can assist healthcare providers in allocating scarce hospital resources.

“It is very, very difficult because the patients’ family members are just grasping for any kind of information, and in the absence of that, they’re just flailing,” Sharma said. “With this kind of robust information, they’re able to make decisions for their loved one and feel at peace with themselves.”

According to Sharma, worse patient outcomes for individuals living in rural areas could be due to chronic conditions that are more prominent in rural communities, such as diabetes and COPD.

“We realized that because of this crunch in resources, these critical access hospitals were taking the burden of these patients, which they were totally ill-equipped to do,” Sharma explained.

“This wasn’t the fault of the hospitals. They just were not designed to handle this kind of pandemic. You’re talking about the worst type of respiratory failure that you encounter. These are things that we see in tertiary care hospitals, but these critical access hospitals don’t see that. For them, it was very overwhelming to manage those patients.”

To improve population health and lower mortality rates, Sharma urges individuals to get their COVID-19 vaccine.

“We’re not talking about New York City or Atlanta, Georgia,” Sharma stated. “This is us—West Virginia. So, get vaccinated because this is terrible news. Our mortality is much higher than in other areas. If you’re vaccinated and you do get COVID, then, yes, you might have some bad days—you might feel like you have a bad flu — but you’re going to live.”