After weeks of infiltrating urban areas, the omicron variant is expected to hit rural parts of North Carolina even worse.
On Tuesday, some counties in eastern North Carolina reported record-breaking numbers of COVID-19 cases. Scientists from UNC-Chapel Hill, NC State, and Georgia Tech project that hospitalizations in rural areas are about to increase four-to-six times what they were last week.
On top of that, rural communities have been facing a health care worker shortage for years. All but one rural county in North Carolina are undergoing a shortage of primary care workers — the only exception, Moore County, is still short on dental health care professionals. The shortage was already there, but got worse as COVID did.
When you do the math, it’s clear: twice the cases and half the health care workers mean rural health care systems are unprepared for the ongoing explosion of cases, both among their community and among their staff.
This is part of the same cycle we’ve seen throughout two years of COVID-19. After cases appear in densely-populated cities across the United States, they end up in North Carolina’s urban areas. After a few weeks, cases begin spiking in rural areas of the state, and the devastation worsens.
Folks living in rural areas were already twice as likely to die from COVID-19. Rural areas also have lower vaccination rates for people over 65 than more urban parts of North Carolina.
There should be more short-term solutions, like increasing the small number of FEMA ambulances and national guard members deployed into rural communities. There should also be more preventative community work on the importance of continuing to wear masks, even as we get tired of them.
But the problem can’t be boiled down to COVID. It’s proof of a long-term problems with the commodification of the health care system, and how it operates as a business venture more than a public need.
Eleven hospitals in rural North Carolina have closed since 2005, and only two were transformed into an urgent care or outpatient option in the years since. As of 2017, eight more of these hospitals were considered in financial distress.
Facilities, however, are still being built.
In July, Atrium Health got approval for a $154 million hospital in Cornelius, a Charlotte suburb. In December, Novant Health announced a $169 million facility in Matthews, another Charlotte suburb. The Triangle has recently added a new UNC Rex hospital in Holly Springs, added onto a WakeMed hospital in Cary, and is expected to see the completion of a Duke University hospital by 2026.
Rural areas also are failing to attract young doctors, nurses, and other providers. There are programs where medical school attendees can have their student loans partially paid for if they agree to work in rural areas with health care worker shortages, but keeping them in these communities after the contracts end requires looking at the community outside of health care.
Brandy Bynum Dawson, the Senior Director of Policy and Advocacy at the NC Rural Center, says one of the economic non-profit’s concerns is growing businesses in these rural areas, and creating a place that folks would consider moving to, from good schools to exciting places to shop and eat. If you create an inviting community, you’ll invite new workers of all kinds to the area, including doctors.
“The rural, small downtowns are really key and pivotal to driving interest in investment in communities across the state,” Bynum Dawson says.
One solution continues to stare down the NC General Assembly: expanding Medicaid. The Rural Center estimates that closing the health insurance gap would bring in $5.6 billion over four years to North Carolina’s rural communities, and add 43,000 jobs. Closing that gap means more insured people, which would hypothetically mean fewer people dependent on uncompensated care offered by non-profit hospitals. This affects rural hospitals in particular, where people are more likely to be uninsured and therefore likelier to seek out care after problems have worsened instead of proactively. This also is worsened by the underlying health conditions folks in rural areas are likelier to have.
But zoom out to the bigger picture. North Carolina needs health care workers everywhere, but especially in rural areas. Maybe we need to be thinking about what more we could offer.