COVID-19 in a Rural Health System in New York – Case Series and an Approach to Management

Abstract

Background: Many rural hospitals and health systems in the U.S. lack sufficient resources to treat COVID-19. We developed a system for managing inpatient COVID-19 hospital admissions in St. Lawrence County, an underserved rural county which is the largest county in New York State. Methods: We used a hub and spoke system to route COVID-19 patients in the St. Lawrence Health System to its flagship hospital. We assembled a small clinical team to manage admitted COVID-19 patients and to stay abreast of a quickly changing body of literature and standard of care. We subsequently completed a review of clinical data for patients who were treated by our inpatient COVID-19 treatment team between March 20 and May 22, 2020. Results: Twenty COVID-19 patients were identified. Sixteen patients (80%) met NIH criteria for severe or critical disease. One patient died. No patients were transferred to other hospitals. Conclusions: During the first two months of the pandemic, we were able to manage hospitalized COVID-19 patients in our rural community. Development of similar treatment models in other rural areas should be considered.

Exploring rural doctors’ early experiences of coping with the emerging COVID‐19 pandemic

“…Lessons learned from this study include the importance of rural doctors’ creativity and leadership in local solution‐focused strategies within their own context during crises. These findings parallel accounts of rural “collaboration and creativity” from the United States, where small communities mobilized the resources available to them, building local capacity to respond to the COVID‐19 crisis 19,20 …”

“…These findings parallel accounts of rural "collaboration and creativity" from the United States, where small communities mobilized the resources available to them, building local capacity to respond to the COVID-19 crisis. 19,20 Participants described emotion-focused coping strategies to manage their stress, such as meditation or prayer, taking time for physical F I G U R E 1 Appraisal processes and coping strategies related to rural doctors responding to COVID-19 (adapted from Folkman, 1997) 17 activity, and maintaining social contact with family and friends. Sharing experiences with peers was a vital source of information and support for these doctors, as reported elsewhere.…”