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1. Progression of COVID‐19 From Urban to Rural Areas in the United States: A Spatiotemporal Analysis of Prevalence Rates

   https://doi.org/10.1111/jrh.12486  

   Paul, Rajib ; Arif, Ahmed A. ; Adeyemi, Oluwaseun ; Ghosh, Subhanwita ; Han, Dan ( June 2020 , The Journal of Rural Health)

   There are growing signs that the COVID‐19 virus has started to spread to rural areas and can impact the rural health care system that is already stretched and lacks resources. To aid in the legislative decision process and proper channelizing of resources, we estimated and compared the county‐level change in prevalence rates of COVID‐19 by rural‐urban status over 3 weeks. Additionally, we identified hotspots based on estimated prevalence rates.

   We used crowdsourced data on COVID‐19 and linked them to county‐level demographics, smoking rates, and chronic diseases. We fitted a Bayesian hierarchical spatiotemporal model using the Markov Chain Monte Carlo algorithm in R‐studio. We mapped the estimated prevalence rates using ArcGIS 10.8, and identified hotspots using Gettis‐Ord local statistics.

   In the rural counties, the mean prevalence of COVID‐19 increased from 3.6 per 100,000 population to 43.6 per 100,000 within 3 weeks from April 3 to April 22, 2020. In the urban counties, the median prevalence of COVID‐19 increased from 10.1 per 100,000 population to 107.6 per 100,000 within the same period. The COVID‐19 adjusted prevalence rates in rural counties were substantially elevated in counties with higher black populations, smoking rates, and obesity rates. Counties with high rates of people aged 25‐49 years had increased COVID‐19 prevalence rates.

   Our findings show a rapid spread of COVID‐19 across urban and rural areas in 21 days. Studies based on quality data are needed to explain further the role of social determinants of health on COVID‐19 prevalence.

    

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2. Which ‘Public’ in Public Health? : LGBTQ+ Black and Latinx Mobilization in the US D uring the COVID - 19 Pandemic

   Nolan Kline ( October 2021 , Society for the Scientific Study of Science annual meeting)

   During the COVID - 19 pandemic, the United States (US) operated a patchwork response of varying closures and restrictions that depended on individual states. At the federal level, efforts to address COVID - 19 risk focused primarily on elderly populations and largely ignored the disproportionately high risk of COVID - 19 exposure among Black , Latin x, and lesbian, gay, bisexual, transgender and otherwise queer - identifying (LGBTQ+) populations . These groups have elevated risk of COVID - 1 9 exposure due to social, political, and economic vulnerabilities that structure poor health. In this paper, I describe how a grassroots racial, sexual, and gender justice organization responded to state failings in meeting the needs of LGBTQ+ Black and Latinx populations during the COVID - 19 pandemic. Drawing from ongoing ethnographic fieldwork in Orlando, Florida, that began in 2016 following the Pulse shooting, I describe how a social justice organization advanced a notion of intersectional belonging in response to the absence of health and social services during the COVID - 19 pandemic. Specifically, I show how one organization, the Contigo Fund, created an LGBTQ+ COVID - 19 relief effort that provided financial assistance to Black and Latinx LGBTQ+ populations when the state of Florida failed to marshal resources for its most marginalized communities . The state’s failure is just one of many ways the state has historically refused to meet the needs of populations with intersecting queer and racial minority identities , reproducing longstanding health and social inequities. Overall, I argue that the Contigo Fund’s response demonstrates how grassroots mobilization can challenge the necropolitcs of state - sponsored neglect and advance health equity 

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3. Risk perceptions and behaviors concerning rural tourism and economic-political drivers of COVID-19 policy in 2020

   https://doi.org/10.1371/journal.pone.0299841  

   Lieberthal, Brandon ; Jackson, Sarah ; de_Urioste-Stone, Sandra ( April 2024 , PLOS ONE)

   Alam, Mumtaz (Ed.)

   When COVID-19 was first introduced to the United States, state and local governments enacted a variety of policies intended to mitigate the virulence of the epidemic. At the time, the most effective measures to prevent the spread of COVID-19 included stay-at-home orders, closing of nonessential businesses, and mask mandates. Although it was well known that regions with high population density and cold climates were at the highest risk for disease spread, rural counties that are economically reliant on tourism were incentivized to enact fewer precautions against COVID-19. The uncertainty of the COVID-19 pandemic, the multiple policies to reduce transmission, and the changes in outdoor recreation behavior had a significant impact on rural tourism destinations and management of protected spaces. We utilize fine-scale incidence and demographic data to study the relationship between local economic and political concerns, COVID-19 mitigation measures, and the subsequent severity of outbreaks throughout the continental United States. We also present results from an online survey that measured travel behavior, health risk perceptions, knowledge and experience with COVID-19, and evaluation of destination attributes by 407 out-of-state visitors who traveled to Maine from 2020 to 2021. We synthesize this research to present a narrative on how perceptions of COVID-19 risk and public perceptions of rural tourism put certain communities at greater risk of illness throughout 2020. This research could inform future rural destination management and public health policies to help reduce negative socioeconomic, health and environmental impacts of pandemic-derived changes in travel and outdoor recreation behavior.

    

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4. Associations between rurality and regional differences in sociodemographic factors and the 1918–20 influenza and 2020–21 COVID-19 pandemics in Missouri counties: An ecological study

   https://doi.org/10.1371/journal.pone.0290294  

   Sattenspiel, Lisa ; Orbann, Carolyn ; Bogan, Aaron ; Ramirez, Hailey ; Pirrone, Sean ; Dahal, Sushma ; McElroy, Jane A. ; Wikle, Christopher K. ( August 2023 , PLOS ONE)

   Acharya, Binod (Ed.)

   This study compares pandemic experiences of Missouri’s 115 counties based on rurality and sociodemographic characteristics during the 1918–20 influenza and 2020–21 COVID-19 pandemics. The state’s counties and overall population distribution have remained relatively stable over the last century, which enables identification of long-lasting pandemic attributes. Sociodemographic data available at the county level for both time periods were taken from U.S. census data and used to create clusters of similar counties. Counties were also grouped by rural status (RSU), including fully (100%) rural, semirural (1–49% living in urban areas), and urban (>50% of the population living in urban areas). Deaths from 1918 through 1920 were collated from the Missouri Digital Heritage database and COVID-19 cases and deaths were downloaded from the Missouri COVID-19 dashboard. Results from sociodemographic analyses indicate that, during both time periods, average farm value, proportion White, and literacy were the most important determinants of sociodemographic clusters. Furthermore, the Urban/Central and Southeastern regions experienced higher mortality during both pandemics than did the North and South. Analyses comparing county groups by rurality indicated that throughout the 1918–20 influenza pandemic, urban counties had the highest and rural had the lowest mortality rates. Early in the 2020–21 COVID-19 pandemic, urban counties saw the most extensive epidemic spread and highest mortality, but as the epidemic progressed, cumulative mortality became highest in semirural counties. Additional results highlight the greater effects both pandemics had on county groups with lower rates of education and a lower proportion of Whites in the population. This was especially true for the far southeastern counties of Missouri (“the Bootheel”) during the COVID-19 pandemic. These results indicate that rural-urban and socioeconomic differences in health outcomes are long-standing problems that continue to be of significant importance, even though the overall quality of health care is substantially better in the 21 st century. 

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5. Telehealth Challenges for California Rural Hospitals in Reaching Latino Populations During COVID-19

   https://doi.org/10.2196/41562  

   Mauricio, Noemi ; Newhart, Glen ; Herber, Steven ; Ahumada-Newhart, Veronica ( January 2023 , Journal of Medical Internet Research (JMIR), Iproceedings)

   Rural and remote communities were especially vulnerable to the COVID-19 pandemic due to the availability and capacity of rural health services. Research has found that key issues surrounded (1) the lack of staff, (2) the need for coordinated health services, and (3) operational and facility issues. Similarly, research also confirms that irrespective of hospital capacity issues existing during crisis, compared to urban communities, rural communities typically face poorer access to health services. Telehealth programs have long held promise for addressing health disparities perpetuated by inadequate health care access. In response to the current COVID-19 pandemic, Adventist Health Saint Helena Hospital, a rural hospital in northern California, urgently worked to expand telehealth services. However, as Adventist Health Saint Helena Hospital is the longest-serving rural hospital in the state of California, administrators were also able to draw on experiences from the pandemic of 1918/1919. Understanding their historically rural and heavily Latino populations, their telehealth approach was coupled with cultural approaches for prioritizing socially responsive and equitable access to health services.

   This study aimed to present one rural community’s holistic sociotechnical response to COVID-19 in redesigning their health care delivery approach. Redesign efforts included the expansion of digital health services coupled with county-wide collaborations for nondigital mobile health centers, testing, and vaccination clinics to meet the needs of those with limited digital access and language barriers.

   We present data on telehealth services for maintaining critical care services and a framework on the feasibility of private-public partnerships to address COVID-19 challenges.

   In this paper, we provide a critical review of how a rural hospital adapted its health care approach to incorporate telehealth services and distance services to meet the needs of a diverse population.

   This paper contributes empirical data on how rural communities can use telehealth technologies and community partnerships for a holistic community approach to meet health needs during a natural disaster.

   None declared.

    

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