Dartmouth Study: Rural N.H. Prepared Strong Response to COVID-19
When the coronavirus pandemic first hit New Hampshire, many public health leaders worried about the state’s rural communities. Smaller towns tend to have more elderly patients and fewer health care resources. Some doctors warned that even a small number of cases could overwhelm the region’s hospitals.
But a new report finds that rural areas of Vermont and New Hampshire handled the coronavirus outbreak better than expected. The authors of the report, Dartmouth College Professors Elizabeth Carpenter-Song and Anne Sosin, joined NHPR’s All Things Considered host Peter Biello to discuss some of the highlights of their study.
(Below is a lightly edited transcript of the interview.)
Why was it important to track how rural communities responded to the Coronavirus pandemic?
ANNE SOSIN: When we launched this research in early March, the region was bracing for a surge in COVID-19 cases. And we had seen the ways in which the pandemic had strained the capacity of the health infrastructure in urban centers. Our region also appeared especially vulnerable given that rural communities are, on average, older and in poorer health than their urban counterparts. And many of our rural communities have significant underlying social vulnerabilities.
When it comes to vulnerabilities, what vulnerabilities are you talking about? You mentioned an aging population, but are there others?
ELIZABETH CARPENTER-SONG: Certainly, so we're very concerned not only for older adults but also for those with underlying chronic health conditions. Also in our region we entered the pandemic, as you know, contending with the substance abuse epidemic so we were also very concerned about those with behavioral health challenges, as well as those living in poverty and homeless populations.
Your study focuses on public health, but it also looks at how social services changed during the pandemic. Elizabeth, why did the report focus so much on housing?
CARPENTER-SONG: Well, we’ve entered into the pandemic with a tremendous shortage of affordable housing within the bi-state area. And so, within that context, many individuals and families double-up due to the lack of available housing stock in both Vermont and New Hampshire. And so in March, as we were entering into the pandemic phase, many individuals and families who were housed very precariously and doubled with others, this became an untenable situation strategy for them due to fear of infections. So we heard many reports of people being kicked out due to these types of situations, and we heard reports of the tremendous effort that was put into play to identify and also to house individuals who became homeless within the context of the pandemic, particularly in Vermont. The availability of some state funding to house some people in area motels was something that very much guarded against the rates of infection that we have seen in urban centers such as San Francisco and in Boston, among homeless populations.
You also found, with respect to housing, essential workers, essential healthcare workers in particular, also had a harder time in New Hampshire than in Vermont finding a place to stay when they couldn’t necessarily go home to their families each night because they weren’t sure if they were going to bring COVID-19 home with them.
CARPENTER-SONG: Absolutely, those types of concerns at the household level, both in terms of housing and in terms of access to childcare became real challenges for healthcare workers within the region.
If there is a second surge of the pandemic, are rural hospitals going to be prepared for it?
SOSIN: To provide a little bit of background, our critical access and small community hospitals really form the backbone of our rural health system. But many have minimal capacity to deliver ICU care. Coos County, the northernmost county of New Hampshire had only three ICU beds. The Northeast Kingdom of Vermont had only nine beds and these hospitals quickly mobilized, not only to expand critical care capacity, but really to create it. We saw hospitals repurpose their infrastructure, source ICU equipment, redeploy and train staff, and take other measures to expand overall hospital capacity. So while that capacity ultimately wasn’t needed in the first phase of the epidemic, it remains in place if the region sees an uptick in cases over the next several months.
That said, hospitals will continue to require support to procure PPE and other essential supplies and equipment and to ensure that their providers are able to continue to practice.
CARPENTER-SONG: Our health systems were able to gain access to several sources of financial support.I think the concern that we heard from our stakeholder partners moving forward is what happens over the long-term horizon of the pandemic? And in particular, voicing the need for continued financial support. As Anne was saying, there is a tension now between reopening of our health systems, reopening of our communities, but also maintaining high levels of preparedness within our health systems. And this is more than a mindset, this is something that requires resources as well as maintaining capacity in the event of an overflow type of event.
What can the rest of New England learn from how rural communities responded to the outbreak?
CARPENTER-SONG: As we think about the tremendous care and attention, particularly to vulnerable populations and community members, this is something that really stands out for us: we see in our work that poor outcomes, especially for the most vulnerable, are not inevitable.;
SOSIN: Our region faced the triple challenge of having high rates of medically vulnerable populations, high rates of social vulnerability, and health systems with limited resources. And yet we were able to avoid the worst outcomes that we’ve seen in other regions. Our research offers a counterargument to the notion that vast disparities in outcomes are inevitable or that vulnerable populations will ultimately fare very poorly in the context of a pandemic or another disaster.