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Health care in rural America was already fragile. Can it survive COVID-19?

Cases of COVID-19 have been rising in some rural parts of the U.S. -- many of which were already squeezed for medical care before the pandemic. With fewer resources available in these places, a spike in patients requiring hospitalization and intensive care can be especially dangerous. William Brangham talks to Dr. Shanti Akers, a pulmonologist at the Phoebe Putney Health System in Albany, Georgia.

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  • Judy Woodruff:

    The number of COVID cases has been picking up in some rural parts of the country. And, in many areas, the hospitals there were already feeling squeezed before this health emergency.

    Georgia, as we just heard, is very much front and center right now in the public debate over reopening. In fact, it has one of the highest per capita outbreaks in the country. Currently, there are roughly 24,000 confirmed cases in the state, and nearly 1,000 people have died.

    William Brangham has this view from the front lines in Southwest Georgia.

  • William Brangham:

    That's right.

    For a look at how one rural community in the South is dealing with their unique outbreak, I'm joined by Dr. Shanti Akers. She is a pulmonologist at the Phoebe Putney Health System in Albany, Georgia.

    Dr. Akers, thank you very much for being here.

    I wonder if you could just start off by telling us — some people may be familiar with this case of how the first case came to your community, through a funeral, if I remember correctly. Can you tell us about how that happened?

  • Shanti Akers:

    Sure.

    So, our index case happened almost six weeks ago now, if not earlier, actually, in my recollection. We had a person who came down for a local funeral. They, unfortunately, started becoming ill as they were down here.

    And so they came to our hospital. They ended up requiring intensive care. And so the funeral that he had attended was fully attended with numerous people in the community, people that knew the gentleman who had passed away.

    And at that time, there was a lot of touching. People in the South, we like to hug and kiss and hold each other's hands. And so we know that there was a lot of interaction in very close quarters for a prolonged period of time during that funeral.

    And that's the initial first case that we had been aware of. And then, subsequent to that, we found out that there was this large cluster of other people he had been in contact with that started arriving in our hospital, and subsequently pretty much exploded the cases in our area.

  • William Brangham:

    Is that right, exploded? I mean, I know that's not necessarily the medical term.

    How quickly did you see a rise in cases?

  • Shanti Akers:

    He had come and gone.

    And then, within, quickly — I believe in one or two weeks, we started noticing a significant increase in the cases. Initially, it was a handful. They filled up one of our ICUs. But, very quickly, in two, three weeks, we filled up all three of our regular ICUs.

  • William Brangham:

    Did you guys feel well-prepared? I mean, obviously, you had been watching the news that was coming out of China and then the first cases on the West Coast.

    Did you guys feel prepared to deal with this?

  • Shanti Akers:

    We had been anticipating that, eventually, it might reach our town, but I don't think we were prepared for when it did.

    I think the case that we had started much earlier than many parts of the country, with the exception of parts of the West Coast and East Coast. So, at the time, you know, our health care system had been planning on increasing the amount of PPE and things of that nature with the anticipation of cases coming.

    I don't think any of us were ready for the cases when it finally showed up, though.

  • William Brangham:

    For people who have been watching this primarily as an outbreak happening in major cities, New York in particular, I understand that you would say that there are particular challenges that a rural community has that are different than what a big city has.

  • Shanti Akers:

    People are obviously very well aware of New York City.

    But the main distinguishing factor is that coronavirus doesn't distinguish whether you live in New York City or whether you live in rural Georgia. And so, for us, it was a challenge, because we don't have the resources of an NYU or a Mount Sinai health system with which to pull resources.

    So it required very early on us reaching out to people like our governor, to our state public health department and to our state emergency relief departments, in order to help us provide the care that we needed.

    Additionally, the patient populations are often very different. You know, in a rural community environment, you may have patients with various socioeconomic status. You will have some people that are very well-insured, but a lot of people that are underinsured or similarly have no insurance at all.

    Georgia has been a state that has not expanded Medicaid. So we do have patients that come in with chronic medical problems, utilizing parts of our hospital system that should be saved for acute issues.

  • William Brangham:

    And those are all factors that were preexisting to the pandemic arriving.

  • Shanti Akers:

    Exactly.

    And I think it's sort of those differences and disparities that really get even much more exacerbated during a pandemic.

  • William Brangham:

    As you well know, your governor is one of several who is starting to say, it's time for us to start opening our economy back up and let some businesses start to reopen.

    How does that sit with you?

  • Shanti Akers:

    That's a very difficult question, because, you know, as we know, a lot of people have been very negatively impacted by the closing of businesses, and unemployment has been quite high.

    At the same time, that has impacted our hospital as well. We have been unable to perform elective procedures, things that people in our community count on to just help quality of life, perhaps a knee replacement surgery for someone who's had a difficult time walking.

    We have had our peak about two weeks ago, so we have definitely seen some de-escalation in terms of the volume of cases coming in the door. So it seems like we are in a position to (AUDIO GAP) resources to handle the state opening.

    But it worries us, for obvious reasons, one of which is obviously that we are the only large hospital within our area. And so if people start socially interacting much more, that that influx and that — you know, that caseload that we saw a few weeks ago, a few months ago is going to pick back up.

  • William Brangham:

    Well, let's keep our fingers crossed that that doesn't occur.

    Dr. Shanti Akers at Phoebe Putney in Albany, Georgia, thank you so much for your time.

  • Shanti Akers:

    Thank you.

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