The outbreak of the new coronavirus in Vermont has been largest in the most populous areas. But the state’s most rural areas may be in more danger because of a combination of demographics and access to health care.
As of April 3, the majority of cases in the state were in Chittenden, Addison and Windsor counties, while places like Orleans and Caledonia counties have only a handful.
But Lamoille County is catching up with 14 cases confirmed. And Sen. Rich Westman, R-Lamoille, thinks the lack of primary care doctors could cause underreporting.
Right now, residents who want to get tested for Covid-19 have to be referred by a primary care doctor, he said. But he estimates that as many as one in six Vermonters don’t have one.
“Presently, across the state, the places that have the fewest primary care doctors are in rural communities,” he said.
Towns like Johnson have no primary care doctors, he said, compounding the problems of getting tested.
Transportation to doctors can be an issue as well, said Audrey von Lepel, medical director of the Northern Tier Center for Health, or NOTCH, a primary care organization with several locations in Franklin and Grand Isle counties.
NOTCH has shifted to doing many more telehealth consults, but it has been difficult in the past to get people help when they’re a great distance from urban areas.
“That’s the biggest issue with us, is the distance between us and UVM, and even our hospital, people who live in Richford, it’s quite a ways to Northwestern Medical Center,” she said.
She said NOTCH is doing valuable work screening patients for Covid-19, as it can triage people for symptoms before they get tested and reduce the load of hospitals by providing other types of care.
Nursing shortages are also a big issue in rural areas, said Rep. Lucy Rogers, D-Waterville. The state has 4,000 openings for nurses at the moment.
“The bigger hospitals have better cash flows to offer payback on loans,” she said. “Small, independent practices can’t offer those things.”
At the same time, the health care systems in rural areas of Vermont have had financial trouble in recent years. Six of Vermont’s 14 hospitals lost revenue in fiscal year 2019, as financial pressures have caused rural hospitals across the country to close.
Westman sits on the board of Copley Hospital in Morrisville. He said the coronavirus crisis is going to hit rural hospitals even harder.
“When every hospital has put off everything that isn’t emergency surgery, and anything that is elective, every community hospital in the state is putting off everything that makes money,” he said.
Rural areas may also be in greater danger for another reason: their demographics, according to new research by a Syracuse University professor. Rural areas tend to have a higher rate of older people, who are more at-risk from the virus.
“On the one hand, rural parts of the U.S. may be comparatively better off than urban places due to lower population density in rural areas,” said Shannon Monnat, a researcher with the Lerner Center, in an issue brief. “On the other hand, there are several features of rural populations and places that increase their risk of coronavirus-related mortality and other long-term health impacts.”
One of those risk factors is the aging population of rural areas, as older people appear to be more likely to experience complications from the virus. Nationally, 15% of large metropolitan areas are residents 65 or older, compared to 22% of small, nonmetropolitan areas.
Vermont is older than the national average, with about a fifth of the population being over 65, according to Census data. But even within Vermont, more rural areas like the Northeast Kingdom tend to have a higher concentration of older residents.
Rural counties also tend to have more risk factors in health and chronic conditions: Franklin, Orleans and Essex counties lead the state in adult smoking levels, according to CDC data. The World Health Organization reports that smoking is a risk factor for complications from the coronavirus, although other researchers caution that the quality of data on smoking and other health behaviors is still poor.
Rogers believes there’s a small benefit for rural Vermonters: “There are certain privileges to living in rural areas compared to urban ones” when you’re social distancing, she said.
“So many cities are wishing they were living in rural areas right now,” she said.
Meg Burmeister, executive director of the Northeast Kingdom Council on Aging, said she’s seen “tremendous community partnerships” to support everyone being safe.
“If somebody says I’m having a problem with this, five people say, ‘I’ll help ya.’”
Justin Trombly contributed reporting to this story.