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Local student shares how pandemic affects rural America

The sun rises over the lush green hills of the Shenandoah Valley. Carter DePoy wakes up in her childhood home and makes a plan for the day: assignments due for her senior-level kinesiology classes, preparing for finals, and checking-in on her loved ones. Under normal circumstances, DePoy would be spending this day in April with her classmates at the University of Tennessee, five hours away from her home in Rockingham County, Virginia. But everything about today is far from normal.
When COVID-19 forced university closures, DePoy realized she was stuck at home. “I was initially going to go home for spring break regardless of coronavirus. When I went home for spring break, I imagined coming back to campus after that two-week period,” DePoy says. “But then that period was extended, and things ramped up with the coronavirus, and I just decided it would be safer to stay home and not risk myself and my family by coming and going.”
Rural Virginia is an especially challenging place to be while finishing school and navigating a global pandemic. According to the Centers for Disease Control and Prevention, more than 46 million Americans live in rural areas, and in general, residents of rural areas in the United States tend to be older and sicker than their urban counterparts. Higher percentages of people in rural areas have chronic diseases than in urban areas. This means that once COVID-19 hits the rural areas, it’s going to hit hard.
Amanda Letheren is a public health PhD student at UT, where she is researching rural hospital closures and their impacts on rural healthcare. She explains that in rural America, there is generally less access to healthcare, less access to healthier foods, higher mortality rate, and higher poverty rate compared to urban areas. “Older, sicker, and higher poverty rate is like a feeding ground for COVID-19,” Letheren says.
So far, news has been focusing on the effects of COVID-19 in cities, which are more populated and densely packed. This is compared to somewhere like Rockingham County, where DePoy’s closest neighbors are half-a-mile away. COVID-19 cases in rural areas will potentially increase in the near future.
“I think we will see more implications for rural America as we progress, as it travels,” Letheren says. “Because rural America is great at social distancing, we haven’t seen an influx there yet. But that can only last for so long.”
DePoy’s aunt is a local dental hygienist who was working the week prior to dental office closures. Ten days after working with a patient later confirmed as her point-of-contact, she began having COVID-19 symptoms. Her COVID-19 test came back negative, but doctors were convinced it was a false negative because her lungs were full of fluid. When doctors performed an antibody test, Carter’s aunt, her husband, and her children all showed antibodies for COVID-19, confirming
the whole family had been infected with the virus.
“Doctors said the test was only 71 percent accurate… It was scary. It was really serious,” DePoy says. Her aunt never had to go on a ventilator, and she recovered and was sent home, where she has been self-quarantining in her basement since Easter. Running errands for her aunt, uncle, and their three kids has become another obstacle DePoy is facing while trying to finish her senior year. According to DePoy, her aunt should not have long-term lung issues like some COVID-19 patients, but she has been suffering from vertigo that may be a side effect of the medication the doctors were using.
According to Letheren, 170 rural hospitals have closed since 2005. Many rural hospitals rely on elective surgeries as a crucial source of revenue. Hospitals were forced to temporarily postpone elective surgeries to reduce COVID-19 exposure and to conserve personal protective equipment, and the results have been furloughed employees and dips in hospital revenues. In some rural communities, hospitals are one of the major employers, which has further damaged local economies.
“This pandemic is basically magnifying the problem we are already seeing: that rural hospitals are struggling and they have been. Now the pandemic is exaggerating the problem because we are having more closures… we need to really think about the best strategies that are cost effective and efficient in order to deliver this healthcare to these individuals in these rural areas,” Letheren says.
Many healthcare providers have been experimenting with Telehealth (a secure phone call or online video chat between a patient and their healthcare provider). Rural communities generally have less access to internet and other technology resources. With news being spread primarily online, individuals living in rural communities are often at a disadvantage to receiving timely and reliable news. Also, technology challenges in rural areas influence the ability for people to work remotely.
DePoy is unable to get internet access to her house, but UT mailed her an internet hotspot to use. Technology was a major stressor for DePoy when she realized she had to finish school online and her mom would be working remotely from home. Many individuals living in rural areas suffer from unreliable internet access. According to DePoy, the local Dairy Queen advertised to the community that they had expanded their Wi-Fi so that it would reach into the parking lot, where individuals could be socially distant in their cars while receiving internet access.
Those living in rural areas rely on flexibility and the community banding together during this time. “As long as we still have our advocates for rural America talking at the local state and national level, that dialogue just needs to be continued as the disease progresses,” Letheren says.
For DePoy, the future just looks like taking it one day at a time. “I’m almost done with school. I’m not working at the moment. I had plans to travel, and the work that I wanted to do is currently on hold because they have a hiring freeze… I’m trying to do things that are helpful for myself and productive for others,” DePoy says. “It’s just been getting in a routine with my mom and getting used to the new normal of life at home for extended periods of time.”
(Shelby Whitehead was born and raised in Elizabethton, and currently lives in Knoxville, where she attends the University of Tennessee. In the past, she published online with Oak Ridge National Laboratory and the National Association of Science Writers. She authoredthe UTDepartment of Microbiology annual newsletter Microscope, and has stories in UT campus news outlets The Daily Beacon and TNJN.)