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Compounding disparities in rural areas
Future outbreaks will likely be centered around those left vulnerable by low vaccination rates. “Right now, we’re at the level that we were in June of last year. We considered it horrific then, and now, we’re all opening up,” says Alan Morgan, chief executive officer of the National Rural Health Association (NRHA), who studies county-level data daily.
For some, vaccine hesitancy is the root of the problem. NRHA recently conducted a survey of almost 200 hospitals and found that even though healthcare workers have had access to shots for months, a third of rural hospitals reported that less than half of their employees had been vaccinated. Morgan notes that may cause a workforce problem if these employees get sick, making these communities less able to respond to surges. A recent Kaiser Family Foundation survey found that
three in 10 Republicans, essential workers, and younger adults say they will definitely not get vaccinated. Rural residents also say they are less likely to wear a mask.
“There’s a real risk of a slow burn in rural places which the country ignores,” Morgan says. “The fact of the matter is I’m worried about rural America being a reservoir for COVID.”
These are often areas with already fragile health-care systems. Rural populations tend to be older, as well as health-compromised, whether from jobs with greater occupational hazards, or from difficulties accessing preventative care, explains Tom Mueller, assistant professor of sociology at Utah State University. “It’s hard to get rural healthcare, and it’s likely only gotten worse during the pandemic,” he says.
But he adds, “It’s important to remember rural America is not a monolith—it’s not just conservative white people.” There are also significant Black, Latino, and Native American rural communities, for whom, Mueller suspects, it’s more about access than hesitancy. Another
Kaiser Family Foundation survey supports these suspicions; they found that less than half of Black adults say their rural communities have enough vaccine supply, compared to 59 percent of white rural adults.
Cities have similar equity issues, says Julia Raifman, who conducts research on health and social policies as an assistant professor at Boston University. “It’s not really a surprise that there are large racial and ethnic disparities in vaccinations,” she says. “That’s a logical result of our prioritization policies.” She points to structural barriers, like the ability to take time off work to recover from side effects, or transportation to get to vaccine appointments. Even being five miles from a clinic, as the Biden administration says
90 percent of Americans now are, is a hurdle if you don’t have access to a car. “I not only expect there will be outbreaks, but that the people most affected will continue to be Black, Latinx, and Native American,” Raifman says.
As the pandemic shifts into a new phase, Chapple-McGruder is concerned about children, who she says are now seeing a disproportionate burden of disease as adults get vaccinated; Texas and Iowa have nevertheless
banned masks in schools. Morgan predicts that workplace exposures will continue to be significant. Last summer, he was able to anticipate surges in communities that have summer resort destinations, major truck stops, or processing plants—”communities where people travel in, congregate, and travel out again.” It’s a dynamic he expects will repeat this summer. Raifman adds the new CDC guidelines will exacerbate these disparities by removing indoor masking before many essential workers have a chance to be vaccinated.
For Ramirez, the new recommendations are also making it harder to do her job. Despite Fairbank’s surge, doctors and nurses at Fairbanks Memorial Hospital have been frustrated by patients refusing to wear masks within the hospital, which follows CDC guidelines for healthcare facilities that all individuals should be masked, regardless of vaccination status. She says the hospital has also had patients and family members who didn’t believe their doctors’ diagnoses. “When people tell you to your face they don’t believe what you’re saying—that really hits the core of the relationship between caregivers and patients.” And when patients don’t get better, it adds to the staff’s trauma. “It’s really hard when people die of preventable illnesses, and even harder when it’s a young person,” she says. “This didn’t have to happen—that pulls at people.”
The situation in Fairbanks is improving now; Ramirez says that as a low-density area, it doesn’t take much to reduce transmission, highlighting the importance of behavior. But looking ahead, Ramirez says she’s afraid COVID-19 is going to be an endemic disease in Alaska. “I think we lost our chance,” she says, referring to Alaska’s plateauing vaccination rates. “Which really brings home that until we have a significant number of people vaccinated, or people wear masks, we are at risk.”
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