Rural health-care systems in the South are crumbling from the pressures of the pandemic, Politico reports

Health-care systems in rural America, especially in the South, are crumbling amid the pressures of the coronavirus pandemic. Daniel Payne of Politico reports in a wide-ranging story.

"Of the 50 counties with the highest Covid deaths per capita, 24 are within 40 miles of a hospital that has closed, according to a Politico analysis in late January. Nearly all 50 counties were in rural areas." That doesn't prove the closure of hospitals led to higher death rates, because rural counties generally have higher infection rates, lower vaccination rates and lower health status than urban and suburban counties. But Payne raises the possibility that the closure of 181 rural hospitals since 2005 has discouraged vaccination and other preventive measures: "In the communities where health resources disappear, so too does confidence in the medical system. Trusted sources of information go elsewhere."

And the list of closures "may be just the beginning," Payne writes. "Over 450 rural hospitals are at risk of closure, according to an analysis by the Chartis Group, one of the nation’s largest independent health-care advisory firms."

In pandemic surges, rural residents with a local hospital couldn't always access treatment. The nationwide bed shortage led to long waits in rural emergency rooms and critical patients left waiting for transfers to larger hospitals, Payne reports. "The entire system clogged up," Claude Brunson, executive director of the Mississippi State Medical Association, told him. "Without a doubt, there are some patients who died because we did get bottlenecked and couldn’t establish a very good flow of care across the system — because we had lost the numbers of beds that we truly did need."

Payne's object example is Haywood County, Tennessee, which "had its health care system ground down in the years leading up to the pandemic: Ever since the 84-year-old Haywood County Community Hospital closed its doors in 2014, the numbers of doctors and other health care professionals dwindled. Residents who once were on a first-name basis with their care professionals were left to book appointments at facilities miles from where they’d raised their families and grown older."

One factor Payne doesn't note: the lack of Medicaid expansion under the Affordable Care Act in Tennessee and most other Southern states.