Introduction: Many rural hospitals and health systems in the USA lack sufficient resources to treat COVID-19. St Lawrence Health (SLH) developed a system for managing inpatient COVID-19 hospital admissions in St Lawrence County, an underserved rural county that is the largest county in New York State. Methods: SLH used a hub-and-spoke system to route COVID-19 patients to its flagship hospital. It further assembled a small clinical team to manage admitted COVID-19 patients and to stay abreast of a quickly changing body of literature and standard of care. A review of clinical data was completed for patients who were treated by SLH's inpatient COVID-19 treatment team between 20 March and 22 May 2020. Results: Twenty COVID-19 patients were identified. Sixteen patients (80%) met National Institutes of Health criteria for severe or critical disease. One patient died. No patients were transferred to other hospitals. Conclusion:During the first 2 months of the pandemic, the authors were able to manage hospitalized COVID-19 patients in their rural community. Development of similar treatment models in other rural areas should be considered.

Background: Many rural hospitals and health systems in the U.S. lack sufficient resources to treat COVID-19. We developed a system for managing inpatient COVID-19 hospital admissions in St. Lawrence County, an underserved rural county which is the largest county in New York State. Methods: We used a hub and spoke system to route COVID-19 patients in the St. Lawrence Health System to its flagship hospital. We assembled a small clinical team to manage admitted COVID-19 patients and to stay abreast of a quickly changing body of literature and standard of care. We subsequently completed a review of clinical data for patients who were treated by our inpatient COVID-19 treatment team between March 20 and May 22, 2020. Results: Twenty COVID-19 patients were identified. Sixteen patients (80%) met NIH criteria for severe or critical disease. One patient died. No patients were transferred to other hospitals. Conclusions: During the first two months of the pandemic, we were able to manage hospitalized COVID-19 patients in our rural community. Development of similar treatment models in other rural areas should be considered.