Guidance for Healthcare Providers Managing COVID-19 in Rural and Underserved Areas

Sharma, Sunil; Cain, James; Sakhuja, Ankit; Schaefer, Gregory; Krupica, Troy; Sarwari, Arif R.

doi:10.1007/s40615-020-00820-9

Cited by 13 publications

(16 citation statements)

References 19 publications

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“…The population living in rural areas has more chronic diseases than the urban population 23 , which is a possible factor that justifies a higher risk of COVID-19-related mortality in rural and peri-urban areas. Moreover, living in rural areas decreases ICU admission, probably because of the lack of ICU care in the public health service in the region 24 . Previous studies have shown a rapid increase in COVID-19, with greater dispersion in the interior and rural areas, increasing the need for care within this population 25 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for critical illness and death among adult Brazilians with COVID-19

Silva

Faria

Ferreira

et al. 2021

Rev. Soc. Bras. Med. Trop.

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Introduction: Severe acute respiratory syndrome coronavirus 2 has infected more than 9,834,513 Brazilians up to February 2021. Knowledge of risk factors of coronavirus disease among Brazilians remains scarce, especially in the adult population. This study verified the risk factors for intensive care unit admission and mortality for coronavirus disease among 20-59-year-old Brazilians. Methods: A Brazilian database on respiratory illness was analyzed on October 9, 2020, to gather data on age, sex, ethnicity, education, housing area, and comorbidities (cardiovascular disease, diabetes, and obesity). Multivariate logistic regression analysis was performed to identify the risk factors for coronavirus disease. Results: Overall, 1,048,575 persons were tested for coronavirus disease; among them, 43,662 were admitted to the intensive care unit, and 34,704 patients died. Male sex (odds ratio=1.235 and 1.193), obesity (odds ratio=1.941 and 1.889), living in rural areas (odds ratio=0.855 and 1.337), and peri-urban areas (odds ratio=1.253 and 1.577) were predictors of intensive care unit admission and mortality, respectively. Cardiovascular disease (odds ratio=1.552) was a risk factor for intensive care unit admission. Indigenous people had reduced chances (odds ratio=0.724) for intensive care unit admission, and black, mixed, East Asian, and indigenous ethnicity (odds ratio=1.756, 1.564, 1.679, and 1.613, respectively) were risk factors for mortality. Conclusions: Risk factors for intensive care unit admission and mortality among adult Brazilians were higher in men, obese individuals, and non-urban areas. Obesity was the strongest risk factor for intensive care unit admission and mortality.

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Section: Discussionmentioning

confidence: 99%

Risk factors for critical illness and death among adult Brazilians with COVID-19

Silva

Faria

Ferreira

et al. 2021

Rev. Soc. Bras. Med. Trop.

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“… 9 These factors could compound the disparities that already exist between rural citizens and those who live elsewhere due to the higher prevalence of high-risk populations, and less access to transportation, the internet, healthcare, and mental health services in rural settings. 10 , 11 Addressing these health disparities needs to be a priority to minimize morbidity and mortality among rural citizens. In addition, it is imperative to address the misconceptions and inaccurate beliefs about COVID-19 transmission heard by IPs in this study in order to increase compliance with public health safeguards among rural community members.…”

Section: Discussionmentioning

confidence: 99%

Rural infection preventionists’ experiences during the COVID-19 pandemic: Findings from focus groups conducted with association of professionals in infection control & epidemiology (APIC) members

Rebmann

Alvino²,

Mazzara

et al. 2021

American Journal of Infection Control

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Background SARS CoV-2, the virus that causes COVID-19, was identified and quickly developed into a pandemic in spring, 2020. This event posed immense difficulties for healthcare nationally, with rural areas experiencing different challenges than other regions. Methods The Association of Professionals in Infection Control & Epidemiology conducted focus groups with infection preventionist (IP) members in September and October, 2020. Zoom sessions were recorded and transcribed. Content analysis was used to identify themes. Results In all, 38 IPs who work at a critical access hospital or a healthcare facility in a rural location participated. Major challenges identified by IPs in this study included addressing the lack of access to personal protective equipment (PPE), overwhelming workloads caused by the pandemic and multiple roles/responsibilities, inaccurate social media messages, and generalized disbelief and disregard about the pandemic among rural community members. Conclusions Gaps in preparedness identified in this study, such as the lack of PPE, need to be addressed to prevent occupational illness. In addition, health disparities and inaccurate beliefs about COVID-19 heard by IPs in this study need to be addressed in order to increase compliance with public health safeguards among rural community members and minimize morbidity and mortality in these regions.

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“…Intensive infection control can affect the conditions of nursing homes, especially in rural settings with scant healthcare resources [ 21 , 22 ]. Infection control requires limiting medical care in medical facilities and reducing the duration of care provided to patients, which can lead to low-quality medical care and the risk of missing signs of acute conditions in patients [ 23 , 24 , 25 ]. Additionally, as few healthcare resources are available in nursing homes in rural areas, the staff cannot take a day off if they are symptomatic [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes

Ohta¹,

Ryu²,

Sano

2021

IJERPH

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This study aimed to clarify the effect of coronavirus disease (hereafter, COVID-19) control on patients’ health conditions and staff’s working conditions in rural nursing homes. An interventional study including all staff and patients in a rural nursing home was performed from 1 April 2019 to 31 March 2021. Infection control measures against COVID-19 were initiated on 1 April 2020. The primary outcome was the frequency of patients’ medical care visits to the outpatient and emergency departments. The secondary outcome was the number of days-off taken by staff. Each group (pre- and post-COVID-19 control groups) had 48 participants. The number of visits to the outpatient department reduced from the pre-COVID-19 to post-COVID-19 control period the difference in number of visits to the emergency department was not significant, due to the low statistical power. The number of days-off taken by the staff was increased from the pre-COVID-19 to post-COVID-19 control period. This is the first study investigating COVID-19 control measures in a rural nursing home. It may help reduce the number of patient visits to medical facilities without increasing the risk of emergencies. A strict health check of the staff can allow staff to take more days off in rural contexts.

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Guidance for Healthcare Providers Managing COVID-19 in Rural and Underserved Areas

Cited by 13 publications

References 19 publications

Risk factors for critical illness and death among adult Brazilians with COVID-19

Risk factors for critical illness and death among adult Brazilians with COVID-19

Rural infection preventionists’ experiences during the COVID-19 pandemic: Findings from focus groups conducted with association of professionals in infection control & epidemiology (APIC) members

Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes

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