Editor's note: For the latest news on coronavirus disease 2019, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
Coronavirus disease 2019 (COVID-19) likely will reach rural areas, and federal health officials are offering advice on how clinicians can prepare.
“I think it’s reasonable to assume while the entry into rural areas may be lower and it may be easier to do some social distancing because of the lower population, we shouldn’t assume any part of the country is going to be spared,” said Jay C. Butler, M.D., deputy director for infectious diseases at the Centers for Disease Control and Prevention (CDC).
Tests aren’t widely available in doctor’s offices, so rural clinicians should work with their state and local health departments and commercial laboratories to facilitate COVID-19 testing, Dr. Butler said. They should prioritize patients who are at high risk of severe illness like those ages 60 and older or have underlying health conditions. Health care workers also should be a priority.
Staff at rural hospitals also should be reviewing their pandemic response plans.
“Plans are no good if they just sit on the shelf, so I hope everybody who is running these hospitals has had a chance to pull down their plans and think about what they learned during pre-pandemic tabletop exercises and how they’ll deal with some unique aspects of this particular pandemic,” Dr. Butler said.
Those unique aspects include the possibility health care workers become ill or can’t come to work due to school closures.
In areas where hospitals have closed or decreased services, health care providers should make a plan for transporting people with COVID-19 to other facilities for care and consider whether closed facilities can be used temporarily to at least provide low levels of care with volunteer staff, Dr. Butler suggested.
Asked about shortages of supplies, he said federal officials are working on supply chain issues and suggested providers review CDC guidance on maximizing existing personal protective equipment, which can be found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html.
Whether clinicians continue to see patients with other conditions will depend on the spread of the virus and availability of resources in a community.
“Just very broadly, our recommendation from the CDC is to consider deferring non-emergent procedures or elective surgeries or visits to a provider,” Dr. Butler said. “But just when to do that depends on the local situation because we don’t want to do things so early that we have things that aren’t emergent become emergent.”
The AAP suggests conducting well-child visits for newborns, infants and younger children who require immunizations and rescheduling visits for older children; limiting well visits to the morning; dedicating separate rooms for sick and well visits; and considering telehealth when appropriate. The guidance is available at https://services.aap.org/en/pages/covid-19-clinical-guidance-q-a/.
