Coronavirus Files: Rural counties bear the brunt

coronavirus
October 27, 2020

Since April, The Center for Health Journalism has been publishing a special newsletter geared to journalists as they report on one of the biggest and most complex stories of our times. Each Monday, while the pandemic runs its course, The Coronavirus Files will provide tips and resources and highlight exemplary work to help you with your coverage. This week, The Center for Health Journalism’s Coronavirus Files Monday newsletter is curated and reported by CHJ content editor Ryan White and community editor Chinyere Amobi. Have a suggestion or a request? Write us at editor@centerforhealthjournalism.org.
 
The Health Divide: Rural counties bear brunt
 
About one in four recorded COVID-19 deaths in the U.S. now are in rural counties. “Where earlier peaks saw virus cases concentrated mainly in cities and suburbs, the current surge is the most geographically dispersed yet, and it is hitting hard remote counties that often lack a hospital or other critical health care resources,” writes Lauren Leatherby for The New York Times. Most counties in the U.S. that are experiencing large outbreaks have populations less than 50,000, and are located in the Midwest or Mountain West. Local facilities are already struggling with capacity, while many residents find themselves hours away from an available hospital bed.  
 
Surge overwhelms contact tracers
 
“North Dakota is now asking residents who test positive for COVID-19 to inform their own close contacts of the diagnosis as a recent surge in new cases of the virus has overloaded the state's contact tracing operation,” writes Jeremy Turley of the Grand Forks Herald. The state’s health department announced the policy shift through a tweet last week, citing a growing backlog of case investigations that resulted in North Dakotans learning their results three days after they were tested. “The health department's change of course comes as the state announced a pandemic-high 1,036 new COVID-19 cases on Tuesday,” writes Turley. The state recently reported the most COVID-19 cases and deaths per capita in the country.
 
North Dakota isn’t the only state feeling the strain. Alaska was able to keep the virus in check even as tourists and seasonal workers arrived during the summer months, thanks largely to more testing and contract tracing than nearly any other state. Aided by the state’s wide open spaces and regional isolation, contact tracers tracked nearly every person with a positive diagnosis, followed by daily calls for the infected and their close contacts. “It paid off: Even with the extensive search for possible infections, Alaska was recording some of the fewest coronavirus cases per capita in the nation,” writes Mike Baker for The New York Times. But by October 16, Alaska’s weekly average of new coronavirus cases had reached its highest point in the year, adding to fears that COVID-19 spread will surge as temperatures drop around the country and recreation turns indoors. It’s now taking public health officials longer to reach infected residents — 48 hours in some cases — after their diagnosis. “We are still doing contact tracing,” said Dr. Anne Zink, Alaska’s chief medical officer. “It’s just a more bare-bones contact tracing than it was earlier in the pandemic.”
 
The cavalry may experience delays
 
While the world anxiously waits for the arrival of a vaccine, a great deal of hope has been pinned on a class of therapeutic treatments known as monoclonal antibodies. These drugs got a huge news boost earlier this month, when President Trump was given Regeneron’s experimental antibody cocktail after contracting COVID-19. Trump went on to praise the treatment as a miracle cure and pledged he would make sure the drugs would soon be in every hospital. Not so fast, says New York Times reporter Katie Thomas in a story that details the “extremely limited” supply of these drugs and the huge logistical challenges of identifying the right patients and getting them the treatment in time. (That’s all assuming the drugs are proven to be effective, which they haven’t yet.)
 
Regeneron and Eli Lilly have both applied for emergency authorizations for their antibody treatments, but as Thomas reports, Regeneron will only have 50,000 doses initially, while Eli Lilly says it will have 100,000. For comparison, upwards of 60,000 Americans a day are testing positive for COVID-19 right now. Distributing these doses poses another hurdle, as seen with remdesivir, and the antibodies have to be delivered intravenously, requiring infected patients to visit hospitals or clinics. And figuring out which patients should receive these drugs will require rapid testing and contract tracing, which are still severely lacking in much of the country. The predicted shortages also raise ethical questions: Will wealthy and well-connected patients be able to jump the line? The severe supply constraints are expected to ease by early next year, however, with Regeneron, Eli Lilly and AstraZeneca all making plans to ramp up production. Regeneron said a partnership with Roche would allow it to produce up to 250,000 doses a month, Thomas reports.
 
This round on the government?
 
As spring gave way to summer, lots of bars and restaurants across the country moved drinks and dining outdoors to lower the risk of infection. Plunging temperatures and soaring case counts are dampening that party and forcing more intrepid patrons back inside, where coronavirus loves to table hop. At least some patrons are feeling the stress. So, how do we stop these potential super-spreader events from culminating in one of the darkest winters imaginable? Elisabeth Rosenthal, a former physician and current editor in chief of Kaiser Health News, has an idea: Pay bars and eateries to close. “That may sound radical, but it makes scientific sense and even has a political precedent,” Rosenthal writes in the opinion pages of The New York Times. “We pay farmers not to cultivate some fields (in theory, at least, to protect the environment), so why not pay bars that cannot operate safely to shut down (to protect public health)?”
 
As anyone who has stepped into a muggy packed bar in winter knows, air circulation is not on tap here. The fact that patrons can be wildly infectious well before symptoms appear compounds the risk. Rosenthal talks to Danish researcher Kim Sneppen who explains that coronavirus is a “heterogenous spreader,” meaning it explodes in clusters or hot-spots, rather than uniformly colonizing a population. He tells Rosenthal: “You can close down certain types of gatherings and a few types of places and tamp down the majority of the spread of the disease. And you can carry on with the rest as pretty normal.” Yet we want bars and restaurants to still be around when life assumes some normalcy again. “So why not pay owners who cannot keep their businesses afloat safely during the pandemic an average of their normal monthly income to shut down for some months?” Rosenthal suggests. “They would keep paying their employees and help break the chain of coronavirus transmission.”
 
When boring is good
 
Last Thursday featured the most hotly anticipated meeting in history for the Vaccines and Related Biological Products Advisory Committee, an expert panel advising the FDA on the development of COVID-19 vaccines. With a name like that, you’d be right not to expect fireworks. Nor did this meeting discuss any of the vaccines under development or present data from their clinical trials. Rather, the goal was a broader discussion of how the vaccine approval process should work — and what issues need to be flagged now. The meeting can be read as a sign that the FDA plans to “make decisions based not on political timetables but on data that show whether new vaccines are safe and effective,” wrote STAT’s Helen Branswell.
 
Politico’s Sarah Owermohle identified four key takeaways from the meeting. Among them: Vaccine trials underway need to continue even if a vaccine gets an emergency authorization. In a letter to the FDA, Pfizer has said it wants to vaccinate its trial participants who received the placebo should its vaccine gain emergency approval. But that would mean the trial would suddenly lose its control group and with it the experiment’s power to compare the two groups on matters of vaccine safety and efficacy. The expert panel also stressed the need for vaccine trials to include more minorities, children, elderly and pregnant women. “We know that individuals from underserved minorities are hit harder by this pandemic,” said Hilary Marston, a medical officer at the National Institute of Allergy and Infectious Diseases, who added that anti-vaccine sentiments — higher among some minority groups — could hinder any vaccine rollout. Read Owermohle’s fuller recap here.
 
And Don't Miss...
 
  • Pivotal Studies of Covid-19 Vaccines From AstraZeneca, J&J Resuming, WSJ 
  • What Fans of ‘Herd Immunity’ Don’t Tell You, The New York Times
  • The Price for Not Wearing Masks: Perhaps 130,000 Lives, The New York Times
  • CDC Expands Definition of 'Close Contacts,' After Study Suggests COVID-19 Can be Passed in Brief Interactions, STAT
  • States Finalizing Plans to Distribute COVID-19 Vaccine, Side Effects Public Media
  • Why the U.S. Doesn't Have an At-Home Coronavirus Test Yet, Politico