UAB: Care of rural population during pandemic calls for testing, vaccines

Dr. William Curry, associate dean of UAB Primary Care and Rural Medicine, said Alabama's high infection rate for COVID-19 underscores the need of testing and vaccinations. The Alabama Department of Public Health map shows that in rural counties, incidents of COVID-19 per 10,000 people are higher than in almost any urban area of the state. (Getty Images)

Most of Alabama is now a COVID-19 “hot spot,” similar to most other states.

As cases continue to mushroom statewide, UAB and other hospitals are feeling the stress of treating COVID-19 patients, more so in rural areas of northern Alabama. Dr. William Curry, a primary care physician and the associate dean of UAB Primary Care and Rural Medicine, is keeping a wary eye on COVID’s impact on Alabama’s rural and underserved communities.

“The most recent numbers show 10 counties are more than 45% positive in the latest average for COVID testing, and seven are entirely rural or mostly rural,” Curry said. “In those areas, there had been less impact, with fewer cases and fewer deaths until the latest surge.”

From an epidemiological standpoint, Curry said it’s critical to pinpoint and focus attention on the COVID hot spots. Fayette, Marion, and Franklin counties are experiencing an accelerated pace of diseases compared to some areas of central Alabama, the Black Belt or the Wiregrass area.

“Everybody across the state is exceedingly abundant with cases of COVID,” he said. “Every doctor that I talk to across the state – from north to south – tells me their systems are stressed and stretched, and that they’re worried.

“We are really under a lot of stress, the health care systems at every level, from our smallest rural hospitals and health systems or clinics all the way up to University Hospital, we are stretching capacity both in terms of space and personnel to be able to provide the care that is needed,” Curry said.

COVID tests can help slow infection rate

The high infection rate underscores the heightened need for COVID testing. The Alabama Department of Public Health (ADPH) map shows that in rural counties, incidents of COVID per 10,000 people are higher than in almost any urban area.

“Because of the penetration of the infection right now, actually by population there are more cases than there are in Birmingham or Montgomery,” Curry pointed out. “Testing is really important for us for understanding where things are hot, but also because it’s our single best opportunity for direct contact with somebody for mitigation, to slow the spread of infection.”

Dr. William Curry of UAB talks COVID-19 pandemic, vaccinations in rural Alabama from Alabama NewsCenter on Vimeo.

Tracing efforts have been difficult throughout the country. When people get the call that they have COVID, it is an opportunity to let them know what they should do medically and to act responsibly: Let family members, friends, and people to whom they’ve been exposed know that they need to quarantine, or to be tested to slow the spread of the disease.

Experts point to numerous reasons people aren’t tested. Many have COVID “fatigue” from nonstop news coverage. There are not enough testing sites for people in rural areas, meaning that people may have to drive many miles for testing. Some may find it difficult to get off work, among other reasons, and the time frame for receiving test results – up to a week or more in some areas – is a problem for many people.

Since around May or June, UAB has successfully partnered with ADPH and Alabama Civil Air Patrol to supply COVID tests and results from more than 50 mobile sites statewide. The program began with underserved communities in Jefferson County and was then adapted for rural sites. With help from the civil air patrol – which flies in test results – UAB offers COVID test results within 24 hours on weekdays and 48 hours, at most, on weekends.

Vaccines on the way

The new COVID vaccines – similar to testing – have their own barriers. Curry said that COVID fatigue, skepticism about vaccine safety, and the need for it, now that medicines are available, may lead some people to refuse the vaccine. Some populations distrust the health care system and access to the vaccine.

Curry said the vaccine is 94% to 95% effective. People don’t get as severely ill after the vaccine; if they do get sick afterward, only 4% to 5% experience negative effects.

To get the vaccine to rural Alabama, UAB proposes using the Area Health Education Centers (AHEC) in Alabama – used in getting young people into health careers – and repurposing of AHEC facilities for the pandemic. The AHECs have contacts and networks in every rural county.

Vaccinating up to 70% to 80% of Alabama’s population is a “very daunting task,” he said. “And we need to do it quickly. We’re not talking about something we do over the course of months or years.”

UAB is working to address the state’s rural partnerships – with the intent of working with ADPH and EMS agencies, hospitals, clinics, qualified health centers, fire departments, and the fire college, and other partners – in hope of getting the vaccine into rural Alabama.

Curry noted that in surveys over the past couple of months about whether people will take the vaccine, “the best that came about was 50% said they were likely, and the other 50% said they were either undecided or negative. In minority populations, it was only 25% that said they were likely to get the vaccine.” Some people are taking a “wait-and-see” stance.

Technologies for the vaccine have been a long time coming, with research accomplished the past 10 years. Curry said getting the vaccines positioned and ready was a great business decision involving the government and the military.

“The FDA and the vaccine committee took the right amount of time and made the right decision, as have those in other countries. … The evaluation hasn’t been rushed; it’s just that we were able to compress the things that we could. I plan to get my vaccine as soon as I can,” Curry said.

“We believe that, with good planning, we can get the vaccine to rural communities. We stop this pandemic and we go back to a more normal life. That is a great benefit,” he said.

Republished with the permission of the Alabama NewsCenter.