“Since 2010, the year the Affordable Care Act was passed, 129 rural hospitals in the United States have closed,” Trump said. “Predictably, financial distress is the strongest driver for risk of closure, and many rural hospitals lack sufficient patient volume to be sustainable under traditional healthcare reimbursement mechanisms. From 2015 to 2017, the average occupancy rate of a hospital that closed was only 22 percent. When hospitals close, the patient population around them carries an increased risk of mortality due to increased travel time and decreased access.”

New research featured in Health Affairs also examined the disparities in community ICU beds by median household income. Not surprisingly, 49% of the lowest-⁠income communities had no ICU beds in their communities compared to only 3% of the highest-⁠income communities. Furthermore, income disparities in the availability of community ICU beds were more acute in rural areas than in urban areas.

Research shows telehealth is an important tool for rural hospitals in treating COVID-19, and with the help of government funding, rural hospitals, including those in Oklahoma, have already been using it to manage difficult-to-staff environments.

"Prior to the outbreak of COVID-19, many rural hospitals in Oklahoma were already under serious financial strain, dealing with a very fragile financial outlook," said Rhett Stover, MHA, FACHE, and CEO of Oklahoma State University OSU Medicine, in a statement. "Through the availability of COVID-19 stimulus funding, many rural facilities have benefited from the receipt of additional resources, better positioning each to respond to the increased pressures caused by the novel coronavirus pandemic."

And surgeons at a rural healthcare system on both sides of the New York-Pennsylvania border have reported on their preparedness response plan for dealing with the COVID-19 surge in an article published in the Journal of the American College of Surgeons. The plan includes greater utilization of telehealth, and coordination of resources and communications at affiliated centers spread over a large geographic area.

"We have an older patient population, and they have more comorbid conditions than what you might find in an urban area," said Jean Miner, a general surgeon at Guthrie Clinic/Robert Packer Hospital in Sayre, Pennsylvania. "Our population is also very spread out, with about 77 people per square mile, and some of the research shows that up to 35 percent of the people in rural areas don't have Internet access. Some of our staff doesn't even have Internet access." By comparison, New York City has about 27,500 people per square mile.

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