A Tale of Two Cities

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Living in Charleston, SC comes with many advantages. We have a thriving food culture combining a mixture of seafood, African, French, English, and European influences in both casual and fine dining restaurants. We live in a vacation city with many historical and natural attractions that draw over 7 million visitors during an average year. With the College of Charleston founded in 1670 and The Citadel founded in 1842, Charleston offers two of the oldest educational facilities in the country. Charleston offers beautiful sunsets, stunning harbor views, and many beautiful examples of architecture from many periods of American history. When I moved to this city eight years ago, I never considered the healthcare infrastructure with the cornerstones of the Medical University of South Carolina (MUSC) and Roper St. Francis.

I moved to Charleston for a job in 2013. At the time, I lived in New York City and was looking for an opportunity to leave the city. While I was interviewing in Charleston, I also entertained a job offer in Watertown, New York. Watertown is a small city on the banks of Lake Ontario about 320 miles north of New York City. Had I chose to go north instead of south, my life would have been inevitably different. Aside from the food and beauty of Charleston, I had the healthcare infrastructure of a city to assist my family during the worst of COVID-19.

While both Charleston County (Charleston) and Jefferson County (Watertown) were similar in the percentage of infection rates, the percentage of deaths was significantly different. The COVID 19 mortality rate in Charleston County was approximately .12% of the population. In Jefferson County, the death rate was over double, at .26%.*

The CDC reports that since 2005, 170 rural hospitals have closed, and 700 more are at risk of closure.** Samaritan Medical Center, the primary hospital system in Watertown, temporarily closed some of its health centers and reduced its staff by 96 positions (51 layoffs and 45 open positions eliminated). Additionally, the hospital still had 200 open "critical positions" that they were looking to fill. *** Unfortunately, this is the trend in rural America. Because of the failing resources at many rural hospitals, these facilities have fewer beds, ventilators, and medical professionals to treat severe COVID 19 symptoms.

Independent of healthcare, poverty itself is a risk factor for COVID-19 related deaths. In many of our rural counties, as many as 25% of the residents live below the poverty line. These same counties reported the death rate from COVID 19 as 2.5 times higher than counties with a higher median income.

Of the Top 20 Counties for COVID 19 Death Rates, only one had a population higher than 30,000. And these 20 US counties averaged 440 deaths per 100,000 residents, whereas the United States averaged 76 death per 100,000 residents. **** To put this in perspective, as of April 28, 2021, the Johns Hopkins Resource Center for Coronavirus places US deaths at 573,385. If we were to average 440 deaths per resident (as the Top 20 rural counties averaged), we would be looking at 1,444,080 deaths.

The plight of our rural healthcare system is not one we, as a nation, can continue to ignore. There are only 1805 rural community hospitals left in the United States *****. On average, since 2010, ten rural hospitals close each year. Because many of these rural areas border each other, the strain of one hospital closing increases the burden on neighboring hospitals, creating a domino-effect.

While telehealth and large corporations (Walmart) are stepping in to provide primary and urgent care, the need for emergency and short-term care facilities is not decreasing. We, as a nation, are spiraling down a path where the heartland of our country may soon live more than 30 minutes away from an emergency facility.

While I wish I had the magical solution to stopping this desperate trend, I don't. All I can do is try to get people to do their research and recognize this problem.

• * Sorry, this link from the NY Times is no longer available on their webiste - https://www.nytimes.com/interactive/2021/us/
• ** "COVID-19 And Your Health". Centers For Disease Control And Prevention, 2020, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html.
• *** Keir Chapman, 7 News Staff. "Faced With $10M Shortfall, Samaritan Lays Off 51 Workers, Makes Other Cost-Cutting Changes". Https://Www.Wwnytv.Com, 2021, https://www.wwnytv.com/2020/09/10/faced-with-m-shortfall-samaritan-lays-off-workers-makes-other-cost-cutting-changes/.
• **** "COVID-19 Map - Johns Hopkins Coronavirus Resource Center". Johns Hopkins Coronavirus Resource Center, 2021, https://coronavirus.jhu.edu/map.html.
• ***** "Fast Facts On U.S. Hospitals, 2021 | AHA". American Hospital Association, 2021, https://www.aha.org/statistics/fast-facts-us-hospitals.