The virus infecting thousands of Americans a day is also attacking the country's social fabric. The coronavirus has exposed a weakness in many rural communities, where divisive pandemic politics are alienating some of their most critical residents — health care workers.
A wave of departing medical professionals would leave gaping holes in the rural health care system, and small-town economies, triggering a death spiral in some of these areas that may be hard to stop.
Ten years ago, Dr. Kristina Darnauer and her husband, Jeff, moved to tiny Sterling, Kan., to raise their kids steeped in small-town values.
"The values of hard work, the value of community, taking care of your neighbor, that's what small towns shout from the rooftops, this is what we're good at. We are salt of the earth people who care about each other," Darnauer says. "And here I am saying, then wear a mask because that protects your precious neighbor."
But Darnauer's medical advice and moral admonition were met with contempt from some of her friends, neighbors and patients. People who had routinely buttonholed her for quick medical advice at church and kids' ballgames were suddenly treating her as the enemy and regarding her professional opinion as suspect and offensive.
COVID-19 cases in the county started to climb. Meanwhile, other small Kansas towns flared into some of the pandemic's hottest hot spots.
"It's heartbreaking," Darnauer says. "Because we say, this is what we value. And then when we actually had the chance to walk it out, we did it really poorly."
The pushback was too much. Darnauer resigned her position as Rice County medical director in July. Some friends reached out to support her, and her bonds with other local health care professionals strengthened, but she felt disrespected and betrayed by the ascendant anti-mask portion of the community. Darnauer says the pandemic has exposed a rift that won't be forgotten.
"Hard things should bring us together," Darnauer says. "And instead, this hard thing has driven a wedge between us."
That wedge is splitting off health care workers from communities that desperately need them.
More than a quarter of all the public health administrators in Kansas quit, retired or got fired this year, according to Vicki Collie-Akers, an associate professor of population health at the University of Kansas. Some of them got death threats. Some had to hire armed guards.
"These are leaders in their community," Collie-Akers says. "And they are leaving broken." Collie-Akers notes these professionals also leaving at a terrible time. The pandemic is still raging. Vaccines still need to get from cities to small towns and into people's arms; public health officers are as important as ever.
And who, she asks, is going to take the jobs health care directors are leaving?
"It's not a secret that the position is open because of extreme tension between the health department director and the city commissioner, county commission, or because the person has required a guard," Collie-Akers says.
"No good year for rural health"
And it's not just Kansas. Alan Morgan, CEO of the National Rural Health Association, says this is happening across a lot of rural America.
"It's been a terrible, an absolute terrible, no good year for rural health," Morgan says.
Morgan worries that the loss of county health directors in the middle of a pandemic will lead to sicker rural populations and still more pressure on rural hospitals.
Rural hospitals were in deep trouble before the pandemic. Morgan says 132 of them have closed since 2010. COVID-19 made matters worse. The surge of desperately sick and highly contagious patients stopped hospitals from doing the lucrative elective outpatient procedures that keep them in business. Their small staffs have been run ragged. And the pandemic has filled the air with vitriol against medical expertise.
Rural health care jobs can be hard to fill in the best of times; now, Morgan says many rural hospitals he represents are growing desperate.
"In community after community, after community, all I hear about is workforce, workforce, workforce losing clinical staff, trying to attract clinical staff into these communities. It is taking up the full time of our members right now," Morgan says.
Closing rural hospitals, Morgan says, cuts health care to places where residents tend to be older, sicker and poorer than average.
Lifeblood of community
It also undermines the rural economy. Hospitals are often the biggest employers in small towns, according to Chris Merrett, director of the Illinois Institute for Rural Affairs. And Merrett says health care workers are absolutely vital.
"They are really the lifeblood of any community and a rural community in particular," Merrett says. "These are well-paid individuals who are the ones who are buying cars, buying homes, and really part of that economic anchor of your community."
Merrett says towns that let pandemic politics drive medical professionals away are choosing what he calls "toxic individualism" over the common good.
There are signs that months of pushback against rural health care providers may be starting to slack. Morgan says mask compliance has soared in small towns with major COVID-19 outbreaks.
And though Darnauer has stepped away from the county health department, and thought long and hard about moving out of Sterling this summer, she's decided to stay and practice medicine there, at least for now.
"There were enough people that sort of reached out to give me hope that some of the values and of this small town were still there," Darnauer says. "And that's what's keeping me going."
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