Rural Physician Leaders Roundtable Grapples with Common COVID-19 Challenges

Issues include lab testing, clinical care, masking and preparing for influenza and school re-openings

August 13, 2020

WHA’s Rural Physician Leaders Roundtable held its third set of meetings in 2020 on August 6. The roundtable is a forum for physician leaders in rural communities to connect, discuss common challenges and to share best practices. The Rural Wisconsin Health Cooperative is a key partner of WHA for the roundtable. The latest roundtable meetings focused on the following key issues:

Lab testing
Many rural hospitals lack a consistent supply of testing materials, particularly reagents. Testing turn-around times can be up to 8-10 days for commercial labs. Those hospitals that have access to in-house testing are prioritizing those tests for patients needing care. Almost all hospitals do not have enough kits to test asymptomatic patients who are not a direct contact of a person infected with COVID-19. Many physician leaders are concerned about the additional stress that re-opening schools will place on lab testing ability as the viral respiratory season advances this fall.

Clinical care in rural communities
Roundtable members were generally satisfied with their ability to provide a variety of therapeutic modalities to their patients hospitalized with COVID-19, especially Remdesivir, dexamethasone and even convalescent antibody serum. Several physician leaders noted the pandemic has facilitated greater coordination and communication within their hospitals, their health systems and even across health systems in their communities. Roundtable members consistently described robust system support including ease of transfer when patients need higher levels of care, particularly respiratory support. Some rural hospitals continue to experience challenges transferring patients with COVID-19 to long-term care facilities when those patients are medically ready for transfer.

Masking
Rural physician leaders noted that masking was often a contentious issue in their communities with lots of misinformation that made masking a challenging topic of conversation with patients. Most patients and visitors are complying with hospitals’ mandatory masking policies. But in many rural communities, compliance with Governor Tony Evers’ public health emergency masking mandate is inconsistent. Many patients are making appointments with providers to obtain a written note documenting a masking exemption even though that is not necessary under the most recent public health emergency declaration.

Preparations for fall and winter
Rural hospitals and physicians are proactively working with local school systems to develop testing protocols. One health system is applying for an EUA (emergency use authorization) to perform test pooling in order to conserve supplies. Another hospital is converting its drive-up COVID testing site to a drive-up influenza vaccination site since traditional influenza vaccination clinics are not compatible with the physical distancing appropriate for COVID-19. Roundtable discussions reflected how closely rural providers are working with schools, businesses and local government to lessen the adverse impact of COVID-19 on their communities. In addition to public schools, there was concern shared about testing supply volume in the case of college students returning to campus and being required to test prior to arrival. Outstanding questions include where students will be tested and how testing will be paid for. 

The Rural Physician Leaders Roundtable meets quarterly via videoconference. Physicians interested in learning more or who would like to join the roundtable should contact WHA Chief Medical Officer Mark Kaufman.

This story originally appeared in the August 13, 2020 edition of WHA Newsletter