In rural North Carolina, signs emerge that omicron may overwhelm the most vulnerable communities

By Michael Wilner

WASHINGTON — Rural counties across America have some of the lowest vaccination rates in the country among residents aged 65 and older — and that is where the omicron variant is heading next.

While the initial surge of omicron cases and hospitalizations emerged in major cities, experts fear the next phase will come to areas of the country that are least prepared for it: where communities are disproportionately at risk of severe illness and death, and where hospitals are least equipped to handle it.

In North Carolina, a statistical modeling team named COVSIM — made up of scientists from UNC-Chapel Hill, N.C. State University and Georgia Tech — projected on Wednesday a sharp spike in coronavirus hospitalizations through the first two weeks of February, with rural counties experiencing between a four-fold and six-fold increase in hospitalizations beginning at the end of January.

Some hospitals across the state have asked the health department to consider emergency provisions of state laws that restrict how registered nurses, licensed nurses and physician assistants are allowed to practice. And at least some are also open to allowing nurses who test positive but are asymptomatic to continue treating patients in order to keep staff on the job, said Julie Swann, head of the Department of Industrial and Systems Engineering at N.C. State University.

Kelly Haight Connor, communications manager for North Carolina’s Department of Health and Human Services, said that 86% of the state’s ICU beds are currently in use.

The state is working to “maximize existing flexibilities in scope of practice for health care workers,” Connor said, allowing hospitals to expand their bed capacity and workforce staffing with out-of-state personnel, retirees and students.

But rural hospitals with less flexible teams than city hospitals — those without personnel working on elective surgeries and without large, 100-person emergency room staff — are already limited in their capacity to respond.

“As we have seen cases increase rapidly due to the more contagious omicron variant, we’ve seen COVID-19 hospitalizations increase as well and put a strain on our healthcare system,” Connor said. “As our cases continue to increase, we expect to see our hospitalizations continue to increase.”

A White House official acknowledged the coming strain on rural hospitals in North Carolina and elsewhere, telling McClatchy that, “to help communities battle omicron, 25 FEMA ambulances and 50 personnel providing patient movement statewide arrived in North Carolina on Monday.”

The crisis is forcing hospitals to dust off triage plans that have been updated throughout the pandemic but, for the most part, have not had to be used.

“Do you take someone off of a ventilator if you don’t anticipate they’ll recover, and you’ve got someone else who needs a ventilator? Those are the kinds of hard decisions that we could get to that point,” said Swann, who was an adviser to the Centers for Disease Control and Prevention during its response to the H1N1 pandemic in 2009. “But ventilators aren’t the resource problem – the resource is people. Not beds, but staffed beds.”

Swann said that the COVSIM statistical model tracking omicron in North Carolina, which her team has been updating daily, indicates that in about four to six weeks, “we could really be very stressed in the hospital system — and that increases the risk of death from everything. Heart attacks. Car wrecks. Everything.”

That will particularly strain rural hospitals, she said.

“These are the areas with the least resources, because when you’re a small hospital, you just don’t have the budget,” Swann said. “That’s where the challenges are the greatest in terms of the ability to flex or surge capacity.”

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