GREENSBORO, N.C. — Cone Health shuttered their old Women’s Hospital on Feb. 23 after they opened a new wing at their main hospital. Less than two months later, the hospital was back open. But this time the building had a new mission - it became a hospital dedicated to treating coronavirus patients.

Most COVID patients who need to be hospitalized from Guilford County and three surrounding counties come to this sprawling, low-flung brick building on Green Valley Road.

“We thought maybe we would be here for two or three months and that would be it,” said Dr. Jeffrey McClung, who helped start the COVID hospital for Cone Health.

Forty rural counties in North Carolina are in the coronavirus “red zone,” defined as more than 100 cases per 100,000 residents, and that number has almost doubled in recent weeks. Cases of the virus have been spiking in rural communities around the county, according to researchers.

According to the North Carolina Population Center at UNC Chapel Hill, 40 of the state’s 54 rural counties are in the “red zone.”

“Statewide, COVID-19 infections are rising in both rural and non-rural counties, but they are rising faster in rural areas. While 21% of North Carolina population lives in a rural county, 33% of new infections were in one of these counties in the most recent week of data,” according to the population center.

Dr. Jeffrey McClung helped start the COVID hospital for Cone Health. (Photo: Charles Duncan)

On Thursday, the COVID hospital in Greensboro had about 60 COVID patients, but those numbers fluctuate with the ebb and flow of the virus in Guilford County and the surrounding, mostly rural, area. At its peak, the hospital had about 75 patients.

McClung said the COVID hospital has big advantages for patients, especially those from rural areas. The dedicated hospital means the doctors, nurses and other staff have months of experience treating coronavirus patients.

They also get access to drugs like Remdesivir that can be hard for a smaller hospital with just a handful COVID patients to get.

“We had experience with more and more patients,” he said, and the staff got better and better at treating them and getting them through the virus that has killed more than 210,000 people in the United States.

Treating severe coronavirus patients all in one central hospital has also allowed Cone Health’s other hospitals to continue seeing other patients who may otherwise be afraid of catching the virus if they went to a hospital, McClung said.

“Just because COVID is here doesn’t mean people stop having heart attacks,” he said.

Staff at the hospital jokingly call it a “plague hospital,” McClung said. “It feels like you’re living in a sci-fi scenario,” he said. “You hope that something like this is not needed.”

But it is needed. The pandemic has brought health care disparities for rural communities into sharp focus, according to Katrina Badger, with the Robert Woods Johnson Foundation. The foundation, along with NPR and Harvard University’s School of Public Health, released a new poll Wednesday looking at the impact of COVID on rural America.

She said the study found almost a quarter of rural households are unable to get medical care when they need it.

“More than half of rural households (53%) report anyone in their household is living with a chronic illness, while 42% report anyone in their household is at high risk for developing serious illness from COVID-19 due to their age or underlying medical conditions,” according to the study.

The poll, which was conducted between July 1 and August 3, found that about a third of households with someone who had a chronic illness could not find care during the pandemic.

The pandemic has also helped bring health care technology into rural communities. Almost half of the rural households in the survey reported using telehealth services.

But the coronavirus has also made other problems worse for rural communities, including a lack of broadband internet and increasing unemployment.

“They are weary”

In Robeson County, “the numbers remain stubbornly high,” according to Jason Cox, a vice president at Southeastern Health in Lumberton, near Interstate 95.

There are fewer patients who are critically ill in the intensive care unit, he said, but as of Tuesday, the hospital still had 25 patients admitted with the coronavirus.

But it’s still taking a toll on the communities and the hospital’s staff. “They are weary,” he said, but “the morale has somewhat improved recently” after the hospital was able to give temporary pay increases.

Cox’s hospital serves a rural area along the border with South Carolina.

He said his hospital is better able to get things like personal protective equipment, but is still having trouble getting basic testing supplies like swab tips.

Cox said the virus, and public health mandates like mask requirements, has divided the community he serves, mirroring the debate around the country over reopening during the pandemic.

But people are getting tired of trying to be vigilant about the virus. “In March we didn’t know it would be as active as it is coming into the flu season,” he said.

A mural in the Cone Health COVID hospital in Greensboro, North Carolina, asks staff what they do when they take their mask off after working with coronavirus patients all day. (Photo: Charles Duncan)


Community connections

“One of the strengths in rural areas is for people to connect at the rural level,” said Margaret Sauer, director of the Office of Rural Health for the state Department of Health and Human Services.

The office is working with community nonprofits to hire community health workers around the state, in both urban and rural areas.

Sauer said the program is intended to hire people from within the community to help others get access to COVID testing and care. They can also help people who test positive and need to isolate to connect with services to get financial help, food and other necessities.

She said some health departments in rural counties were going as far as delivering diapers and groceries to families isolating because of the virus. These new community health workers are a way to help relieve that burden and let counties focus on testing and contact tracing.

“Making sure people have access to care is really important,” she said.

Many people in rural areas rely on federally designated rural health clinics. But DHHS found that those clinics are the the least likely to use tools like telemedicine.

North Carolina has the oldest office dedicated to rural health in the country. Sauer said the main challenge is to make sure “we are not doing things to people, we are doing things with people.”

The people in rural areas know their communities better than anyone else and are the best people to help shape how public health officials can help.