CDC on rural COVID-19 response

By: Rural Horizons | 7/30/20

Diane Hall

Q&A with Diane Hall

Diane Hall is a senior policy analyst with the Centers for Disease Control and Prevention (CDC) and lead for the CDC’s Minority Health and Rural Health Team on COVID-19 response. Hall serves as the CDC rural representative on various government task forces, committees, and working groups. In her role, she works to connect CDC program offices with resources, including opportunities for research, publishing, and presenting at professional meetings and conferences. Hall discusses her work on rural health issues and shares insights on the CDC’s response to COVID-19 in rural America.

Q: How do rural communities use data to plan their response to COVID-19?

County-level data can inform targeted prevention and mitigation efforts. With county-level data, we are able to readily see and respond to emerging areas with high COVID-19 activity, many of which have been in meatpacking plants, correctional facilities, and long-term care facilities in rural areas. The CDC provides information about COVID-19 cases and deaths by county, which is updated daily.

Community-level data can be particularly challenging, especially in areas where there has not been a lot of testing. Communities can check with their state or local public health departments for data — they are the best source of up-to-date information.

It is important to realize that people may be infected with COVID-19 but not show symptoms. Often this means that as testing expands locally, cases can sometimes increase rapidly as these asymptomatic cases are uncovered. Local officials should consider this when interpreting surges in positive results that coincide with increases in testing. It is also important to know that the numbers can fluctuate daily. Keeping track of trends can give a more complete picture of what is happening in a community or locality.

Local officials can use data to make decisions about when to impose or lift mitigation strategies in their communities and to track and plan for any surges in cases.

Q: What does CDC data show about meatpacking plants and other high-risk facilities that could cause community spread?

We have seen outbreaks in many meatpacking plants, food processing facilities, correctional facilities, and long-term care facilities located in rural communities. COVID-19 spreads easily in these facilities because people work and in some cases live in close quarters. It is important for the community to work with these facilities to help stop outbreaks and reduce local spread.

Often a rise in COVID-19 cases at these facilities can transmit disease more widely in the community, as people who work in these facilities interact with family members; visit local stores, restaurants, and churches; and engage in other social activities. That’s why it’s vital to continue practicing social distancing, wearing cloth face coverings, washing hands frequently, and practicing other protective actions, as well as following CDC’s guidance for such facilities. Taking these steps can help slow the spread of COVID-19.

Q: Are there other factors that may contribute to the spread of COVID-19 in rural communities?

There is so much we still do not know about this virus, including why some people are more likely to get severely ill than others. In general, we know that older adults and people with serious underlying medical conditions, such as heart disease or diabetes, are at increased risk of severe illness.

We saw rapid spread in some larger urban areas, but we have also seen sustained spread of COVID-19 in less densely populated areas. Close contact with others is the key to this increased spread. While people who live in rural communities might not have the same exposures we see in urban areas (e.g., riding mass transit), other activities can create opportunities for COVID-19 to spread. These include working closely with others in a factory or plant, worshipping together in large groups, or socializing without practicing physical distancing.

Q: What can rural residents do to prevent community spread?

We know the best way to prevent spread is to limit close contact. If you have to be around others, try to remain a distance of six feet. Wash your hands regularly for 20 seconds using soap and water. If you don’t have access to soap and water, using hand sanitizer with 60 percent alcohol can be a substitute. Clean and disinfect frequently touched surfaces.

It’s also important to take steps to protect others in case you have COVID-19. People who are infected can spread the virus, even if they only have mild symptoms or no symptoms at all, so you could be infected and spread it without feeling sick. That’s why it’s important to wear a cloth face covering to help prevent you from spreading the virus to others. If you do feel sick, stay home. Cover your coughs and sneezes with your elbow, not with your hands.

People living in rural communities that have not seen a lot of COVID-19 activity can also take steps to prepare.

• Identify the two closest health care facilities to contact in case of an outbreak.
• Create an information card with the numbers and addresses of health care facilities and the family and friends who are physically nearest to you.
• Create an information card with the numbers and addresses of health care facilities and the family and friends who are physically nearest to you.
• Create a phone tree system (activating a group of people by telephone to get a message out quickly) with family, friends, and neighbors.
• Check with your state or local health department for up-to-date information.

Q: How can rural health professionals use contact tracing and testing to become involved in public health initiatives?

Contact tracing is similar to detective work, and it is fundamental to stopping the spread of diseases. The CDC has developed resources for health departments to help them set up new contact tracing programs and expand existing ones. On that page, we include trainings, fact sheets, interview guides, and information about digital tools.

In terms of testing, rural health clinics are receiving $225 million for COVID-19 testing. The Federal Office of Rural Health Policy has additional information about the awards on their website. HHS also recently awarded $15 million to respond to COVID-19 in rural tribal communities.

Q: What is the CDC’s stance on rural access to and shortages of personal protective equipment?

Personal protective equipment (PPE) is a critical part of infection control. Because of PPE shortages due to the pandemic, the CDC has provided information on ways to optimize supplies of PPE and other equipment. We also have a PPE burn rate calculator to help facilities track their PPE inventory. More contact tracing resources can be found on the CDC’s website.

Q: In what ways does your work with the CDC impact rural health?

My office works to bring rural training workshops to the agency to help build capacity. We created a CDC-wide rural health learning community so staff can connect with one another. We are building a bench of scientists and public health experts with rural health interest and expertise across the agency. I believe all of this work and the visibility we have brought to rural health issues and concerns has culminated in including rural health as a formal part of our COVID-19 response structure.

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