One cause of the spike in Covid-19 cases in rural communities in the West, Northwest, and Midwest is likely the return of in-person classes at colleges and universities, experts in infectious diseases said during a briefing last week

Researchers with the Infectious Diseases Society of America also said the pandemic is likely to stick around until the summer or fall 2021 –  with or without a vaccine. 

States like North Dakota, South Dakota, Utah, Montana, Wisconsin and others avoided high numbers of cases throughout the summer. But cases began to accelerate in early September. That timing leads Andrew Pavia, M.D., chief of the division of pediatric infectious diseases at the University of Utah School of Medicine, to theorize that the reopening of colleges was a major factor in the surge in those states.

“There are many colleges in these states where young people come from all over and gather,” Pavia said. “Most of the states that are heavily hit have kept in-person schooling and, probably more important, have kept their extracurricular and sports going on.”

Pavia was joined by Daniel P. McQuillen, M.D., senior physician with the division of infectious diseases at Beth Israel Lahey Health in Burlington, Massachusetts. He and Pavia spoke to reporters last week via a video conference call about the rise in Covid cases in rural areas. 

Individual events like the Sturgis, South Dakota, motorcycle rally and failure to follow social-distancing and mask guidelines have contributed to the surge, Pavia said. But the return to campus of thousands of students across the regions stoked the embers of the pandemic, he said.

“Because you bring people in from many different places, they’re living together, they’re recreating together and all the things college kids do together. And within a few weeks we were seeing increases in cases in young people.” 

Soon the spread included all age groups. The concern now, they said, isthe strain these extra cases were putting on rural hospitals, already strapped to begin with. 

“Our public health resources are being stretched thin,” Pavia said. “Not only are the overflow ICUs that were purposely built filling up,… but the shortage of staff is becoming critical. These folks have been working flat out for eight months now. On top of that, they’re becoming ill, their family members are getting ill. They’re facing crisis after crisis.” 

Another concern is that many of the counties being hit with the coronavirus now lack the specialists needed to treat patients. According to McQuillen, around 80% of the counties currently coping with the wave of infections lack an infectious disease specialist. These specialized doctors, McQuillen said, are proven to create better results, with patients recovering quicker and not returning once they’re released. 

The doctors said that while outcomes are getting better because medical professionals know more about the disease, there’s still much to learn. New treatments like dexamethasone and remdesivir, as well as not putting people on ventilators as quickly and stopping blood clotting, have led to lower death rates for the disease. 

However, Pavia said, things will get worse over the next two months or so.

“We’re very concerned,” he said. “The big problem is hospitalizations go up a week to two weeks after case rates go up. Deaths go up about a month after hospitalizations go up. Our case rates are still going up, we need to flatten them. The situation in the hospitals is going to be quite a bit worse (in a few weeks) than it is today.”

The doctors said how people handle Thanksgiving will be the key to lowering case rates. If families will scale back on their Thanksgiving celebrations and do not hold large gatherings, another acceleration could be avoided going into Christmas, Pavia said. 

While news from Pfizer about a possible vaccine is good, it’s not going to help in the short term.. According to Pavia, the vaccine, even if available, won’t end the pandemic this winter. The realistic timeline, he said, is the next summer or fall.

In the meantime, the doctors said, people in rural areas can help slow the spread by wearing masks, washing their hands, and avoiding large groups. That includes being vigilant at home. 

While there’s a feeling that people are safe within their family bubble, McQuillen said, once someone within the home goes out to a bar or a restaurant or such, they can bring it back to the home and spread it to the rest of their family. 

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