A health system in Upstate New York is one of only a handful of locations serving rural areas that are part of clinical trials for Operation Warp Speed, the federal research effort to test treatments for Covid-19. 

“[The trials] provide a large number of the Covid-19 patients in our area with a potential treatment option that isn’t yet on the market,” said principal investigator Eyal Kedar, M.D., a rheumatologist in the St. Lawrence Health System in St. Lawrence County. 

“And since there’s so little clinical research infrastructure in general in rural America, we are the rare rural site that is able to offer these clinical trial options in the pandemic.”

St. Lawrence is the largest county in New York by area and is bounded by the St. Lawrence River and Canada to the north. Covering an area larger than Delaware, the county has four municipalities with more than 10,000 residents. But the closest U.S. metropolitan center is Syracuse, about 150 miles to the southwest, over the Tug Hill Plateau, one of the snowiest places in the U.S. 

Dr. Eyal Kedar and Carly Lovelett discuss how building a better rural health-research system can reduce disparities and improve prospects for rural communities. This podcast is from Kedar’s website, Rural America and Covid-19.

The St. Lawrence Health System encompasses multiple primary-care centers, clinics, and three hospitals, two of which have only 25 beds.

The research is pursuing two tracks, Kedar said.

“In our Covid-19 clinical trials program, ACTIV-1 provides a potential treatment for hospitalized patients,” he said. “And ACTIV-2 provides a potential treatment for the many patients who have tested positive for Covid-19 but who have not been admitted to the hospital.” 

Clinical trials are essentially research studies where volunteers receive new drugs or treatments so scientists can determine how effective they are. 

Currently, the National Institutes of Health are conducting clinical trials for everything from vaccines to new treatment methods – for those in outpatient care, as well as those who are hospitalized. 

“It’s important to have new medications studied for Covid-19 because we have so little right now, and in particular because we still have nothing for patients with milder disease,” Kedar said. 

“For the sickest patients, dexamethasone can prevent death. But it doesn’t help and may even harm patients with milder forms of the disease. We also have Remdesivir, which has been shown to reduce the time a patient spends in the hospital but has not been shown to prevent patients from dying.”

It’s not the first time the health system has been involved in research trials. Over the past six years, Kedar said, the health system developed a clinical and rural health research department and participated in a variety of clinical trials. 

“When Covid-19 struck, our track record in having already served as a site for a variety of clinical trials over the past six years enabled us to be competitive for Covid-19 trials. We have now participated in or are participating in three Covid-19 trials, and this number will likely increase as the pandemic continues,” he said. 

The decision to enter the trials is made by the Covid treatment team, the Department of Clinical and Rural Health Research in the St. Lawrence Health System and the administration of the St. Lawrence Health System. 

Having clinical trials in rural hospitals is important for a number of reasons, Kedar said. 

“For one, it’s really important for rural Americans to know that their local health systems are on par with urban ones,” he said. “This can provide not only a sense of confidence in rural health systems, but  in a pandemic such as this one it can also provide rural patients with a sense of hope.”

It can also decrease disparities between rural and urban hospitals, he said. 

“It’s important also to continue to work towards eliminating health care inequality in rural communities,” Kedar said. “One of the ugliest things about this pandemic is that it’s both revealed and worsened a number of longstanding health and healthcare disparities in rural America.”

Lack of access to clinical trials in rural areas can erode trust in the healthcare system and potentially affect medical care there.

“When you don’t have access to research trials (in rural areas), some of the most key treatment opportunities that we have for Covid don’t get offered to you,” he said. “And the results of that can range from decreased confidence in the larger American medical system on the part of those who have been left behind and don’t have access to these opportunities, to potentially increased mortality rates for patients who don’t have access to life saving medications.”

Working as part of Operation Warp Speed has been a way to bridge the rural-urban divide, he said. 

“It’s been a very good experience, and it’s been very gratifying,” he said. “When I look at the site lists for these large clinical trials, it’s been very encouraging to see our rural health system’s name alongside the names of so many large urban and academic health centers.”

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