Incidence of each long-Covid feature in the 180 days after Covid-19. (Source:Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19)

With the Covid-19 infection rate consistently higher in rural areas than in urban ones, healthcare experts are wondering what kind of an impact long-haulers will have on rural health systems. These patients experience symptoms such as brain fog, fatigue, headaches, dizziness, and shortness of breath for months.

Long-haulers who need oxygen or other medical treatment could put an additional strain on facilities trying to cope Covid and routine healthcare needs in rural areas, experts said.

A study published in the journal PLOS Medicine in September found that as many as one-third of all Covid patients report long-haul symptoms that last between three and six months. Some studies have suggested that those who come down with severe cases of Covid have a 50% chance of having symptoms long-term. A small study in Germany found that 78 out of 100 Covid patients had lingering cardiovascular issues.

Carrie Henning-Smith, deputy director of the University of Minnesota Rural Health Research Center and associate professor in the Division of Health Policy and Management at the University of Minnesota School of Public Healthm said long-haul Covid patients will likely add to rural health challenges in areas where residents tend to be older, sicker, and poorer.

“I think that will be an additional challenge for rural health care, especially as we’re seeing higher rates of Covid and lower vaccination rates in rural populations,” she said in an email interview. The national rural vaccination rate is about 20% lower than the urban rate, and the Covid infection rate is about 40% higher in rural areas, according to the Daily Yonder’s most recent reports.

“All of that will likely amount to a disproportionate burden of long-term Covid symptoms in rural areas, compounded by already higher rates of other health conditions and older populations,” Henning-Smith said.

Long-haulers could also add to rural hospitals’ financial burden, she said.

“On top of that, rural residents have higher rates of uninsurance, which might result in more uncompensated Covid-related care for rural health care facilities. … There’s still so much we don’t know about long-term Covid and the full scope of its impact.”

But it’s not a problem that many hospitals are grappling with right now, said Brock Slabach, chief operations officer of the National Rural Health Association.

“The honest answer is we just don’t know the impact yet,” Slabach said. “I know clinicians are struggling to even identify it when they see it. Then there is the cascade of symptoms that can manifest, all of them chronic in nature… this could be a huge cost to the American healthcare system.”

Slabach said that in some ways this aspect of Covid is similar to influenza, where patients can report symptoms for up to three months. Most of those, he said, are people who report “just not being back to normal” whose symptoms normally resolve themselves without notice.

The long-term impact of Covid and long haul symptoms are still to be determined, he said.

“I think that rural systems of care will be taxed with huge volumes of this disease if it develops into something serious,” he said. “I think we’re so consumed, generally, with the acute phase of this disease, that the chronic phase hasn’t yet been assessed in a detailed, evidence-based way.”

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