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Transmission rates may be lower in rural areas, the percentage of cases resulting in death and other serious complications could be higher in rural than in urban areas.

CORONAVIRUS

THE DAILY YONDER | By Shannon Monnat On Mar 24, 2020

As rates of coronavirus (COVID-19) infection and death continue to rise, it is important to consider how rural areas may be differentially affected. On the one hand, rural parts of the U.S. may be comparatively better off than urban places due to lower population density in rural areas. Lower population density reduces opportunities for virus spread. On the other hand, there are several features of rural populations and places that increase their risk of coronavirus-related mortality and other long-term health impacts.

These include the realities that rural populations are older and have higher rates of several chronic health conditions, and rural areas have a less robust health care infrastructure to deal with coronavirus cases. Rural economies may also be affected in different ways than their urban counterparts, which has implications for long-term rural population health outcomes.

Rural Populations Are Older

Coronavirus infection is more deadly for older adults.  According to a recent CDC report, thus far, 31% of COVID-19 cases, 45% of hospitalizations, 53% of intensive care admissions, and 80% of deaths have been among adults aged 65 and older, with the highest percentage of severe outcomes among those 85 years and older. This is bad news for rural America. Nineteen percent of the rural population is 65 years or older, compared with 15% in urban areas. Whereas the average share of the population that is age 65+ is only 15.2% among large metropolitan counties, the average share of the population that is age 65+ is 21.7% in the smallest nonmetropolitan counties (see Figure 1). Nearly two-thirds of the U.S.’s  643 small metropolitan counties are considered “older-age counties”— counties where more than 20% of the population is age 65 or older (see Figure 2). Only 7% of large metropolitan counties fall into this category.

In addition to its implications for mortality rates, the older age structure in rural areas has implications for informal caregiving. Older adults nationwide rely on informal caregivers (e.g., friends, family, neighbors) for support, but access to informal caregivers may be more difficult in rural areas given longer travel times. This may lead to greater isolation among older adults in rural areas and may mean that they do not get necessary healthcare services and other essential resources, like medications, groceries, and social interaction.

Higher Prevalence of Chronic Health Conditions

Early data from China [PDF] show that people with certain serious chronic medical conditions, such as heart disease, diabetes, chronic respiratory disease, lung cancer, and depression are at greater risk of death and other serious complications from COVID-19 because these conditions weaken the body’s health defense and immune system against viral infection. Rural Americans have higher rates of each of these chronic health conditions than their urban peers (see Figure 3). This means that although transmission rates may be lower in rural areas, the percentage of cases resulting in death and other serious complications could be higher in rural than in urban areas.

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PHOENIX NEW TIMES | STEVEN HSIEH | MARCH 17, 2020 | 5:02PM

Dr. Gail Guerrero-Tucker takes her temperature before every shift.

It's a new procedure, one of several routines that Gila Valley Clinic in Safford, Arizona, has implemented since Graham County's first coronavirus patient walked through its doors last week. The patient, an elementary school teacher, tested positive for the virus on Friday.

The positive case jolted the health care community in Safford, as well as the surrounding towns that make up a mining and ranch community in southeast Arizona. Clinics are rationing masks, public health officials are dissuading residents from overwhelming the strained health system, and the sole hospital in the region is grappling with the possibility that it may no longer have the option to airlift seriously ill patients to big cities.

While the largest known coronavirus outbreaks in the United States so far have occurred in densely packed cities — such as Seattle and New York — the case in Graham County highlights the risks of the global pandemic in rural communities. 

Safford sits along a cluster of small towns near U.S. Route 70 in southeast Arizona, including Pima, Central, Thatcher, and Solomon. Mt. Graham Regional Medical Center — the only hospital in the Safford area — serves a population of about 40,000 people.

It's a tight-knit community that comes with its own problems when dealing with a virus that spreads via shared surfaces and respiratory droplets. 

Town residents shop at the same Walmart, grab last-minute meals at the same fast food joints, and watch movies in one of two Safford theaters.

"We’re being encouraged to get takeout stuff, but what if one of those kids from Pima works at the Dairy Queen?" Guerrero-Tucker said. "You’re almost afraid because there is no anonymity and nobody knows what to do."

Most families in the area likely know someone who attends Pima Elementary School, the center of the Graham County outbreak. Authorities asked 166 students and five staff members who may have been exposed to voluntarily self-quarantine, but health officials did not expect everyone to follow the order.

"I am not expecting that we would be able to contain this exposure. We’re planning for that unfortunate end," said Matt Bolinger, infectious disease epidemiologist for Greenlee and Graham counties.

At Gila Valley Clinic, the staff of five physicians and four nurse practitioners have been taking unprecedented steps to prevent coronavirus spread. They're separating patients with upper respiratory symptoms. They're dividing the day into two shifts: One for "well patients" without illnesses, and one for sick patients. They made a mother wait in her car during her child's appointment after finding out she was exposed to the virus.

And they're rationing N95 respirator masks, which are critical to protecting health workers from coronavirus. Guerrero-Tucker said staff found a few in storage units, and the county health department delivered a handful of "duck bill" masks, which are not quite as protective. 

"But honestly if we have a big outbreak here, we’ll run out of masks within a week," Guerrero-Tucker said.

Pulling Together

Down the street from Gila Valley Clinic, Mt. Graham Regional Medical center is making its own preparations. 

Arizona as a whole faces a potential statewide shortage of hospital beds in case of a large coronavirus outbreak. The problem could be even more acute at rural hospitals, which are not as well equipped to handle severe trauma and illnesses.

Mt. Graham Regional Medical Center has licensed 49 beds, according to CEO Roland Knox. With state restrictions waived, the hospital could convert rooms and have "probably closer to 80."

That would not be enough to handle a worst-case scenario in Safford, where hundreds or even thousands of patients could require hospitalization for coronavirus.

The hospital owns 10 ventilators that potentially could be used to keep seriously ill patients alive, including six that would have to be borrowed from operating rooms. That's not all the ventilators Mt. Graham has access to. The Graham County Health Department lent the hospital three ventilators and a private ambulatory company in town spared two of its own, bringing the total at the facility to 15, a relatively large inventory for a hospital of Mt. Graham's size.

"It’s just amazing how everybody pulled together," Knox said.

One of the starkest challenges that Mt. Graham could face is keeping the hospital staffed amid a large-scale outbreak. On Monday, the hospital held a meeting with local clinicians, including Guerrero-Tucker, to get a sense of who might be available to staff the hospital in case any doctors there become exposed. Everyone in the room said they could fill in if necessary.

"We’re trying to preserve, so to speak, our staff," Knox said. "If you had 60 patients in the building that can normally handle 49, soon it becomes very difficult to keep all of the staff safe and well rested and well nourished."

When the coronavirus outbreak occurred, Mt. Graham Regional Medical Center had been working on qualifying as a Critical Access Hospital, a federal designation for rural hospitals with fewer than 25 beds that are within 35 miles from another hospital facility, that have a 24/7 emergency department, and have an average length of stay of less than 96 hours.

Arizona's 15 critical access hospitals are mostly Level IV or Level II trauma centers, meaning they don't typically have the equipment or staff to stabilize patients for long periods of time, according to Dr. Daniel Derksen, director of the University of Arizona's Arizona Center for Rural Health. In cases that require long-term stabilization, these hospitals transport patients to Level I trauma centers, which are almost always located in urban areas.

Rural hospitals will have to contend with the possibility that they may no longer have the option to transport patients to big cities.

"If this is widespread all over the state, we’re going to have to care for our own folks here," said Bolinger, the
county epidemiologist. "We may not have the option of shipping them out to Tucson or Phoenix."

Up until about a month ago, Bolinger said, he had been telling people that asked about the coronavirus that they had a better chance of dying from the flu.

Now Bolinger stresses the importance of everyone staying home ("do puzzles, watch Netflix, whatever") to prevent coronavirus spread and keep the health care system from becoming overwhelmed. Otherwise Graham County, just like anywhere else in the world, could become the next coronavirus disaster zone.

"Where are we going to get the oxygen for all these people?" he said. "It’s an apocalyptic subject to me."

PHOENIX NEW TIMES | Steven Hsieh | March 16, 2020

Could Arizona handle a widespread coronavirus outbreak, such as those seen in Italy and China?

It doesn't appear so. At least, not with how things stand now.

The state has one of the lowest number of hospital beds in the country, according to a 2018 analysis from the Kaiser Family Foundation. With about 1.9 beds for every 1,000 people, Arizona ranks among the bottom 10 states.

There are 14,790 available hospital beds in Arizona as of Monday, according to Holly Ward, a spokesperson for the Arizona Hospital and Healthcare Association (AZHHA). That's out of a total of roughly 16,000 licensed beds in the state.

The CDC estimates that between 2.4 million to 21 million Americans could require hospitalization for COVID-19, the disease caused by the coronavirus. Do the math in Arizona, a state of about 7.1 million people, and that's about 50,000 hospitalizations for a conservatively estimated outbreak, and 460,000 in the worst-case scenario.

USA Today's own nationwide analysis found that Arizona would only have one bed available for every 22 to 24 severely ill patients amid a serious coronavirus spike.

It's unclear how many of those beds are located in intensive care units equipped to treat severe cases of COVID-19. Neither Arizona health officials nor the AZHHA could provide that information by deadline.

Also unclear is Arizona's supply of ventilators, which have been necessary in some cases to keep coronavirus patients alive. Neither Arizona health officials nor the AZHHA could provide that information by deadline. Banner Health also did not have the number of ventilators in their system offhand. 

Public health experts have warned that ventilator shortages could become a problem nationwide if large outbreaks of coronavirus happen in the United States. 

During a press conference on Monday, Banner Health Chief Medical Officer Dr. Marjorie Bessel said there is no current shortage of beds or ventilators. "I want to be clear about this," Bessel said. 

But she could not answer a question from a reporter asking whether Banner — the largest health care system in Arizona — could handle a large surge of coronavirus cases.

"At this time it is a very fluid situation," Bessel said. "We are taking absolutely every planning step we can, working very closely with the county, the state and other federal agencies to put ourselves in the best possible position to rise to the occasion and take care of everybody in the state of Arizona who is going to need us."

Bessel added that Banner has "plans for alternatives sites of care," should the network reach bed capacity, but did not elaborate on what those sites may be. 

During the press conference, Bessel repeatedly emphasized the importance of "social distancing" and personal hygiene (washing hands, avoiding face-touching) to prevent the spread of the coronavirus. Known as "flattening the curve," the concept aims to slow down the virus so as not to overwhelm hospitals.

"It’s very important that gatherings of more than 200 people stop," Bessel said. "Gatherings of more than 50 people should stop. Individuals over the age of 60 should not be in a gathering of more than 10."

To prevent the spread of coronavirus within its own facilities, Banner has implemented visitor restrictions. Patients will only be allowed one visitor a day, and Banner will conduct temperature screenings on everyone who comes into a hospital. Those who show symptoms of illness will not be allowed to visit patients.

Bessel said that Banner is also considering a moratorium or a significant reduction in elective surgeries to free up space in case of a coronavirus case surge.

Just as critical as beds and medical equipment will be adequate hospital staffing, said Dr. Daniel Derksen, associate vice president for Health Equity, Outreach and Interprofessional Activities at University of Arizona Health Services. The Arizona State Department of Health Services has not answered a question on whether it has assessed the state's current medical workforce.

"Hospitals generally try to be lean and efficient and not have redundancies," Derksen said. "Measures will have to address how many people need those tertiary levels of care and how we build redundancies in our system as this goes along."

Critical to keeping staffing levels up will be ensuring that medical workers do not become infected, Derksen added. And keeping nurses and doctors healthy will require an adequate supply of protective gear, like masks and gloves.

At the press conference, Bessel said Banner does not currently have a shortage of protective equipment.

"If we begin to run short, we will work with state and federal agencies to secure supplies," she said.

CHRISTIAN SCIENCE MONITOR | By Francine Kiefer Staff writer & Ann Scott Tyson Staff writer | March 12, 2020

Mohammed Salarzai is part of the vanguard in Seattle’s fight against coronavirus. A minimum-wage airport worker, he greets passengers arriving on international flights.

“The virus has not stopped us from working,” says Mr. Salarzai, even though, he says, “it’s the frontline, and we are very scared.”

But without sick leave or benefits, Mr. Salarzai worries that if he fell ill and had to stay home for more than two weeks he couldn’t pay rent. Worse, he fears he would lose his job at Seattle-Tacoma International Airport. 

“If I miss [work] for too long, they won’t keep me there,” says the father of five from Kent, Washington.

About a third of U.S. workers in the private sector do not have paid sick leave, according to the U.S. Bureau of Labor Statistics. That adds up to tens of millions of workers who face a trade-off between their health – and the nation’s virus containment efforts – and their financial security.

But the fast-spreading virus and the plight of workers such as Mr. Salarzai may be changing attitudes about access to health care. The subject is already top of mind for voters. While the big questions about America’s health care system will be debated in this year’s presidential campaign, more targeted changes, such as paid sick leave, look to be gathering more support. 

Major companies such as Walmart and McDonald’s that rely heavily on hourly workers are adjusting their time-off policies because of coronavirus concerns. Both Uber and Lyft, for whom Mr. Salarzai works part-time, have announced help for drivers affected by the virus. This week, the nation’s major health insurers said they will cover the entire cost of testing for the virus – though not treatment – as will Medicare, Medicaid, and insurance plans under the Affordable Care Act. 

State and local governments have swung into action, and Washington is also getting to work on a second tranche of virus-related federal assistance – much as it would respond to a natural disaster.

“There’s been a greater awareness now about people who either don’t have health insurance or have very-high deductible health insurance and might hesitate to get tested or seek care if they get sick,” says Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy in Washington. The lack of sick leave also “makes it harder to control the epidemic.”

Will the outbreak – now declared a pandemic by the World Health Organization – break through the partisan gridlock over the cost and availability of health care? Probably not, says Mr. Ginsburg, given fundamental differences between the parties over health care. 

But Mr. Ginsburg and others say the crisis could be a catalyst for real change in sick leave, one reason being cost. Unlike health insurance, paid time off for illness is a proportional expense for employers, depending on wages and hours worked. Paid leave generally is inching forward: Congress agreed in December to provide paid family and medical leave for federal employees. Twelve states and the District of Columbia now require employers to offer paid sick leave (though other states have specifically forbidden such mandates).

“The big issue we have is that many people are ... not full-time employees where there is paid leave, so unless you’re literally at death’s door, people don’t take time off,” says Amanda Glassman, a senior fellow at the Center for Global Development in Washington.

Mr. Salarzai is taking precautions to stay well. He wears gloves while at work, but says face masks are often not available. “They train us to keep away from people, but when you talk with them, you need to be close,” he says, explaining how he assists travelers with scanning their passports, as well as those with disabilities.  

Companies roll out policies

Restaurants rely on part-time and hourly workers. Darden Restaurants, which owns Olive Garden and Longhorn, is among those companies that have responded to the virus by announcing paid time off. Its policy covers all of its hourly workers with 1 hour of leave for every 30 hours worked.

Spokesman Rich Jeffers said the new policy was in the works for the better part of a year and was rolled out early. Feedback from managers and employees was “overwhelmingly positive,” he says.

But help can’t come fast enough for workers such as Bridgette Robertson, a part-time employee at Café on The Ave in Seattle’s University District. Usually, this is a bustling eatery, but this week its tables are mostly empty, as they are at other local restaurants.

“It’s a lot slower than usual,” says Ms. Robertson, a part-time employee, in between wiping down tables with Lysol and washing her hands. “If we don’t get hours and tips, it’s bad for us,” says Ms. Robertson, who has no sick leave.

Small businesses in Seattle, which employ more than 200,000 people – many without sick leave – are being hit hard by virus-related disruptions. The area is one of several concentrations of the coronavirus outbreak in the U.S.

Revenues for restaurants in Seattle’s Chinatown International District are down between 20% and 50%, and some hotels that normally have 70% occupancy now are down to less than one-third, says Bobby Lee, director of Seattle’s Office of Economic Development. 

Emergency federal aid

That’s why lawmakers and the White House are gearing up to help.

Last week, Congress passed and the president signed $8.3 billion aid package to pay for vaccines and treatment and to help state and local health officials fight the virus. Now they are working on an economic stimulus that includes a stronger safety net for individuals who may be affected by the virus – though whether Republicans and Democrats can quickly agree on a package remains to be seen.

On Wednesday evening, President Donald Trump announced a 30-day ban on most travel from Europe beginning on Friday. 

Asked Thursday about the Europe travel restrictions, Mr. Salarzai says his schedule is set for the next two weeks but he expects very limited hours after that period. “It will definitely effect everyone,” he wrote in a text message. “I hope this crisis doesn’t last long. The airport looks dead.”

House Democrats on Thursday are expected to pass a bill that includes temporary paid sick leave, food aid, unemployment insurance, and widespread free testing for the virus. It’s not clear what will actually become law. 

Nor is it clear whether this emergency response is a sign that federal lawmakers will eventually take long-term steps that bring the U.S. up to speed with other wealthy countries that provide broad health care coverage as well as paid sick leave. 

G. William Hoagland, senior vice president at the Bipartisan Policy Center in Washington, thinks a second rescue package would be less a remedy for what ails America’s health care system and more “like a natural disaster” response. Indeed, he hopes that epidemics will be added to the list of urgent crises that qualify for federal emergency aid.

As with natural disasters, state and local officials are on the front lines. Late Wednesday, Democratic Gov. Gavin Newsom of California announced new statewide health guidelines canceling or postponing nonessential gatherings of more than 250 people through at least the end of March. It followed an announcement by Washington state Democratic Gov. Jay Inslee that morning, legally prohibiting such gatherings under the authority of a state of emergency. 

“These changes will cause real stress – especially for families and businesses least equipped financially to deal with them,” Governor Newsom said in a statement. But the state is trying to relieve some of that stress by, for instance, encouraging workers affected by the virus to apply for paid family leave, unemployment insurance, or paid sick leave under California law.

Also on Tuesday, Governor Inslee announced an expansion of unemployment insurance for workers whose jobs are impacted by the coronavirus.

Tech giants step up

Seattle Mayor Jenny Durkan says that while big local companies are resilient, help is critical for small businesses and their employees who lack paid leave, and she is urging federal relief for those businesses. In the meantime, she unveiled initial recovery measures including a deferral of some business taxes. 

Seattle’s tech giants Microsoft and Amazon have recommended employees work remotely if possible and pledged to continue paying normal wages to hourly workers even if their hours are cut back. 

Microsoft and Amazon, together with Starbucks, Alaska Airlines, and nonprofit foundations, have donated millions of dollars to a local support fund that will help ensure access to food and housing for needy people in the Seattle area.

But many of the steps that are being taken, both in government and in the private sector, are temporary.

The pandemic has exposed “weak links” in America’s health care system that need to be fixed, says Daniel Derksen, a health policy expert at the University of Arizona in Tucson. For the second year in a row, the number of uninsured people rose to 30 million in 2018. Health costs are the leading cause of bankruptcy in the country, he says. States that have not yet expanded Medicaid could do so, even temporarily, and that would improve access during the coronavirus outbreak, but it looks like the larger issue of access and affordability lie ahead to tackle.

“Once again, in this election cycle, health care is the number one issue on voters’ minds,” says Dr. Derksen. “This is a teachable moment for Americans about why it’s so important to make primary and preventive services widely available.” 

Health professionals say the reduced person-to-person contact in rural areas will help buffer them from the virus. But everyone should still prepare.

DAILY YONDER | HEALTH | By Liz Carey On Mar 4, 2020 Last updated Mar 4, 2020

Urban residents are more at risk for person-to-person spread of the coronavirus, but those in rural areas aren’t off the hook, a global health researcher said.

“Overcrowding and high population densities, which can be common to cities, can play a major role in the transmission of diseases with epidemic potential – including respiratory disease, like COVID-19,” said Matt Boyce, senior research associate in the Center for Global Health Science and Security at Georgetown University.

At this point cities are the point of transmission for the virus, he said.

“Thus far, travel to and between cities has played a major role in how this outbreak has spread, but that said, the disease can still spread to rural areas and it is still likely that they will be impacted by the outbreak. For example, earlier this month, a rural community was quarantined in Vietnam because of COVID-19 cases.”

But preparing for the event is wise, he said.

“Currently, there are no special preparations or instructions for rural residents, per se. But ensuring a supply of non-perishable food items, cleaning supplies, daily medicines, and fever reducers is a good place for anyone to start preparing.”

Leslie Marsh, CEO of Lexington Regional Health Center in Lexington, Nebraska, said she felt those in more rural areas could be safer.

“If you live in a farming community some distance from an interstate or main highway, then I think your odds of coming into contact with, or actually becoming infected with COVID 19, are pretty slim,” she said. “If you live and work in a more diverse, less homogenous community, your risk is slightly higher than a more remote area. I think this infectious disease, like most, will be spread more easily if the environment has a lot of people working or living in close quarters. If you consider China, the cruise ship and Italy, it seems like the closer the quarters the more people become infected.”

But, she said, it’s much too early to tell. 

“I’m not overly worried yet, we haven’t had anyone in our community express concern or even call the hospital with questions about having COVID 19 but viruses mutate and this particular virus has had a lot of people to experiment on, so it is possible that it will mutate,” she said. “However, I definitely am not a psychic or even an epidemiologist. Right now, I remain way more concerned about influenza complications. That statement is based on my current situation including experiences and existing information. As we know, that impression, which is influenced by credible information, may be fleeting since new information seems to emerge daily if not hourly.   

On Thursday, U. S. Transportation Secretary Elaine Chao said that an estimated 15,000 Americans are being tested for the virus after returning home from abroad. Minnesota, Virginia and New York City have announced that they are or have tested residents for the virus. U. S Health and Human Services Secretary Alexander Azar said ‘the immediate risk to the American public remains low” while admitting the U.S. can expect to see new confirmed cases of coronavirus in the future.

Officials with the Minnesota Department of Health recommended those in rural areas follow CDC guidelines to utilize nonpharmaceutical interventions, or NPIs, to protect themselves from the disease. Those include: avoiding close contact (closer than 3 feet) with others, staying home if someone in your house is sick, and washing your hands frequently with soap and water for at least 20 seconds. 

If someone in your house is sick, the CDC also recommends creating a separate room for them isolated from other household members, using a facemask around them (as well as having them wear a facemask at home, or in public), avoiding sharing personal items with them and postponing or canceling attendance at large events for both those sick and those around sick people. 

Maine Public Radio recommended that residents be prepared to self-isolate for a few weeks with enough over-the-counter medicines and food to last for two or three weeks, and to purchase masks, gloves and cleaning supplies (like bleach, hand sanitizer and anti-bacterial wipes) to help protect yourself against the virus. 

Information coming out of China indicates that 80 percent of those who catch the virus will have mild cases, similar to the flu. But as much as 18 percent may become serious or critical. About 8 percent of all the closed cases of coronavirus have been fatal.

For context, since 2010, influenza in the U. S. kills between 12,000-61,000 people each year, out of the more than 9 to 45 million cases contracted annually, or less than 1 percent.

Sarah Bates, a retired nurse in Wytheville, Virginia, said in the  Appalachian Americans Facebook group that she was taking the precaution of buying extra food and stocking up her first aid kit just to be sure. Preparing like any other emergency, she said, would help in the eventuality something happens. From extra batteries and water to stocking up on reading material, she said she’s prepared to stay away from others.

“I think we all face the same risk due to the mobility of modern society,” she said. “I do think if a given area has an outbreak – city or rural – it’s wise to avoid big crowds or indoor space with large gatherings.” 

Others said they didn’t think there was anything to worry about. 

Brandon Boyd, from Wilkesboro, North Carolina, said he’s not worried.

“Turning my news off. Rolling with whatever comes my way. Protecting mine and myself,” he said in the group.

KOLD 13 | Tucson

By Jasmine Ramirez | January 30, 2020 at 7:14 PM MST - Updated January 30 at 7:14 PM 

TUCSON, Ariz. (KOLD News 13) - The University of Arizona will cover tuition for medical students who commit to practicing primary care in rural or under-served communities in Arizona for at least two years after completing residency.

The goal of the new scholarship program is to address physician shortages in Arizona and help lessen student debt.

Cazandra Zaragoza is a fourth-year medical school student at the UA and a participant in the program.

“The primary reason for pursuing this scholarship was the care and health of the people of Arizona,” she said. “I have deep roots here in the state and I aim to repay that.”

She calls herself a non-traditional student because she chose to take a gap between getting her undergraduate degree and going to medical school.

Zaragoza wanted to get married and start a family earlier in life than later. Her decision to have children before going to medical school was motivated by the death of her brother.

“He passed away unexpectedly so that made me want to start my own family and settle down,” Zaragoza said.

Another life loss pushed her to a career in medicine and develop a passion for helping under-served populations. Zaragoza lost her biological mother and was adopted at two weeks old.

“My biological mother was very poor, a working class woman, she cleaned houses for a living,” she said. “She had a treatable illness but was not able to access the healthcare and resources to get help.”

Her goal is to help those who don’t have access to healthcare.

“It really did influence a lot of what I chose to do with my life,” she said.

Zaragoza will graduate with her medical degree in May and then begin her residency.

The first 21 scholarship recipients from the UA College of Medicine in Tucson will receive recognition at a reception Friday.

Nearly 100 medical school students at UA medical schools in Tucson and Phoenix could receive free tuition through the program. The annual funding was approved by Arizona legislature in May.

Copyright 2020 KOLD News 13. All rights reserved.

NPR | December 30, 20195:03 AM ET | Heard on  Morning Edition

Dr. Angela Gatzke-Plamann didn't fully grasp her community's opioid crisis until one desperate patient called on a Friday afternoon in 2016.

"He was in complete crisis because he was admitting to me that he had lost control of his use of opioids," recalls Gatzke-Plamann.

The patient had used opioids for several years for what Gatzke-Plamann calls "a very painful condition." But a urine screening one week earlier had revealed heroin and morphine in his system as well. He denied any misuse that day. Now he was not only admitting it, but asking for help.

Gatzke-Plamann is the only full-time family physician in the central Wisconsin village of Necedah, population 916. She wanted to help but had no resources to offer. She and the patient started searching the Internet while still on the phone, trying to find somewhere nearby that could help. No luck.

Here was a patient with a family and job who spiraled into addiction because of doctor-prescribed pain pills, yet the community's bare-bones health system left him on his own to find treatment — which he later did, 65 miles away. If that situation was going to change in Necedah, it was up to Gatzke-Plamann.

"That weekend I went home and I said, 'I've got to do something different,' " she recalls.

In many ways, rural communities like Necedah have become the face of the nation's opioid epidemic. Drug overdose deaths are more common by population size in rural areas than in urban ones. And rural doctors prescribe opioids more often by far,despite a nationwide decline in prescribing rates since 2012. Meanwhile, rural Americans have fewer alternatives to treat their very real pain, and they disproportionately lack access to effective addiction medication such as buprenorphine.

It used to be rare for primary care physicians outside of big cities to take on the challenges of opioid misuse, according to Dr. Erin Krebs, a professor of medicine at the University of Minnesota who researches chronic pain management. Now, Krebs says it's becoming increasingly common "out of necessity."

"We just have a lot of people who need this kind of care and they need it where they are," Krebs says.

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