A new commentary in The Journal of Rural Health examines the relationship between substance use and coronavirus in the Southern Mountains region of Appalachia.  Authors cite recent data showing greater and faster-increasing COVID-19 rates in Appalachia and the South and rural-specific challenges to programs for overdose prevention and infection control. Read more here.

In a free-access blog post, the publication Health Affairs highlights rural-focused philanthropies responding to the COVID-19 pandemic by quickly providing funding specific to rural communities and organizations. Read more here.

Advance care planning (ACP) is decision-making between a care provider and a patient (or their loved ones) about treatment in a sudden medical crisis. A new article in The Rural Monitor provides an inside look at the challenges rural clinicians face when ACP is more urgent due to COVID-19. Read more here.

Hundreds of people in Western Pennsylvania will be allowed to participate in clinical research trials for COVID-19 vaccines, UPMC and the University of Pittsburgh announced last week. The trials are part of the COVID-19 Prevention Network and Operation Warp Speed, the national initiative to accelerate the development of a safe, effective vaccine for SARS-CoV-2, the coronavirus that causes COVID-19. Recruitment for the Pittsburgh trials begins immediately. Read more.

The Senate is working on its newest relief package, CARES 2.0 Act. The $1 trillion bill including $25 billion for provider relief funding, $7.6 billion for Community Health Centers, a second round of Paycheck Protection Program loans, tax deductions for employer purchases of testing, PPE and other supplies, and a provision that telemedicine reimbursement policies are extended through the end of 2021. The bill also allows state/local governments to use CARES Act money to make up lost revenues. A draft summary of the Senate proposal can be found here. NACHC and PACHC sent letters to the two PA Senators asking for $7.6 billion for FQHCs for COVID-19 and $41.9 billion over five years for long-term stable funding for the health center program.

The Trump administration has restored public access to coronavirus data reported by hospitals to the federal government, after an outcry over missing data and controversy over a change in the agency that collects it. The information is now being published on the HHS Protect website of the Department of Health and Human Services (HHS) instead of the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network. The change was necessary, officials said, because they believed the CDC’s system was too slow, and was unable to keep up with the constantly changing information about the virus. Read more.

The Pennsylvania Department of Health (DOH) has released updated guidance for making decisions about return to work for healthcare personnel (HCP) with confirmed COVID-19, or who have suspected COVID-19 (e.g., developed symptoms of COVID-19 but did not get tested for COVID-19). These updates are consistent with those published by the CDC on July 17, 2020. This 2020-PAHAN-516-07-18-UPD replaces PA-HAN-501. The changes include:

• Except for rare situations, a test-based strategy is no longer recommended to determine when to allow HCP to return to work
• For healthcare providers (HCP) with severe to critical illness or who are severely immunocompromised, the recommended duration for work exclusion was extended to 20 days after symptom onset (or 20 days after their initial positive SARS-CoV-2 diagnostic test for asymptomatic persons)
• Other symptom-based criteria were modified as follows:

• • Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications
  • Changed from “improvement in respiratory symptoms” to improvement in symptoms” to address the expanding list of symptoms associated with COVID-19

If you have questions about this guidance, please contact DOH at 1-877-PA-HEALTH (1-877-724-3258) or your local health department.

After metropolitan areas were battered by the COIVD-19 pandemic, rural areas have emerged as the new frontline for the virus. Small rural hospitals are struggling to keep their doors open after losing profits due to forgoing elective procedures. It is estimated that hospitals and health systems have lost $202.6 billion between March and June and will lose an additional $120.5 billion by the end of the year. Projections claim that federal relief from the CARES Act is not nearly enough to counteract the losses hospitals face. Experts in health policy and management are forecasting a major change in rural hospital policy over the course of the pandemic and into the long-term future due to these struggles.

Hospitals are seeking guidance from HHS on how to utilize past distributed funds with the next package getting ready to be dispersed. The response may lead to hospitals needing to return portions of the coronavirus relief package funding. The Coronavirus Aid, Relief, and Economic Security (CARES) Act was passed to protect rural hospitals forced to stop elective procedures during the pandemic. Now, five months into the pandemic, economic disruptions are continuing and hospitals are wondering how long CARES funding will replace the money they have lost. Ten billion dollars was distributed to rural hospitals, but people worry about how long the funding will last, especially hospitals that never treated COVID-19 patients.