COVID-19 in a Rural Health System in New York – Case Series and an Approach to Management

Background Many rural hospitals and health systems in the U.S. lack sufficient resources to treat COVID-19. We developed a system for managing inpatient COVID-19 hospital admissions in St. Lawrence County, an underserved rural county which is the largest county in New York State. Methods We used a hub and spoke system to route COVID-19 patients in the St. Lawrence Health System to its flagship hospital. We assembled a small clinical team to manage admitted COVID-19 patients and to stay abreast of a quickly changing body of literature and standard of care. We subsequently completed a review of clinical data for patients who were treated by our inpatient COVID-19 treatment team between March 20 and May 22, 2020. Results Twenty COVID-19 patients were identified. Sixteen patients (80%) met NIH criteria for severe or critical disease. One patient died. No patients were transferred to other hospitals. Conclusions During the first two months of the pandemic, we were able to manage hospitalized COVID-19 patients in our rural community. Development of similar treatment models in other rural areas should be considered.