More than half of all rural low-income communities in the U.S. have zero ICU beds, forcing local hospitals to rely on transfers to wealthier communities for their sickest coronavirus patients, according to a new study.

The findings, published in Health Affairs, underscore the economic disparities shaping the nation”;s coronavirus response, especially as the virus shifts from wealthier coastal metros to rural communities in the Southeast and West that have historically struggled with access to care.

“;Early in the pandemic, the health care system would be able to handle this well because these are rich people going to well-resourced hospitals,”; said lead author Genevieve Kanter, a professor of health ethics and policy at the University of Pennsylvania. “;But what we saw coming down the pike is that there are going to be more low-income populations affected.”;

Using Medicare data to pinpoint ICU beds, the authors found 49 percent of all low-income areas didn”;t have any ICU beds, compared to just 3 percent of the wealthiest communities. While this gap existed across rural and urban settings, it is much greater in rural America –; even the poorest urban areas had more ICU beds per capita than the wealthiest rural areas, on average.

Some hard-hit areas have surged ICU bed capacity to handle an influx of coronavirus patients, a factor study authors could not have accounted for with the data available. In recent months, some rural hospitals have brought in staff and equipment to convert regular beds to ICU beds, while others have relied more heavily on transfers to urban hospitals.

This lack of access to care and a higher prevalence of chronic health conditions increase risks for patients in rural America, undercutting progress made by new treatments, Kanter said. A study published in JAMA Internal Medicine last month found that Covid-19 patients were more likely to die if they were admitted to hospitals with fewer ICU beds.

During a Senate Finance Committee hearing on Thursday, Sen. Ron Wyden (D-Ore.) warned that problems with supply chains and uneven access to medical care in rural areas could further exacerbate the racial disparities already evident in the pandemic”;s death toll.

“;In rural America, particularly in communities of color, there are scores and scores of hospitals and providers falling between the cracks,”; Wyden said.

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