Original Research

COVID-19 in a rural health system in New York – case series and an approach to management


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Eyal Kedar1
MD, Rheumatologist *

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Regina Scott2

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Daniel M Soule3
Medical Director of Infectious Diseases and Antimicrobial Stewardship

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Carly Lovelett4

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Kyle Tower5

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Kylie Broughal6

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Daniel Jaremczuk7

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Sara Mohaddes8

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Imre Rainey-Spence9

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Timothy Atkinson10


1 Rheumatology, St. Lawrence Health System, 50 Leroy Street, Potsdam, NY 13676, USA

2, 3, 4, 5, 6, 7, 8, 9, 10 Infectious Diseases, Canton Potsdam Hospital, 50 Leroy Street, Potsdam, NY 13676, USA

ACCEPTED: 16 May 2021

early abstract:

Background: Many rural hospitals and health systems in the US lack sufficient resources to treat COVID-19. The St. Lawrence Health System (SLHS) developed a system for managing inpatient COVID-19 hospital admissions in St. Lawrence County, an underserved rural county that is the largest county in New York State.
Methods: The SLHS used a hub and spoke system to route COVID-19 patients to its flagship hospital. It further 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. A review of clinical data was completed for patients who were treated by the SHLS’s inpatient COVID-19 treatment team between 20 March and 22 May, 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.