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OPINION. On December 31, 2019, the World Health Organization (WHO) reported an abnormal viral pneumonia in Wuhan, China. The cause of this pneumonia was later found to be a novel coronavirus dubbed COVID-19, leading to a global pandemic of historic proportions. Later, on February 26, 2020, the first U.S. confirmed case of non-travel associated COVID-19 was found in a California resident, with a second U.S. case of COVID-19 appearing two days later in the State of Washington. 

These events soon snowballed out of control, with the U.S. reaching 7.09 million cases of COVID-19 with 204,328 deaths as of September 28, 2020. Further investigation of those who expired showed a staggering correlation, with some populations being more susceptible than others. According to a CDC study, researchers had found that only 6 percent of mortalities died of COVID-19 alone

The remaining 94 percent of victims were found to be suffering from an average of 2.6 preexisting conditions alongside COVID-19. It is from this data we can conclude that not all patients are equal, and that some are more vulnerable than others. Based on the above statistic, one population that must be addressed are those living in rural locations. 

Rural Populations Struggle

Rural populations are a diverse group distributed over an immense geographic distribution, but they share a number of traits across the U.S. that leave them significantly more susceptible compared to their urban peers. On average, rural citizens are older, poorer, and suffer from higher rates of chronic illness than their urban peers. Since 80 percent of older Americans have at least one chronic disease and 77 percent have at least two or more chronic illnesses, rural populations are at a significantly higher risk of mortality from COVID-19 than urban populations. It is for that reason that our current healthcare system must be reformatted to defend our most vulnerable US population. 

One community that has worked to overcome the COVID-19 pandemic is the Pueblo of Acoma located in New Mexico. Pueblo of Acoma is a rural American Indian community in New Mexico’s Cibola County spanning 411.5 square miles with an average of 6.8 people per square mile. Of the 2,784 citizens in Acoma, 18 percent of the population are above the age of 50 while 20 percent of senior residents are below the poverty line.  

Despite their similarities and the presence of Acoma in Cibola County, a look at their COVID-19 cases and responses shows how Pueblo of Acoma’s reaction to the pandemic led to a statistically significant decrease in cases.  According to the National Institute of Health, Cibola County suffered from 413 cases of COVID-19 with 20 COVID-19 associated deaths as of September 23, 2020. This statistic spreads over a population of 26,746 residents causing roughly 1,544 cases of COVID-19 per 100,000 residents. 

Acoma COVID-19 Strategy Decreases Spread 

The U.S. as a whole had a significantly higher number of cases per 100,000 residents, with the CDC placing that number at 2,103 cases per 100,000. As for Acoma, it was reported that 38 cases of COVID-19 spread over 2,784 citizens on September 18. This leaves roughly 1,364 cases per 100,000 citizens, a 12 percent decrease compared to Cibola as a whole. The reason behind our decreased infection rate may be attributed to our response to the COVID-19 pandemic in the early stages and our willingness to innovate our health systems in the midst of the pandemic.

At the beginning of the COVID-19 pandemic, Acoma took isolationist measures to deter outside citizens from visiting. This was further compounded with universal testing across our populace to locate and isolate potential infection hotspots. We also promoted social distancing and facial coverings among our populace to inhibit the spread of COVID-19 and prevent the collapse of our healthcare system. 

While this has shown to be an effective response across the U.S., Acoma’s decreased infection compared to its peers may be attributed to our willingness to adopt innovative methods designed with the pandemic in mind. 

As the pandemic progressed, the Pueblo of Acoma’s Health and Human Service (POA HHS) officials adopted novel strategies to protect our community and most vulnerable population as COVID-19 spread nationwide. 

Healthcare Outreach and Telehealth

One of our actions was to expand the use of healthcare outreach programs such as telehealth clinics to limit travel and expand healthcare access for our constituents as a whole, allowing healthcare providers to tend to our community’s needs without overtaxing workers. 

We also plan to enact the use of healthcare IT solutions and telehealth clinics to create preventive care services focused on defending patients with chronic illnesses. One example of such measures will be the Zoeticx ProVizion solutions recently adopted by Acoma. 

The solution suite supports healthcare providers’ ability to regularly track, monitor, and anticipate deteriorating patient health induced by chronic illnesses and acute infection from COVID-19. These remote telehealth plans were also highly cost effective for both hospitals and local government, with the Centers for Medicare and Medicaid Services (CMS) reimbursing hospitals and clinics, generating valuable revenue streams. 

Through the above adoption, our organization POA HHS has taken another step to pro-actively plan for the post COVID-19 pandemic, aimed at protecting our most vulnerable population. What we have learnt through this difficult period is to be ahead of the curve and ready to act on the next potential challenge as well as establishing a long-term strategy for post COVID-19. 

Our strategy is aligned to shift to proactive care on COVID-19. First, by establishing a dedicated clinic in our area with preventive care focus on our vulnerable population – patients with multiple chronic conditions, we put this effort in place to actively monitor and track our populations overall health. Second, by leveraged the federally funded CMS, we will be able to sustain such operation even after the current federal grants for COVID-19. 

Zoeticx Brings New IT Solutions

Third, by adopting the healthcare IT solutions from Zoeticx, we will be able to modernize our approach to healthcare by leveraging their competencies in automation and resource planning for an effective and efficient care delivery system. Telehealth is also a major element of our strategy to address the lack of healthcare access for our citizens. The COVID-19 pandemic has caused destruction on a scale unseen since the Spanish Flu of the 20th century, crippling our economy and claiming the lives of more than 200,000 Americans. While Acoma was not able to escape from the pandemic unscathed, we would like to share our innovative, pro-active approach to overcome our rural demographics and the lack of access to healthcare to our citizens.  

By utilizing modern technology to relieve some of the burden placed on our healthcare providers and epidemiologists, we can minimize costs and patient travel without compromising the quality of the healthcare they are provided.  

Tonya M. Ortiz-Louis is Executive Director at Pueblo of Acoma Health and Human Services.

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