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Rural COVID-19 Cases May Be Low, But That’s 'Tip Of The Iceberg,' Says UF Expert

Horse on a farm field
The lack of testing – particularly in rural areas – means low numbers may not reflect the real number of infections.";s:

Some counties in Florida have reported no -- or very few -- cases of coronavirus, a reason Gov. Ron DeSantis cited Wednesday for waiting so long to issue a statewide stay-at-home order.

But Jerne Shapiro, an epidemiologist and lecturer at the University of Florida, says the lack of testing – particularly in rural areas – means low numbers may not reflect the real number of infections.

“You’ve got be able to test to be able to find, ok? So we know there is a limited supply (and limited) access to kits. And there are specific guidelines that you must meet to be able to receive a test,” Shapiro said.

According to the CDC, the first priority for testing goes to people who are hospitalized with symptoms of COVID-19, or healthcare workers with symptoms. After that, it’s people over 65, first responders or people with underlying conditions with symptoms.

People without symptoms are not a priority. And public health experts say about 80 percent of people with active coronavirus infections show no symptoms at all.

“What we are seeing with the tests, or when people are hospitalized, or require ICU beds -- these are the tip of the iceberg for how much community spread is occurring in an area,” Shapiro said.

Coronavirus Testing in Florida's 10 Least Populated Counties: 

A table showing how many tests for COVID-19 in the ten least populated counties of Florida
Credit Source: 4/1/2020 Florida Dept of Health,
Coronavirus test results in the ten least populated counties in Florida as of April 1. Population figures reflect 2018 U.S. Census data - the latest figures available.

Even though some rural areas appear to have fewer coronavirus cases now, they face a range of challenges that will make coping with the mounting caseload even harder.

Rural areas have more people who do not have health insurance, higher rates of poverty and smaller, often understaffed health departments.

“Our rural counties are unique populations and have special circumstances that occur in those areas that limit their access to healthcare simply by having to drive perhaps an hour or more to see a doctor,” said Shapiro.

She has been asked by the Alachua County Department of Health to assist in tracing the contacts of people who have tested positive, and to help educate people in how to isolate and avoid spreading the virus to others.

She is also organizing a student and faculty volunteer task force to help local health officials.

A headshot of lecturer Jerne Shaprio
Credit University of Florida
Jerne Shapiro is a lecturer at the University of Florida, and received her Master’s in Public Health with a Concentration in Communicable and Tropical Health from the University of South Florida.

The coronavirus pandemic is also revealing the extent of the nation’s shortcomings when it comes to public health, according to Shapiro.

“Public health is purchasable. And we have failed to invest in public health in Florida for the past decade or so,” she said.

“It’s been an underserved area for quite some time and that is going to become more obvious as this plays out.”

Whether case counts are high or low in any given area, Shapiro said it’s important to understand that community spread is indeed happening in Florida, and social distancing is key, regardless of one’s age or location.

“Our health depends on everybody’s health and this includes providing easier access to care, addressing some of the rural hospitals that have been closing, looking at insurance, health literacy, poverty, and making sure that our public health infrastructure is strong and solid.”

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