Rural

medicine

Lung ultrasound training to help rural emergency medicine providers diagnose COVID-19

TUCSON, Ariz. – The University of Arizona Health Sciences is developing a lung ultrasound education program for rural emergency medicine providers to better diagnose COVID-19.

Lung ultrasound can be particularly useful in rural emergency departments (EDs), as many lack CT scan capabilities or have limited access to COVID-19 testing. With the disparate impact of COVID-19 on rural populations in Arizona, it is important to expand use of the imaging tool across the state.

Elaine Situ-LaCasse, MD, an assistant professor in the Department of Emergency Medicine at the UArizona College of Medicine – Tucson and a scholar of the National Foundation of Emergency Medicine (NFoEM), is leading the effort to develop the ultrasound education program for rural emergency medicine providers.

“The ability to perform lung ultrasound could help rural physicians with screening, management and follow-up,” Dr. Situ-LaCasse said. “This tele-ultrasound education program would allow rural EM providers to connect with POCUS experts for education, image review, consultation and quality assurance.”

One of the rural sites participating in the program is Copper Queen Community Hospital in Bisbee, Arizona.

“As a critical care hospital, we often lack staff and resources but, despite these barriers, we strive to provide quality care to rural communities,” said Julia M. Brown, MD, the hospital’s Emergency Department medical director. “Our providers are excited to partner with Dr. Situ-Lacasse using state-of-the-art ultrasound to help diagnose and treat our patients.”

Lung ultrasound (LUS) plays a critical role in the COVID-19 pandemic. Evidence is mounting regarding its effectiveness to diagnose and assess the severity of coronavirus infections in hospital EDs. Sonographic features correlate well to computed tomography (CT) chest findings and a bedside LUS scan performed by a trained clinician, along with clinical examination, could be an alternative to chest X-ray and CT chest scans in these patients.

The project, “CLUE Study: A Tele-ultrasound Pilot Study in Rural Emergency Departments,” is funded by a NFoEM research grant. Upon completion of the CLUE (COVID-19 Lung Ultrasound Education) pilot study, Dr. Situ-LaCasse plans to expand the effort to a multi-center study that would include more rural EDs in other geographic regions of the United States. She also plans to expand this tele-ultrasound education platform to community EDs and other point-of-care ultrasound (POCUS) applications, such as cardiac ultrasound.

Dr. Situ-LaCasse will investigate the knowledge gap in rural emergency medicine providers’ use of lung ultrasound. Her research team will build upon various tele-ultrasound platforms to create a sustainable, reproducible and scalable tele-ultrasound education program to help rural ED physicians feel more comfortable performing lung ultrasounds in the diagnosis and management of suspected or confirmed COVID-19 patients.

Dr. Situ-LaCasse is a part of NFoEM’s Scholar/Mentor Program, which provides an opportunity for scholars from 10 partner institutions to work on translational medicine research and foster professional development. She is one of nine scholar-mentor pairs receiving NFoEM funding for their COVID-19-related research projects. Her mentor is Srikar Adhikari, MD, a UArizona emergency medicine professor, Emergency Ultrasound Section chief and program director of the

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medicine

Students reaping rewards in rural medicine

Two new medical students at Queens General Hospital in Liverpool are getting first-hand experience in rural medicine.

Ben DuPlessis and Marrissa Ley are part of the 48-week South Shore Longitudinal Integrated Clerkship Dalhousie (LCID) program, which is designed to introduce students to practising medicine in a rural community.

The program was initiated at the Dalhousie’s New Brunswick campus. It was introduced to Nova Scotia last year when four students took part in hospitals in North Sydney and New Waterford.

DuPlessis and Ley are two of five students who are working on the South Shore this year as part of the program. Two other students in the program are working at the South Shore Regional Hospital in Bridgewater, while another student is at the Fishermen’s Memorial Hospital in Lunenburg.

The Doctor of Medicine or MD program at Dalhousie lasts four years, followed by two or more years of residency. The LCID program is an alternative to classic studies that see students rotate through various disciplines and in various blocks of times.

“I’m liking it. We had an option of doing this program or stay at a place for a few weeks, then move on to another place for a few weeks and probably not see the same people again. I thought it would be nice to settle in one place for a year and get to know some people,” said DuPlessis, who is from Dartmouth.

“There is a much higher chance, this way, that I will see some patients again and again over the year, and I’ll work with the same docs and really get to know them and their style and the different things they bring to medicine.”

Typically students don’t learn a lot about rural medicine in their first two years of schooling, while this program provides an opportunity to learn more, said DuPlessis.

He’s finding the experience inspiring.

“I can see myself settling down in a smaller place for sure. I definitely didn’t use to think like that, but I am more interested in it now, more than ever. I used to be more interested in procedures, the surgical side of things, but this is great,” he said. “I’ve gotten a sense that doctors really know their patients and I like that.”

The student also remarked on the camaraderie among staff.

“The doctors have all been fantastic. They all seem very close to each other, which is nice. Actually, all the staff are really close, cordial and friendly, and it’s been really easy to get to know people,” said DuPlessis, adding that the patients that he has talked to have also been very good to him.

When he gets some spare time, DuPlessis is looking forward to heading out on the trails with his partner and dogs, visiting the beaches, and doing a little surfing.

Hailing from Glace Bay, Ley also is enjoying the community and being closer to nature, as well as spending time with family doctors and physicians and experiencing their day-to-day routines.

She’s spoken with

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health

The Coronavirus Pandemic Will Keep Killing People Across Rural America, and in Missouri

In a normal year, hospitals in rural southern Missouri see a lot of snake bites and rolled ankles.

They’re ailments you acquire canoeing in the early autumn sun or “hold-my-beer-and-watch-this-ing” at night, as an emergency doctor in the area who requested anonymity because he had not been given clearance to speak on behalf of his hospital told The Daily Beast.

“Obviously, this year is really different,” said the doctor, who noted that he contracts out to several hospitals in the area, sometimes driving three hours from his home to serve rural communities coping with COVID-19 outbreaks. Although New York and Washington were dealing with overflowing hospitals and piles of body bags in March, the Missouri doctor told The Daily Beast he didn’t treat a coronavirus-positive patient until May.

Things increased slowly at first, but the past six weeks have been a test of fortitude for the doctor, his nurses, respiratory therapists, and their facilities staff. And regardless of who prevails in a presidential election that saw little campaigning in this erstwhile swing state, the scale of the suffering and loss of life here—coupled with lingering pandemic skepticism—demonstrates the size of the hole out of which the country must still dig itself.

“I get dirty looks going into the gas station wearing a mask,” said the doctor. “It’s just unfathomable the disconnect between being one of the worst areas for COVID, while people who are not necessarily healthy at a baseline are still just acting like there is absolutely nothing going on.”

As of Tuesday, Missouri had reported a total of 190,424 cumulative COVID-19 infections and 3,064 deaths. About 16,111 of those cases had been recorded in the past seven days, according to the state’s coronavirus dashboard. Though there have been significant improvements in the state’s ability to test for the virus, its positivity rate measured over the past seven days was a staggering 28.6 percent. A popular threshold for a percent positive being “too high” is 5 percent.

A number of other largely rural states in the Midwest were struggling on Tuesday, with North and South Dakota in particular emerging as nationwide hotspots. North Dakota has seen a 167-percent increase in cases in just one month. Nationwide, on Tuesday alone, at least 540 new deaths and 93,581 new cases were reported. Those numbers are even more concerning when factoring in the 232,529 Americans who’ve already lost their lives from the virus—an amount some experts see doubling by the end of February 2021.

And the pandemic picture is a disastrous one even in rural areas that have failed to capture much of the national spotlight.

Missouri hit a record number of COVID-19 hospitalizations for the fourth day in a row on Sunday, when the health department reported a total of 1,649 patients hospitalized with the virus. According to reporting from the St. Louis Public Radio, the rise in rural cases have driven the state’s numbers. When smaller rural hospitals must refer a majority of patients to larger ones in other parts

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health

These Female Healthcare Workers Are Rural India’s First Defense Against COVID-19

Archana Ghugare’s ringtone, a Hindu devotional song, has been the background score of her life since March. By 7 a.m. on a mid-October day, the 41-year-old has already received two calls about suspected COVID-19 cases in Pavnar, her village in the Indian state of Maharashtra. As she gets ready and rushes out the door an hour later, she receives at least four more.

“My family jokes that not even Prime Minister Modi gets as many calls as I do,” she says.

Ghugare, and nearly a million other Accredited Social Health Activists (ASHAs) assigned to rural villages and small towns across India, are on the front lines of the country’s fight against the coronavirus. Every day, Ghugare goes door to door in search of potential COVID-19 cases, working to get patients tested or to help them find treatment.

With 8 million confirmed COVID-19 cases, India has the second-highest tally in the world after the United States and its health infrastructure struggled to cope with the surge in COVID-19 patients this summer. India spends only 1.3% of its GDP on public health care, among the lowest in the world. The situation is stark in rural areas where 66% of India’s 1.3 billion people live and where health facilities are scant and medical professionals can be hard to find.

India’s ASHA program is likely the world’s largest army of all-female community health workers. They are the foot soldiers of the country’s health system. Established in 2005, a key focus of the program was reducing maternal and infant deaths, so all recruits are women. They have also played an essential role in India’s efforts to eradicate polio and increase immunization, according to numerous studies.

Read More: How the Pandemic Is Reshaping India

But even as health authorities have leaned on ASHAs to quell the spread of COVID-19 in rural areas, where a substantial number of new cases have been reported, many of these health care workers say the government is failing them. Pay was meager to begin with, but some workers have reported not being paid for months. Their hours have increased dramatically, but pay rises, when they have come, have not reflected the increased demands. Many ASHAs have also complained about not being provided adequate protective equipment for their high-risk work.

“They are the unsung heroes who are fighting to contain the unfettered spread of the virus in rural areas,” says Dr. Smisha Agarwal, Research Director at the John Hopkins Global Health Initiative. She argues it is vital to improve pay to boost morale and sustain this frontline workforce.

Ghugare was chosen from her village of 7,000 people in 2011. Since then, she has overseen countless births, meticulously monitored the health of thousands of newborn babies and strictly ensured immunization through door-to-door awareness campaigns. The personal relationships she built over the years have helped in the fight against COVID-19, giving her a good grasp of the medical histories of most of the 1,500 people assigned to her. “It’s all in

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health

They met in Hawaii and built a life in rural Maryland. This fall, they died two days apart.

When the chief barber retired, Doris took over the first chair. She knew everyone, said her grandson, Jeffrey Grim.

“When she was in the hospital, her respiratory therapist said, ‘Did you cut hair?’ and she was like, ‘Yeah,’ ” Grim recalled in an interview, describing Doris’s hospitalization for covid-19 this summer. The respiratory therapist then said, “ ‘My dad used to take me to you when I was a little boy.’ ”

Doris Bender died of complications of coronavirus on Sept. 3, in Room 4107 of Meritus Medical Center Intensive Care Unit in Robinwood. Jacob had died Sept. 1 in the same hospital, also of covid-19, in Room 4109.

Jacob, who was 83, died at 2:36 p.m.. Doris, who was 81, died at 2:34 p.m.

“Two days apart, two minutes apart, two rooms apart,” said Grim, a PhD candidate at the University of Michigan at Ann Arbor. “It’s really hard to lose both of them at the same time. My family will never be the same. And they were old, but I think we would have had a lot more years with them, if it wasn’t for covid.”

Grim said he isn’t certain how his grandparents contracted the virus. He remembers that the couple came into contact with someone who had the virus, but tested negative shortly thereafter. In August, Doris began experiencing heart attack-like symptoms.

“When they took her to the hospital, as protocol they did a covid test and found out that it was indeed the covid that was attacking her lungs and heart,” Grim said.

Jacob, who Grim called Pap-Pap, tested positive two days later, on Aug. 14. He was home for two weeks after Doris was hospitalized, but then his condition grew worse.

“All of a sudden, he just went downhill quickly” Grim said. “And we really think that because Grandma was such a caretaker, she wanted to make sure he passed before she was ready to go.”

Grim said that after Doris died, the family found a notebook where she kept count of how many newborn hats she had made for the hospital: 3,241 in all.

Before the pandemic, Doris enjoyed going out to play Bingo with her daughter Theresa on Wednesday nights and playing a Japanese card game called Hanafuda on Sundays, Grim said. She hated staying home during the pandemic, and even called it “jail.”

The couple tended to their garden, where they planted vegetables such as tomatoes, peppers, and squash. Grim said when Doris was in the hospital, the doctors told the family she was delirious and was talking about her cantaloupes being ready. But when Grim visited the garden afterward, he found “two perfectly bright cantaloupes.”

Doris would have turned 82 last week. The family didn’t come together to observe her birthday out of safety concerns. But Grim and his brother, Josh, bought anthuriums, a tropical flower their grandmother loved, to put on her grave.

Source Article

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COVID-19 Surges In Rural Communities, Some Midwest Hospitals Overwhelmed : Shots

Rural communities across the country, places largely spared during the early days of the pandemic, are now seeing spikes in infections and hospitalizations.

Daniel Acker/Bloomberg via Getty Images


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Daniel Acker/Bloomberg via Getty Images

Rural communities across the country, places largely spared during the early days of the pandemic, are now seeing spikes in infections and hospitalizations.

Daniel Acker/Bloomberg via Getty Images

As the coronavirus outbreak surges across the country, many rural communities — places which were largely spared during the early months of the pandemic — are now seeing an unprecedented spike in infections and hospitalizations.

The pandemic’s grip on rural America is especially alarming because many of these less populated areas rely on small hospitals, which don’t have the beds or staff to absorb a crush of patients, especially those who require high levels of care.

In early September, the rate of new infections per capita started climbing quickly in the country’s most rural counties reaching what are now record levels — significantly higher than what is being seen in the major urban areas, according to data from the Centers for Disease Control and Prevention.

There is a similar trend in smaller metro areas, although not quite as dramatic.

“Rural is not a refuge,” says Keith Mueller, a professor at the University of Iowa College of Public Health and director of the Rural Policy Research Institute. These counties may be sparsely populated, but it also means that sparsely populated is not an assurance that spread won’t happen.”

In the Midwest, cases have climbed on average nearly 60% over the past two weeks, compared to 35% nationally. And across the country, most non-metropolitan counties have now recorded at least 100 cases or more per 10,000 people since the pandemic began — that’s almost double what it was in early September.

Even though the raw numbers may seem small compared to cities, rural counties in states like Kansas, Montana, South Dakota and Nebraska now have some of the highest rates of infections per capita in the country. And in many places, hospitalizations are also at record levels.

The surge in rural America is not uniform across the country; some communities got hit during the spring and summer for example, when there were big outbreaks at food processing plants.

This week, Ohio Governor Mike DeWine reiterated his concerns about the pandemic’s foothold in his state’s rural counties, saying that many of the residents being hospitalized are coming from those communities rather than the major cities.

“Please wear the masks,” DeWine pleaded, “rural counties, we’re not seeing the mask wearing is high, we would like to really see it get up.”

In North Dakota, Dr. Misty Anderson, an internist, is worried about the pandemic’s hold on small cities and towns like Valley City, N.D., where she lives — just an hour west of Fargo.

“I never lost any patients until recently and I lost a couple in just one week,” says Anderson, who’s also president of the North

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Rural Midwest hospitals struggling to handle coronavirus surge: “It just exploded”

Rural Jerauld County in South Dakota didn’t see a single case of the coronavirus for more than two months stretching from June to August. But over the last two weeks, its rate of new cases per person soared to one of the highest in the nation.

“All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.

Virus Outbreak Rural Spread
Dr. Tom Dean poses at his clinic in Wessington Springs, S.D., on Friday. Oct. 16, 2020.

Stephen Groves / AP


As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Dean took to writing a column in the local weekly newspaper, the True Dakotan, to offer his guidance. In recent weeks, he’s watched as one in roughly every 37 people in his county has tested positive for the virus.

It ripped through the nursing home in Wessington Springs where both his parents lived, killing his father. The community’s six deaths may appear minimal compared with thousands who have died in cities, but they have propelled the county of about 2,000 people to a death rate roughly four times higher than the nationwide rate.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins University researchers. Overall, the nation topped 8 million confirmed coronavirus cases in the university’s count on Friday; the true number of infections is believed to be much higher because many people have not been tested.

In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak – and the toll hits close to home in tight-knit towns.

“One or two people with infections can really cause a large impact when you have one grocery store or gas station,” said Misty Rudebusch, the medical director at a network of rural health clinics in South Dakota called Horizon Health Care. “There is such a ripple effect.”

Wessington Springs is a hub for the generations of farmers and ranchers that work the surrounding land. Residents send their children to the same schoolhouse they attended and have preserved cultural offerings like a Shakespeare garden and opera house.

They trust Dean, who for 42 years has tended to everything from broken bones to high blood pressure. When a patient needs a higher level of care, the family physician usually depends on a transfer to a hospital 130 miles (209 kilometers) away.

As cases surge, hospitals in rural communities are having trouble finding beds. A

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Rural Midwest hospitals struggling to handle virus surge

WESSINGTON SPRINGS, S.D. (AP) — Rural Jerauld County in South Dakota didn’t see a single case of the coronavirus for more than two months stretching from June to August. But over the last two weeks, its rate of new cases per person soared to one of the highest in the nation.

“All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.

As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Dean took to writing a column in the local weekly newspaper, the True Dakotan, to offer his guidance. In recent weeks, he’s watched as one in roughly every 37 people in his county has tested positive for the virus.


It ripped through the nursing home in Wessington Springs where both his parents lived, killing his father. The community’s six deaths may appear minimal compared with thousands who have died in cities, but they have propelled the county of about 2,000 people to a death rate roughly four times higher than the nationwide rate.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins researchers. In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak — and the toll hits close to home in tight-knit towns.

“One or two people with infections can really cause a large impact when you have one grocery store or gas station,” said Misty Rudebusch, the medical director at a network of rural health clinics in South Dakota called Horizon Health Care. “There is such a ripple effect.”

Wessington Springs is a hub for the generations of farmers and ranchers that work the surrounding land. Residents send their children to the same schoolhouse they attended and have preserved cultural offerings like a Shakespeare garden and opera house.

They trust Dean, who for 42 years has tended to everything from broken bones to high blood pressure. When a patient needs a higher level of care, the family physician usually depends on a transfer to a hospital 130 miles (209 kilometers) away.

As cases surge, hospitals in rural communities are having trouble finding beds. A recent request to transfer a “not desperately ill, but pretty” sick COVID-19 patient was denied for several days, until the patient’s condition had worsened, Dean said.

“We’re proud of what we got, but it’s been a struggle,” he said of the 16-bed hospital.

The outbreak that killed Dean’s dad

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Rural Midwest Hospitals Struggling to Handle Virus Surge | South Dakota News

By STEPHEN GROVES, Associated Press

WESSINGTON SPRINGS, S.D. (AP) — Rural Jerauld County in South Dakota didn’t see a single case of the coronavirus for more than two months stretching from June to August. But over the last two weeks, its rate of new cases per person soared to one of the highest in the nation.

“All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.

As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Dean took to writing a column in the local weekly newspaper, the True Dakotan, to offer his guidance. In recent weeks, he’s watched as one in roughly every 37 people in his county has tested positive for the virus.

It ripped through the nursing home in Wessington Springs where both his parents lived, killing his father. The community’s six deaths may appear minimal compared with thousands who have died in cities, but they have propelled the county of about 2,000 people to a death rate roughly four times higher than the nationwide rate.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins researchers. In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak — and the toll hits close to home in tight-knit towns.

“One or two people with infections can really cause a large impact when you have one grocery store or gas station,” said Misty Rudebusch, the medical director at a network of rural health clinics in South Dakota called Horizon Health Care. “There is such a ripple effect.”

Wessington Springs is a hub for the generations of farmers and ranchers that work the surrounding land. Residents send their children to the same schoolhouse they attended and have preserved cultural offerings like a Shakespeare garden and opera house.

They trust Dean, who for 42 years has tended to everything from broken bones to high blood pressure. When a patient needs a higher level of care, the family physician usually depends on a transfer to a hospital 130 miles (209 kilometers) away.

As cases surge, hospitals in rural communities are having trouble finding beds. A recent request to transfer a “not desperately ill, but pretty” sick COVID-19 patient was denied for several days, until the patient’s condition had worsened, Dean said.

“We’re proud of what we got, but it’s been a struggle,” he said of the 16-bed hospital.

The

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health

Rural living, chronic illness and COVID-19

PRAIRIE, Miss. (AP) — COVID-19 hit Prairie native Shirley Judd suddenly and hard. One day in late August, she felt fine; the next, she could barely move.

As soon as the symptoms struck, Judd called her aunt to take her to West Point to see a doctor, where she tested positive for COVID-19.

“When I got home, I had to go straight to bed. I couldn’t even sit up or do anything. I had headaches starting off, and I was just shaking, throwing up,” Judd said. “After about four days, or five, that’s when my throat got so sore I couldn’t swallow. I couldn’t eat anything.”

She visited another doctor in Houston on Labor Day and received shots and antibiotics. By Wednesday, her condition worsened. She was losing weight, and her mouth was swollen. At approximately 8 a.m., she checked into the North Mississippi Medical Center in Tupelo for treatment.

What made Judd’s experience more harrowing was that she has multiple sclerosis, a chronic illness that affects the central nervous system. Judd is 53 and has been on disability for the condition since 1987. She has had two hip replacements because of MS, and changes treatments every two years. She receives infusion treatments every six months and thought her initial illness resulted from MS flaring rather than a COVID-19 diagnosis.

The Centers for Disease Control and Prevention have long said people with underlying medical conditions and older adults are at increased risk for severe illness from COVID-19. While the National Multiple Sclerosis Society website states that current evidence suggests MS doesn’t increase the risk of dying from the COVID-19, possible long-term consequences of MS, age and higher levels of disability can increase the risk of being hospitalized for COVID-19.

Judd’s primary concern was maintaining her household while recovering, and she’s grateful family members stepped in to help. Family friend Lee Thomas did most of her cooking and cleaning, and cousins Yolanda Ewing and Chris Ewing helped bring supplies and food to her.


“Everything and everybody was really good about helping me out until I got straightened out and could get around,” Judd said. “That was a blessing.”

Judd also received financial support from Okolona-based nonprofit Excel Inc. by applying for the COVID-19 Support Fund, which is available to people affected by COVID-19. The organization paid her water and light bills while she was recovering.

“With Excel, I appreciate what they did because at the time, I couldn’t do anything,” Judd said. “It was a blessing and a miracle.”

Judd is also Black and lives in a rural community, both factors the CDC claims might require extra precautions against COVID-19. As of Oct. 11, Black Chickasaw residents of Non-Hispanic and unknown ethnicity were 49% of Chickasaw’s 777 cases since March 11, according to the Mississippi State Department of Health. The U.S. Census Bureau estimates Black people are approximately 45% of Chickasaw’s population. Statewide, Black people account for 48% of COVID-18 cases as of Oct. 4, despite only representing 38% of the

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