Treatment
Treatment can range from small tests to see if someone has COVID-19 to extended hospitalization to support someone into recovery. The low poor state of Safetynet populations' access to health care means have difficulty obtaining these services.
Testing & Screening
Safety net populations face increased challenges when it comes to screening, testing, and treatment of COVID-19
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The first step in the identification of COVID-19 positive patients is screening to determine whether or not a COVID test is necessary for an individual. Some locations, such as CVS stores, do not require a referral from a healthcare provider to perform the test. Screening is performed largely over videocall or telephone through a health care system or specific facility. Populations in rural areas in many cases experience poor broadband coverage as well as occasional poor cellphone reception. Bamberg, Allendale, and Edgefield are all estimated to have a non-mobile broadband availability of less than 75%. This directly impedes the ability of those populations to initiate the screening and testing process.
With regards to COVID-19 testing, rural areas of South Carolina have few if any permanent testing sites, and residents of those counties must rely on testing sites in different counties and mobile clinics. 4 counties (Allendale, Barnwell, Calhoun, and Chester) have zero non-pop-up testing locations for COVID-19. Additionally, 6 counties (Bamberg, Dorchester, Edgefield, Hampton, Jasper, Lee) only have one permanent location. SCDHEC provides a developing list of available COVID testing sites (SCDHEC Screening and Testing Sites) as well as a schedule for mobile testing clinics (SCDHEC Mobile Testing Clinics Schedule).
Test samples obtained at these locations are shipped to either a regional SCDHEC Public Health Laboratory (PHL) or FDA-approved private lab. There are four SCDHEC PHL’s, with one per each South Carolina region (Upstate, Midlands, Pee Dee, Low Country). The majority of tests performed in South Carolina have so far been done by private labs. Only 63,605 of the total 293,754 tests performed in South Carolina by June 15th, have been done by a PHL. The rate at which South Carolina is testing its population lags considerably behind most other states in the U.S. As of June 6th, 2020, out of the 12 states in the Southeast region of the U.S, South Carolina has the lowest testing rate per 100k individuals (4,758). South Carolina has just recently (June 11th) started to report the number of antibody tests and diagnostic PCR tests performed in the state separately (255,557 PCR tests as of June 15th).
Extended Care
In the face of social distancing measures to mitigate the spread of COVID-19, many hospital systems across the country have greatly expanded their telehealth operations. Most, if not all, of South Carolina’s hospital systems (MUSC, Prisma Health, Roper St. Francis, McLeod, Augusta University Health System, etc), as well as smaller healthcare facilities are now offering virtual visits via web browser or an app to provide care for non-pressing, primary care health issues as well as at-home COVID-19 patients. Given that safety net populations struggle with having sufficient broadband, cell coverage, and also may beless able to afford devices with webcams, their access to telehealth care is limited. This may contribute to more people not receiving proper care given heightened fears of risking COVID-19 infection by traveling to healthcare facilities for appointments.
Furthermore, the distribution of hospitals and and healthcare resources (staff, beds, ventilators, etc) favors more urban and higher income counties (e.g Greenville, Richland, and Charleston). Conversely, rural and poorer counties have fewer hospitals andresources. 8 counties (Bamberg, Barnwell, Calhoun, Fairfield, Saluda, McCormick, Marlboro, Lee) have zero acute care hospitals. Additionally, the long-term viability of healthcare facilities which take care of rural and/or low-income communities have beenput at risk by COVID-19. Already running low or negative profit margins due to lower insurance rates, lower patient volume, and higher poverty rates, these facilities are forced to increase expenditures for items such as PPE as well as additional staffing. Most of the profitable elective services have been reduced if not eliminated entirely in recent months. This puts strain on the already limited ability of these critical healthcare facilities to sufficiently care for their populations for health issues across the board, not just pertaining to COVID-19.