Pollution, Food, and C19

I read a wise essay in Mother Earth News in the 1970s, which pointed out that the number of people who can live in an area without seriously polluting it is dependent on technology. With that audience, the tendency was to think much more in terms of absolute numbers. The earth has too many people! We can’t support them all! Pollution is out of control! The author noted that a solitary person living in the wild, defecating on the ground without even a trench, pollutes a sizable area. Without any food preservation or storage techniques he might need a wide area as well. Yet with technology we can build Manhattan, treating our sewage and carting it off. Transportation allows food to travel, so some can specialize in making lots of it and sending it off.

Something similar came up in the C19 discussions that I think got missed. We should be glad that it got missed, because it would only be front-and-center in our thinking if things had gone wrong. Some rural places did have the possibility that their local health systems would be overwhelmed. As there weren’t that many of them, however, they could spread the medical response to nearby hospitals and clinics. In number of cases per thousand people, Dougherty County GA (pop 90K) got hit hard – 140 deaths, as did a couple of neighboring counties. The two counties next to it with about 8,000 people each have a death rate of over twice Dougherty’s 1500/mil. Per capita, Georgia’s rural counties are doing substantially worse than Atlanta. Over 2,000 deaths per million in that SW area. I think that’s worse than NYC.

Rural counties do fine until they don’t, which I think informed a lot of the thinking early on. Once they stop doing fine, it was impossible to get help there when test kits and everything else was so lacking. An outbreak of 20 people in a rural county can quickly become less manageable than an outbreak of 200 in Boston if there’s no hospital nearby. Considering how to handle these counties will definitely have to be part of a response plan going forward. 25 deaths in a county of 8,000 may not make the news, but when you consider 3-4 times as many may have been seriously ill, that’s a lot for one group to handle.

Franklin, NH has about 8,000 people but a disproportionate number of deaths because of one nursing home, with many positives among both staff and residents, who had and have contact with the rest of the community. (There may be more to the story if I were on the ground there. I only know what I read in the papers.) The city has a regional hospital which was nearly overwhelmed, but there are three other hospitals thirty minutes away, two of which were not treating many cases at the time. I didn’t even hear about it an hour away, but the news for that region was full of anxiety and apprehension for a few weeks. Nationally, a few local systems were briefly overwhelmed. How you view that largely depends on whether the word “few,” “briefly,” or “overwhelmed” jumped out at you. Such are the things which create confirmation bias, where we reinforce some ideas without much thinking about them.

5 thoughts on “Pollution, Food, and C19”

  1. Nationally, over 42% of the deaths have occurred in nursing homes. In some states like Ohio and Pennsylvania, nursing homes account for 70 to 80% of deaths. There is a county in Minnesota where 100% of the deaths have occurred in nursing homes.

  2. Two seriously ill patients can overwhelm a rural hospital. I’m not likely to forget standing around an emergency room with my father deteriorating while they were trying to find a way to transport him to the nearest city. We had arrived just after the one advanced life support ambulance in town had left on a two hour round trip. The helipad had just been closed because of obstructions.

    This is an old story and has been for a very long time. Most rural communities are dependent on volunteers that are many times very good but especially limited in equipment. They work together and the ambulance could have just as easily been tied up in another, even smaller town instead. You are dependent on the same system any time you’re out of sight of the tall buildings.

    Here’s a story from South Texas:
    The hook is HCQ but I believe good, proactive care from the nurses and doctor should get at least as much credit. Unfortunately, you’re much more liable to hear about nursing homes that are challenged to notice within 24 hours when one of their charges has died. If a story correlating medicaid patients with fatalities in nursing homes ever comes out, you’ll see real fireworks.

  3. We are Covid 19 free on Vancouver Island. Our last patient left hospital cured. We are slowly opening up the place, and my idea of sinking the ferries, is sadly not catching on. ;)

  4. (RE Robert Sykes comment above):
    In my part of the country, most small towns have a nursing home or similar residential care facility (at least one). And if the town is small enough (say less than about 4,000), then that business is probably the largest employer.

    One bad infection in the small-town nursing home and your contact tracing could easily identify every person in town as potentially exposed.

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