As in so many areas of American life, the response to covid-19 has exposed a rural-urban divide. On one side are policymakers, experts and journalists living mostly in large cities and dense suburbs. The debate around covid tends to reflect their experiences. But what works for Portland or Washington or New York doesn’t necessarily work for the rest of us.
This has become more acute with the spread of the delta variant. Here in Tillamook, early in the pandemic, we moved quickly to limit residents’ exposure to the virus from outside the county. Those measures succeeded, and by July 31, life had almost returned to normal. While every loss was tragic, across the entire duration of the pandemic, our county of 26,000 people had reported only five deaths and 815 confirmed cases. More than 65 percent of eligible residents age 16 and older had been vaccinated, higher than the average county in the state.
Then came August and delta. Just over a month later, our case count had nearly doubled, rising to 1,550. Our lone hospital had to temporarily cease elective surgeries and convert operating recovery rooms to house covid patients. The death toll, meanwhile, nearly quadrupled, climbing to 19, with 12 of those deaths in a single two-week period.
When more than 650,000 Americans have died because of covid, 19 fatalities might not seem like that many. But in rural towns, where everyone knows everyone else, every death hits the community hard.
Perhaps the starkest indicator of how bad our situation has gotten came from Waud’s Funeral Home in downtown Tillamook. It is the county’s single mortuary, licensed to hold up to nine bodies. A few weeks ago, Waud’s owner contacted the county commissioners. Because of the covid surge, the facility was at capacity. He asked that we find a refrigerated morgue truck to hold additional bodies. Klamath County generously offered one of theirs.
In Tillamook, as in the rest of the country, this devastation is playing out overwhelmingly among the unvaccinated. I cannot urge our unvaccinated residents strongly enough to protect themselves, their families, and their friends and neighbors by getting the shots. Yet there is a small, ardent group in our county that simply will not yield. While I may disagree with their decision, it is precisely that: a personal decision.
And measures that our state and federal governments are taking to coerce this group are likely to harm this rural community and others like it. Gov. Kate Brown (D) on Aug. 19 mandated that all health-care workers, schoolteachers and state employees be vaccinated by Oct. 18, with no weekly testing alternative.
Then last week Biden announced his plan to require all health facilities accepting Medicare or Medicaid — essentially every medical facility in our county — to have employees vaccinated. He will also require vaccination for federal workers and many employees of private businesses.
For many localities, these rules might make sense. But in rural Tillamook we don’t have an abundance of workers — let alone trained, licensed workers — to replace those who will not be vaccinated. Our health-care workers are overstretched as it is; if some have to leave their jobs, it will be Tillamook’s patients who suffer most.
Tillamook has two small assisted-living facilities with a total of 60 residents. Over the past 17 months, a total of one covid case has been reported. Come Oct. 18, if some employees choose not to be vaccinated, the facilities won’t have enough trained workers. We’ll face having to relocate their fragile occupants to other accommodations elsewhere in the state — if we can find them.
Under Brown’s decree, the term “health-care worker” includes fire and rescue personnel. In many small rural counties, these workers are mostly volunteers, who lack even the financial incentive to get vaccinated as a condition of employment. We are extremely concerned that, once the mandates are in force, Tillamook will be dangerously short of fire and rescue workers.
On a recent conference call with the Oregon Health Authority, we county officials were encouraged to simply hire more people now in anticipation of losing a percentage of our health-care workers. The authority didn’t seem to comprehend how much more difficult it is for rural counties to hire crucial personnel than it is for our urban neighbors.
In rural America, we want the pandemic to end just like everyone else. In Tillamook, we are doing our best to get our people vaccinated. But where we can’t, we must be free to pursue alternative measures — such as weekly testing — that can help mitigate the pandemic without depriving residents of essential services.