Some rural NY counties face higher COVID-19 risks. Hochul blames low vax, mask use

David Robinson
New York State Team

A crush of unvaccinated New Yorkers infected with COVID-19 ended up lying in hospital beds at Arnot Ogden Medical Center in Elmira recently, struggling to breath and asking the same question: “Can I get the COVID vaccine now and will it help me?”

Dr. Justin Nistico last week recalled his talks with the desperately ill patients, who mostly live in rural parts of Chemung County and surrounding communities in the Southern Tier.

“The answer is always no, and now we’ve got to treat the disease,” he said.

In some cases, Nistico recounted the pleas of vaccine holdouts to family members after they’re placed on breathing machines.   

“It’s heartbreaking for a lot of these families because they see the reality of what this infection can do,” he said, adding some chose to get shots after hearing the vaccine is highly effective at preventing serious illness, not treating it.

Arnot Ogden Medical Center in Elmira.

The medical realizations are unfolding as COVID-19 cases and hospitalizations spiked in some upstate New York counties, despite plunging infections in other communities, including New York City and parts of the Hudson Valley.

Experts suggested the trends offered a glimpse of the pandemic’s next stage in New York, as rural communities across the Finger Lakes, Southern Tier, Mohawk Valley and North Country lag behind statewide vaccination rates and remain at heightened risk of COVID-19 outbreaks.

Some cities such as Rochester, Buffalo and Syracuse with pockets of unvaccinated residents also face similar threats, as New Yorkers this fall and winter spend more time indoors where the highly contagious COVID-19 delta variant spreads most efficiently, experts said.

Further, the situation in New York’s rural counties is raising concerns because rural Americans die due to COVID-19 at twice the rate of urban Americans, according to new research from the Center for Rural Health Policy Analysis at University of Iowa.

“It’s about understanding that rural is not a refuge (from COVID-19), and I think there was a certain amount of thought that it might be,” said Fred Ullrich, the center’s research director.

New Yorkers living in rural communities also tend to be “older, sicker and poorer,” Ullrich added, citing higher rates of smoking, obesity, diabetes and other underlying health conditions in many rural communities nationally where health care access is also often limited.  

“It all forms a conspiracy of factors that make the disease worse,” he said.

What New York is doing about COVID risks

Counties with COVID-19 cases

Gov. Kathy Hochul on Oct. 5 said she was monitoring disparities in COVID-19 outbreaks statewide, asserting it stemmed primarily from differences in vaccination rates and mask wearing.

Hochul said in some communities she will “walk into a building with a mask on, and I’m the only one wearing a mask because they’re now saying they’re not required.” She added New Yorkers in other places will wear masks indoors and outdoors because they’re taking COVID-19 seriously.

The Democrat governor noted she would consider imposing new state COVID-19 restrictions if pandemic conditions warrant action.

“If we’re starting to see spikes that are not good for an area, we’re going to have to take more drastic measures,” she said, suggesting new mask mandates could be one tool deployed.

While mask compliance is largely anecdotal, some rural communities in New York with low vaccination rates have been hit hard by the ongoing wave of infections fueled by the delta variant, according to a USA TODAY Network analysis of state data.

For example, Chemung County had 1,484 COVID-19 cases since Sept. 1, or about 179 per 10,000 residents. Fulton County in the Mohawk Valley had about 161 cases per 10,000 residents.

Meanwhile, the two counties' partial vaccination rate among adults hovered around 60% as of Oct. 4, among the lowest statewide.

In contrast, Monroe County had about 82 cases per 10,000 residents during the same period, and Westchester County had 49 cases per 10,000 residents.

Monroe’s partial vaccination rate among adults was about 80%, and Westchester was nearly 90%. The rate statewide overall was about 85% among adults.

What rural health providers say about COVID

Protestors gathered outside UR Medicine | Noyes Health in Dansville recently to protest vaccine mandates.

Some health leaders Oct. 5 raised concern the continued COVID-19 threat to rural communities across New York is compounded by staffing shortages connected to the state’s vaccine mandate for medical workers.

Several hospitals that had workers quit, suspended or fired due to the mandate, which took effect Sept. 27, have since reduced maternity care, elective procedures and other services, said Gary Fitzgerald, president and CEO of Iroquois Healthcare Association, representing hospitals in 32 counties across upstate New York.

While more than 92% of hospital and nursing home workers complied with the vaccine mandate, about 35,600 medical workers could lose jobs connected to the mandate, including 1,400 fired this week by Northwell Health, the state’s largest hospital network.

“We’re facing a crisis in our hospitals because our staffing before the pandemic was facing severe shortages,” Fitzgerald said.

Outside of medical settings, some health officials voiced frustrations at their long-standing push to sway New Yorkers opposed to COVID-19 vaccines to get shots.

Mary Zelazny, CEO of Finger Lakes Community Health

“We are up against some pretty strong anti-vaccine sentiments for multiple reasons,” said Mary Zelazny, CEO of Finger Lakes Community Health, a federally supported network based in Penn Yan, serving the rural counties of Yates, Wayne, Ontario, Steuben, Cayuga, and Seneca.

“A lot of people think they don’t trust the science and we run across quite a few people that believe it’s an infringement on their freedoms,” she said, adding the recent spikes in cases had limited impact on boosting vaccination rates.

Another potential reason for vaccine disparity is that political affiliations seemed to play a role in some rural communities across the country having below-average vaccination rates, national surveys suggest.

Meanwhile, the uptick in cases strained the health system in many rural communities, where the distance between homes and health care providers inherently results in people waiting for emergency care for diseases like COVID-19.

“One of the things that makes rural more susceptible to lack of care is lack of access,” said Sara Wall Bollinger, a strategic director for the New York State Association for Rural Health. “Everything is just a little further away for rural people.”

Still, Zelazny and others health leaders said combating vaccine opposition and hesitancy, however challenging, remains the key to reducing the virus’ spread in all communities.

New Yorkers “have a lot of freedoms and benefits, but we also have responsibilities to each other and that sometimes includes vaccinating for the good of all of us,” Zelazny said.

COVID deaths rates in metro and nonmetro counties

Trevor Hughes of USA TODAY contributed to this report.

David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached atdrobinson@gannett.com and followed on Twitter:@DrobinsonLoHud