Introducing the Percent, Number, Availability, and Capacity [PNAC] Spatial Approach to Identify Priority Rural Areas Requiring Targeted Health Support in Light of COVID‐19: A Commentary and Applicat
During December 2019, a new coronavirus (COVID‐19) was identified in Wuhan, China.1 The spread of COVID‐19 since identification has quickly emerged as a global issue with the World Health Organization declaring a pandemic on March 11.2 To date (March 29, 2020), there have been over 716,000 reported cases across 177 countries/regions, with deaths approaching 34,000.1 Those who are older than 65 years of age generally face the most extreme consequences of contracting COVID‐19. Data from the United States have confirmed that up to 30% of people 65 or older contracting COVID require hospitalization, while up to 10% will die.3
Aging populations in rural and remote communities may be especially vulnerable to the COVID‐19 pandemic, and in part, this is due to the availability and capacity of rural health services. Edwards et al4 investigated the perspectives that rural hospital decision‐makers had in relation to service delivery during a pandemic avian influenza scenario. Findings from 17 hospitals concluded that key issues surround (i) a lack of staff, (ii) the need for coordinated health services, and (iii) operational and facility issues. Similarly, Harrod et al5 confirmed that staffing constraints also hinder rural hospital performance during a time of crisis. Finally, irrespective of hospital capacity issues existing during crisis, research has confirmed that compared to urban communities, rural communities typically face poorer access to health services.6 This is especially problematic during a pandemic.
For rural communities, responding to the COVID‐19 pandemic requires unique service offerings. Consequently, the most pressing issue that geographically large, developed countries with widely dispersed rural localities (for example, the United States, Canada, and Australia) face in tackling the spread and consequences of COVID‐19 surrounds the identification of priority areas where unique service offerings and resources should be dedicated. Spatial methods have been effective toward identifying where health service gaps exist,6, 7 and they have also confirmed that compared to urban regions, rural areas often experience further travel times to essential services.8 Already, in light of COVID‐19, seminal work by Boulos and Geraghty9 synthesized the extent of spatial applications currently used to track incidences of COVID‐19. They also clarify where geographic information system (GIS) methods can inform decision‐making and suggest that spatial methods can be applied to identify new sites for health services to address COVID‐19 incidences. In the absence of funding and time to develop new sites of service delivery in rural localities, spatial methods can identify rural priority areas where unique service offerings (including the better coordination of services4) are necessary.