CLARIFICATION: Dr. Wendy Welch, PhD, MPH, MEd co-authored "COVID-19 Conspiracy Theories: QAnon, 5G, the New World Order and Other Viral Ideas" and is editing the upcoming work "Masks, Misinformation, and Making Do: Appalachian Health-Care Workers and the COVID-19 Pandemic." (04:57 p.m MST., Aug. 25, 2022)

COVID has been in and out of the news cycle for over two years now, but that news cycle is driven by the experience in major cities. Coverage of the pandemic in rural America hasn't kept pace.

That disparity has had consequences - both for how rural Americans view the pandemic, and how prepared regional hospitals were for local virus outbreaks.

As America shut down in 2020 during the initial COVID wave in large cities, rural Virginia hospitals followed the same protocols and stopped doing routine procedures, even when local COVID cases were low.

The lack of revenue from routine care led first to layoffs, and eventually to the resumption of procedures. Dr. Wendy Welch - executive director of the Southwest Virginia Graduate Medical Education Consortium - said after that, COVID showed up.

"They started doing procedures about a month before they got hit by the first wave of COVID," said Dr. Welch, "and then they had to stop doing the procedures again. So, it was almost the worst-case scenario - your hospital was full of people, and then suddenly, your hospital was full of COVID."

Dr. Welch said the delays in COVID waves have been consistent over the entire pandemic, and the current outbreak in southwest Virginia is on an upswing.

Rural residents may see major media covering COVID stories in large cities when not much is happening locally - and then, as media attention turns to other topics, a virus surge hits rural areas.

"We're going up where other places are going down," said Dr. Welch, "and we're late, because we are more rural. And this has driven up the ability to misinform people about COVID overall in rural areas, because we don't conform to the major patterns you see on the news."

As thousands of local and regional newspapers have shut down, local news coverage has suffered and more distant media outlets aren't making up the difference.

Dr. Welch has co-authored one book on COVID misinformation, and is editing the upcoming work "Masks, Misinformation, and Making Do: Appalachian Health-Care Workers and the COVID-19 Pandemic."

The ongoing incongruity between media attention and COVID reality in rural places has created space for misinformation to take hold, Dr. Welch said, and as the pandemic continues, those ideas have evolved.

"The misinformation is predominantly around the vaccine," said Dr. Welch. "You don't have a lot of people left who are saying there's no such thing as COVID, I mean, for a while there, it was called the 'election virus' - it would go away after the 2020 election. People kind of don't say that anymore."

The state as a whole is still reporting around 2,500 COVID cases a day, but rural areas in southwestern Virginia are reporting the highest numbers per capita.



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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

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New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

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