TUCSON, Ariz. -- While Arizona isn't seeing the surge or "second wave" of COVID-19 cases occurring in other states, public-health officials here are concerned cases could rise again.

Epidemiologists say some rural regions of the state haven't fully recovered from the first wave and could be hit much harder a second time around. Dr. Daniel Derksen, director of the Center for Rural Health at the University of Arizona, said four rural Arizona counties have had double the per-capita number of coronavirus infections and deaths of the state's urban areas.

"Often, the rural health infrastructure isn't geared up to take care of folks who require higher-level care," Derksen said. "That's where we saw a lot of the difficulty, was the number of people admitted exceeded the capacity; they had to create extra inpatient beds."

Derksen said Arizona's rural hospitals and clinics often are forced to transfer their most critical COVID patients to facilities in Flagstaff, metro Phoenix or Tucson. But if cases spike again, urban hospitals may not have the capacity to handle the extra load.

And while dramatic infection and mortality rates were seen in Navajo and Apache counties, which are part of the sprawling Navajo Nation, Derksen noted other regions of the state were hit just as hard.

"The other two counties are Yuma County, way over on the border with California - and of course, shares a border with Mexico - and Santa Cruz County, that also shares a border with Mexico," he said. "They're also experiencing twice the rate of infections, and twice the mortality."

Derksen said during the pandemic, Arizona's rural health-care system has turned to telemedicine to stretch its staff and resources and close the often vast distances between patients and providers.

"That's how a lot of the rural and critical-access hospitals - the rural health clinics, the federally qualified health centers and the private practices in Arizona - have really gotten by, by being quite innovative about how to do visits differently," he said.

A major obstacle to virtual visits, according to Derksen, is the "digital divide" in the state's rural areas. He said it's shown the need for state and federal officials to invest heavily in developing the broadband infrastructure to allow delivery of health services to more rural Arizonans.


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Today is Rare Disease Day, an annual observance to raise awareness about uncommon and often misdiagnosed medical disorders.

Support for families and loved ones of individuals with rare diseases is often limited simply because of their lack of familiarity. One such hereditary condition, known as Hereditary Hemorrhagic Telangiectasia or HHT, affects more than 600 Hoosiers, according to the Indiana Hemophilia and Thrombosis Center.

HHT can cause spontaneous and chronic nosebleeds, and only 20% are estimated to know they have it. Early detection is important, said Dr. Magdalena Lewandowska, a hematologist at the center.

"We confirm this with genetic testing," she said. "So, about 90% of patients who have HHT have a gene mutation. There's a 50% chance of inheriting it if one of your parents is affected with HHT."

She said common symptoms can include malformed blood vessels in the brain, lungs and liver, or pin-sized reddish-purple spots on a person's skin.

An additional barrier for patients with rare diseases is locating a specialist to treat them. The Undiagnosed Diseases Network Foundation defines an "ultra-rare" disease as one that affects one in 50,000 people.

Doctors face challenges in diagnosing HHT and other unique illnesses because a specific disease may not be verifiable, due to very little research about it in medical journals. Patients can be frustrated when the necessary tests are unavailable, or the disease mimics another disorder, leading to misdiagnosis.

In 2022, registered nurse Abby Terzini had symptoms of HHT. She said she was in denial - although three family members had the disease.

"I just started having more nosebleeds," Terzini said. "'It's just allergies' - or, 'It's just this, that or the other, it's not a big deal. I'm not having any big issues with this, so I don't need to go to the doctor.'"

Terzini said she eventually decided to get help from doctors who prescribe "bleed kits" containing medication to prevent or lessen the severity of a nosebleed. In 2024, it was reported that a drug used to treat bone marrow cancer and Kaposi sarcoma - a cancer that affects the blood vessels and lymphatic system - is showing promising results for HHT as well.

Legislation to create paid family and medical leave in Pennsylvania is getting bipartisan support.

House Bill 200 has 58 cosponsors, including three Republicans. It's in the Labor and Industry Committee.

The nonprofit Maternity Care Coalition is among those pushing for passage.

Sara Jann Heinze, the coalition's senior director of policy and advocacy, said the bill would allow families some financial support during childbirth and major illnesses. She added that for new parents and babies, paid leave could cut hospital readmissions in half.

"But the bill covers family and medical leave, so it's a really great and expansive benefit," she said. "So individuals who have a baby, adopt a baby, who are sick themselves or need to care for a loved one, people experiencing domestic violence. It's a really comprehensive program."

House Bill 200 is an update of past legislative attempts known as the Family Care Act, to fund paid leave through employer and employee contributions. Thirteen states have similar programs.

Heinze noted many new mothers return to work even before their six-week checkup because of financial strain, some within ten days.

Heinze said paid family and medical leave has been found to significantly reduce perinatal depression, the most common pregnancy-related complication. Untreated, it can have long-term health effects on both parent and child.

"One in eight folks who are pregnant will experience perinatal depression," she said. "Access to paid leave can reduce the likelihood that you will experience perinatal depression by almost 28%. And this is really critical, too, because perinatal depression is challenging for the individual who has it."

Heinze said some Pennsylvania employers offer paid leave programs, but access is unequal.

"What we see is a concentration of women of color working for organizations or companies that don't offer paid family leave," she said. "So, it's upside down. The people who are most likely to experience adverse birth outcomes are least likely to have access to this program."

While large corporations use paid leave to attract talent, Heinze said, small businesses struggle to offer it, which puts them at a disadvantage in hiring.

Children's Dental Health Month is wrapping up but tips for parents and guardians could help their child's health beyond their teeth.

Oral health is a keystone of overall health for people in all kinds of ways.

Dr. Jessica Lee, professor of pediatric dentistry at the University of North Carolina, said there's no separation between dental health and children's success in other areas.

"If they have a toothache or if they're uncomfortable, they don't do as well in school, they can't concentrate, they miss school days," Lee outlined. "The smaller kids, the very young kids, they can often fail to thrive. So it's really a critical part to have good dental health for a child's overall health."

Lee noted brushing is, of course, crucial for children's dental health. She recommended kids brush their teeth for two minutes, which can be a challenge. Lee suggested adults play a song to encourage kids to brush and watch closely to ensure their children are brushing correctly.

Lee emphasized it is important to watch kids' diets, adding parents can be models for good behavior.

"We have access to so much processed foods, so many refined carbohydrates, so many sugars in our diets," Lee pointed out. "Some of it's so hidden. So for parents and caregivers, just be mindful of what their child is eating."

Lee underscored some adults might be surprised to learn baby teeth can get cavities. She acknowledged treating cavities in young children is difficult.

"If you could imagine a two-year-old getting a cavity and us trying to fix it," Lee said. "It's quite a challenge because they're just too young to sit in the chair and be able to get some really heavy dental treatment done."

Lee stressed fluoridated water is safe and protective for children's dental health. She encouraged parents and guardians to speak to their dentist or pediatrician if they have questions about fluoridated water systems.


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