Rural-urban Differences in Illinois Health Department Capability to Address the COVID-19 Pandemic

Purpose: County-level health departments (HD) have lead roles in COVID-19 response, with actions guided by 15 federal capabilities We sought to assess Illinois HD perception of preparation and ability to accomplish these, and how perceptions might vary by population size and rurality Methods: We attempted contact with all 96 certified HD (4/6-24/2020) and administered a survey asking 4 identical questions regarding each capability: 1) adequacy of past preparation (pastPreparation);2) current ability to accomplish (currAbility);3) sufficiency of current resources (Resources);and 4) sufficiency of local cooperation and support (Cooperation;all Likert 1-5) Rurality was assessed with Rural-Urban Continuum Codes (levels 1-9;stratified as metropolitan [1-3] and nonmetropolitan [4-9]);and population data obtained from the Census Bureau T-test, chi-square and regression analyses were conducted with SAS Results: We received 34 surveys representing 40/100 counties with HDs (11 metropolitan and 23 nonmetropolitan) Respondents/non-respondents did not differ by population or rurality Ave-currAbility (currAbility averaged across all 15 capabilities) was positively associated with population (+3 57E-6;p=0 027), and nonmetropolitan counties reported significantly lower ave-Cooperation (3 37 [95% CI 3 16-3 57] vs 3 93 [3 47-4 38]) For individual capabilities, nonmetropolitan HDs reported significantly lesser Resources for capabilities #2-Community Recovery, #3-Emergency Operation Coordination, and #5-Fatality Management;and lesser Cooperation for #2, #8 and #9-Medical Countermeasure and Material Dispensing, #10-Medical Surge, and #15-Volunteer Management Conclusions: Though metropolitan areas experience greater numbers of COVID-19 cases, many rural communities experience comparably high infection rates Though statewide HD response is critical, many nonmetropolitan HDs report comparatively lesser ability to meet this challenge