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Case study: Rural municipal COVID-19 research leadership

With a population of approximately 5,000, Hollywood, S.C., is home to four community parks, an aquatics complex, a local senior center, a revitalized library, and unique, family-owned small businesses. Hollywood remains home to many African American families who have ancestral ties to generations forced to labor on plantations. While residents have successfully maintained the native culture and rich traditions of their familial lineage, it has not been without the pressures of large-scale economic development.

The only health care access in the town is a federally qualified health center operating on limited hours and prioritizing emergency cases. South Carolina has a statewide telehealth system through the Medical University of South Carolina that offers free virtual consultations and screenings to anyone experiencing COVID-19-symptoms. While this is a wonderful resource, rural communities often struggle with insufficient internet service and broadband access.

The culture and spirit of Hollywood is filled with faith, servitude, family, and tradition. These attributes are essential to their sense of community but are directly jeopardized by social distancing. Additionally, many community events that help cultivate a common identity for the town have been cancelled due to governmental restrictions for COVID-19.

As the nation’s fight against COVID-19 continues, health policy researchers will be dependent on national and state-level metrics to understand rural community impacts. Most rural health research centers will access data from institutions with big data servers, such as the Center for Disease Control or National Center for Health Statistics – but meaningful indicators of how COVID-19 has transformed daily life are at the municipal level. In order to truly assess the effects, we need a national research imperative around qualitative metrics and analyses. Capturing the lived experiences of rural municipal leaders will prioritize the qualitative examination of social impacts of COVID-19, including rural communications, collaborative leadership strategies, and new political realities.

Rural community communications

Like in most communities, Hollywood’s municipal leadership warns residents of the seriousness of COVID-19 through the town website, press releases, social media, and email listservs. Unlike most urban communities, telephone calls with clergymen are critical modes of communication. Many rural senior populations rely on telephone trees and personal calls for information. Hollywood’s municipal leaders know this type of communication is key during this pandemic, given the disruptions of inconsistent broadband and internet service. They developed an additional strategic plan including personalized calls for reaching their high-risk seniors and disabled populations directly.

Collaborative municipal leadership

Rural governance in Hollywood has not been altered, but their physical chamber meetings have been limited to adhere to governmental guidelines. Although Hollywood’s connection to county leadership is supportive, they are continuing to codify resources for their most vulnerable community members, including the disabled (deaf, blind and intellectually disabled) and seniors. For example, the county school district is delivering meals three days a week for individuals 18 years or younger in three core areas of the town, and a local initiative also provides nonperishable foods for anyone in need.

New rural political reality

To maintain local priorities in light of COVID-19, the council has been diligent to advocate for affordable housing programs, funds to extend water lines and connections for residents, and sidewalk installations to improve neighborhood safety. Many rural constituents are hoping to prioritize challenges they have experienced during this pandemic, including loss of employment and inadequate health care resources.

Hollywood municipal leaders will also be faced with addressing the possible impacts of a surge of the virus given the lack of public health support. The FQHC would be overwhelmed, and the usage of a remote hospital would likely be the only option to mitigate the outbreak. After seven weeks of shelter-in-place orders, the FQHC finally has an operational, drive-up testing site for COVID-19. Previously, the nearest testing site was approximately 45 minutes away.

In addition to the health and well-being of the community, economic ramifications due to COVID-19 will be another stressor for the municipal council. Like many other rural communities, Hollywood is hopeful for a governmental stimulus, as well as the opportunity for small business loans. However, there is concern about loans for small businesses and nonprofits. In some cases, applicants have no payment for up to four years, but many rural business owners may need more time to generate revenue before repayment. Given the uncertainty for financial viability following the pandemic, the loan opportunity should be modified to allow small business owners to adjust to the economic strains of their consumers.

This too shall pass

Rural municipal leaders will be called on like never before to respond to the pandemic in their climate of geographic isolation, vulnerable senior populations, and poorly equipped health facilities. Their legal authorities for decision-making at the municipal level will be key regarding federal requests, advocacy for relief funds, communication with their community, and effectiveness of collaborative leadership with state and county officials. Hollywood has had a wakeup call: The rural lifestyle has changed forever. Handshaking, hugging, gathering at church, and fellowshipping as a community will definitely look different, but priorities for the qualitative investigation on the impacts of COVID-19 among rural communities must be recognized in order to prevent a public health disaster.

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