Rural Albertans with COVID-19 overrepresented in hospitals due to ‘3 Cs,’ doctors say

Although COVID-19 cases are slightly declining in Alberta, two doctors who treat patients from rural areas say a fifth wave may be inevitable if people in those communities do not get vaccinated at a faster pace.

Provincial data says 78.3 per cent of eligible Albertans overall, including those who are 12 and older, are fully vaccinated and 86.4 per cent have had at least one shot.

But in at least 19 out of 63 municipalities in northern and southern Alberta, on average, 55 per cent of residents have rolled up their sleeves for just one dose. In some of those areas, that rate is less than 40 per cent.

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Dr. Raman Kumar, a family doctor at Maxwell Medical in Fort McMurray, Alta., says the rural population is overrepresented in overwhelmed intensive care units “simply because of the fact that there has been more vaccine hesitancy” among them.

“For example, here in Fort McMurray, we’ve had significant issues with our intensive care units being full of patients and we transport our patients to other communities,” said Kumar.

“We had seven nurses come from Newfoundland (to Fort McMurray during the fourth wave), so COVID definitely has been a major, major problem for rural communities.”

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In High Level, one of the most northern municipalities in Alberta, 23 per cent of residents have had at least their first dose of vaccine. The number is 39 per cent in the County of Forty Mile in the south and 40 per cent in Two Hills County in east-central Alberta.

On average, 55 per cent of Albertans living in Manning, Peace River, Fairview, Spirit River, St. Paul, and Lethbridge have had their first dose.

“If we don’t achieve higher vaccination rates in some areas, we’ll be at risk of a fifth wave and sixth wave because of the ongoing transmission,” said Dr. Finola Hackett, a rural family health physician working in Pincher Creek.

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“As we’ve seen with the fourth wave, a low vaccination rate did not protect from COVID and the Delta variants, so there’s a higher risk for sure in some rural areas.”

Hackett and Kumar say three main factors contribute to the low vaccine intake in rural communities.

“I call them the three Cs,” said Hackett.

“There is complacency, convenience, and then the third one being conspiracy.”

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Hackett said complacency can be seen in some Albertans “who are especially younger” in rural communities who have told her they don’t want to get a shot because they believe they are healthy. She said she tells them that the vaccine not only protects them from the virus, but also reduces the risk of transmission to others with compromised immunity.

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Convenience is a matter of accessibility.

“The government and other partners send mobile clinics to some rural areas so that helped … but there’s still pockets of those who might have issues with (transportation).”

The third C and most common reason why rural Albertans are not getting vaccinated is the “pandemic of misinformation,” Hackett said.

“Sometimes … a small, tight-knit community is sharing misinformation that spreads fast,” she said.

“Certain rural areas, that tend to be more conservative, are more distrustful of any government program.”

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Hackett and Kumar said they have met several patients in rural Alberta, sometimes multiple times, and have persuaded them to get vaccinated.

“I just don’t think that acting on frustration or polarization gets us anywhere, as hard as it is finding that patience and energy to understand empathetically why someone is vaccine hesitant,” said Hackett.

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The doctors said they are helping to launch a new campaign in rural Alberta through a national multidisciplinary coalition called 19 to Zero that is working to shift public perceptions around COVID-19 behaviours and build confidence in vaccines.

The campaign called “It’s Never Too Late” includes a video shot in an Alberta hospital. It shows a person breathing heavily while being assessed and admitted into intensive care to be intubated.

“I just want to tell Albertans, that heck, get the vaccine,” Kumar said.

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“Let’s get back to normal life, and the way we can do that is by all of us getting our shot.”

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