COVID Increasing In The Rural Midwest

Alabama.     Why was the state listed as the worst place to work during the pandemic?

Alaska     The state has a higher percentage of children with confirmed cases.

Arizona      The FDA approves a University of Arizona antibody test, which is one of the most accurate in the country.

Arkansas, The University of Arkansas, set aside dorm rooms to isolate and quarantine COVID students.  The campus confirmed six cases on Aug 31.

California     As the number of new infections falls to levels not seen since June, the state announces a new tracking system set to begin in October.

Colorado     Local outbreaks noted among a fire station, restaurants, a bank, and schools.

Connecticut       The Governor extends emergency orders through February 2021 as the number of new infections and hospitalizations increase.

Delaware     The state’s positive rate and hospitalizations are the highest since July.

Florida    The governor promotes less testing.

Georgia     Epidemiologist calls for an end to in-class instruction at the University of Georgia as the campus logs 821 new cases in the second week, up from 189 the week prior.

Hawaii      A human relations firm offers tips to businesses on how to handle COVID-19 as the state sees community spread.

Idaho      August was the deadliest month, nearly doubling from the month prior.

Illinois       The state reports most new COVID related deaths since June.

Indiana     Notre Dame University is increasing testing after suspending in-person classes.

Iowa.      Ames, Iowa, was labeled the worst hot spot in the country and is planning to host a football game on September 12 with 25,000 fans.

Kansas.     COVID-19 spreading among fraternities, sororities in the state.

Kentucky.     Hundreds of new cases at the University of Kentucky has school officials debating about what to do.

Louisiana.     The governor is concerned about rising cases related to hurricane Laura.

Maine.      A local pastor held a wedding on Aug 7, and over 100 infections and one death are related.

Maryland.      The governor announced the state would advance to stage 3 reopening on Friday.

Massachusetts      A Boston University nationwide study shows depression is three times higher than it was one year ago.

Michigan.     Colleges see increasing the spread of the COVID virus.

Minnesota     The State Health Commissioner said Minnesota overlooked the risk of viral transmission in family and friend gatherings compared with supermarkets and stores where mask-wearing and social distancing have become the norm.

Mississippi       Health officials confirm the state’s youngest death from COVID after battling it for several months.

Missouri     A high number of transmissions in the state is the reason the White House Task Force recommended a mask mandate two weeks ago.

Montana      Two college campuses are only testing symptomatic students, and some experts fear it will allow for greater spread among students.

Nebraska     If a child gets COVID at school and dies – is the school liable?

Nevada     New hospitalizations due to COVID are declining in the state.

New Hampshire     A new dashboard tracks cases in schools.

New Jersey     Neighbors who dined together in a private home allegedly caused a local community outbreak.

New Mexico     New cases reported among staff at various schools in the state despite students not yet returning to classes.

New York     Nurses are calling on the state to pass minimum staff requirements anticipating a second surge of cases.

North Carolina     The State Senate passes a 1.1 Billion relief bill, which includes money for families with children.

North Dakota     Leaders in the state do not agree with the CDC’s recent guidelines to decrease testing among the asymptomatic.

Ohio      The governor said a surge in cases is related to students returning to schools and colleges.

Oklahoma     Over 150 school districts are reporting COVID cases.

Oregon     The governor extends the state emergency through November 1st.

Pennsylvania     The governor extends emergency for an additional 90 days.

Puerto Rico     Tourists, needed to boost the economy, are cited for not following masking guidelines.

Rhode Island     The number of new cases continues to decline.

Samoa     The island looks to change the 14-day quarantine to 21 days.

South Carolina     The University of South Carolina reports over 1,000 active COVID infections.

South Dakota     So far, twelve states have reported over 260 cases, and one death traced back to the Sturgis Motorcycle Rally.

Tennessee      School-age children testing positive for COVID is increasing over the last two weeks.

Texas     Texas State reports students who live in the residence halls immediately asked to move out or go home when they test positive.

US Virgin Islands     The territory struggles to reopen and consistently enforce protocols as travelers come to the island.

Utah     Parents want more education options amid the pandemic.

Vermont     A party at a ski lodge traced to an outbreak.

Virginia     Cases increase at state colleges and universities.

Washington     State health officials say the timeline for the COVID-19 vaccine can not be political.

West Virginia     Eight deaths reported on Tuesday as hospitalizations tick up.

Wisconsin     Two rural counties have become hot spots in the state over the past week.

Wyoming     Around 50 college students quarantined after an off-campus party.

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Updated 9/3/2020 at 8:30 am EST.

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Kentucky Moon

I grew up in what I believe to be one of the most friendly places in the country, a rural area of south-central Wisconsin. Very early in my education, I was one of the gifted and talented students.  I understood math so well as a first-grader; they asked me to help third graders when my first-grade classmates got their addition and subtraction lessons.  I graduated with honors from high school.  I remember informing the high school counselor I wanted to attend the University of Wisconsin – Madison.  He advised I should consider one of the smaller University of Wisconsin schools such as Eau Clare or La Crosse.  He knew my high school education was not equivalent to the other students I would encounter and compete with at UW-Madison.  He seen a history of prior students attending Madison, drop out, and not graduate from the prestigious university.  I admit, when I got to Madison, some of the things he warned me about were true.  On day one of my calculus class, the professor asked how many of us had calculus in high school.  Eighty percent of the two hundred students in the auditorium raised their hands.  I did struggle with my studies at the UW-Madison, but eventually proved my guidance counselor wrong and graduated with a professional degree as a Physician Assistant.

I met people from all walks of life at the University.  In my first year, I shared a dormitory room with a brilliant man from Cypress who spoke seven languages. His uncle was a professor at MIT and helped invent specific tiles to protect the Space Shuttle so it would not burn up on re-entry into our atmosphere.  My sophomore roommate was an African American man who grew up in Oakland.  He and I also grew up in such different environments.  He often said I trusted everyone.  He didn’t trust anyone until they earned his trust.  Where he grew up, he could not trust others, for risk of being shot and killed.  It never crossed my mind during my entire childhood that I could become a victim of homicide in my hometown area.  In my junior year, I  became a House Fellow working as a resident assistant with other students.  In addition to my studies, I worked as a live-in with two men with disabilities. I donated my time to gain experience at a local community clinic for people with no health insurance. I volunteered at the UW-Hospital Emergency Room and spent time at local homeless shelters.  I learned a lot outside of class by integrating with students who were different than me and with other people on campus who came from diverse backgrounds.  In my first year of college, I signed up at my church for a week of service at a young men’s retreat, helping people in rural Kentucky.  The experience opened my eyes to a different rural culture and my expanding awareness of others’ needs.  

I ended up being the only one from my church who signed up. I told my family about my plans and took a Greyhound bus from Madison to Chicago.  When I got off the bus in downtown Chicago, I found myself let off after dark, in a station full of unsavory characters.  Thankfully, I didn’t wait long until two local men picked me up and brought me back to their residence. The young priests in training fed me dinner that night as well as breakfast the next morning. Then the three of us drove in their vehicle from Chicago to Cincinnati.  When we arrived at a large church in Cincinnati, we joined young men from all over the country who flew or drove there as well.  After several hours of orientation about the week we volunteered for, we loaded up our luggage into two large vans and made the drive to Vanceburg, Kentucky.  

I will never forget the most bright, full moon I viewed when we drove around some foothills just outside of Cincinnati and crossed the state line into Kentucky.  The moon was unusually large and low on the horizon.  At first, the moon hid behind the peaks of the rounded hills and sandstone rocks.  The earth was dark and covered in evergreens.  The curvey country road not easily navigated.   We came around one corner, and I was in awe of this unusually beautiful moon.  I had been to the mountains of Colorado and Wyoming before and never saw such a magnificent moon.  At that moment, I felt my soul speak.  I was heading to a place I had never been before, I trusted that I was going to be ok, and naively agreed to participate in a retreat that I, in reality, was unprepared to experience.  

Image by Steve Buissinne from Pixabay

We arrived at the remote farm where we would be staying for the week.  The church vans safely navigated by the two drivers brought the two priests in training and eighteen college men.  Half of us got a bed in the main house, the other half of us assigned to the barn.  I was fortunate to get a bed in the house as I got to stay in the house all week. One of the two priests in training also got a bed in the house.  We bunked together.  I didn’t get the best sleep that night, sleeping in an unfamiliar place with many strangers.  One of the guys snored, and sharing a cramped room with five other men made it difficult to get comfortable.   The next morning after some hot breakfast, we had another session on what to expect.

We met a volunteer carpenter.  I don’t recall his name, but he was skilled and a patient instructor.  He spoke of how he was the man in charge of the leading project for which we were going to double the size of a local family home.  Our goal was to build an addition onto their home.  The foundation of the project was already down; we would make the walls and roof this week.  The next group of volunteers would eventually finish the interior.  He informed us the family paid for the material.  Not all of us could work the site at once, so we would take turns.  Some of us would do other projects or go to different places until it was our turn to work on the home.  On the day I got help, the carpenter told us the family would offer us drinks and cookies.  We were informed to politely turn down their offer as the local water was not safe to drink.  Thus, we ported in drinking water and food to eat on the site.  At the end of our volunteer week, I finally got my turn.  My job ended up shingling the roof.  The work was hot, tedious, and not very gratifying.

We took a muddy, no gravel road around a few hills and through woods before arriving at a valley where the home was situated.  The house was a trailer, and it was in rough shape.  It was worn, grey, with thin walls and windows.  It had rained the night before, so the enitre site was challenging to walk around.  Two unkept dogs were roaming freely on the property.  One of two dogs was friendly, the other barked and barked – keeping a safe distance away from us.  When we did meet the owners of the home, I was surprised to meet a young couple, likely in their late 20’s and their newborn son.

The man of the home did all of the talking.  He was soft-spoken and incredibly humble.  He probably thanked us five or six times for coming to help his family.  They offered drinks and cookies exactly as the project manager said.  The project manager accepted their offering and took the plate of cookies and pitcher of iced tea from them and then excused us so we could start working.  He showed us what to do, and it was surprisingly easy.  I remember it being a long morning until we broke for lunch.  A more painful and hot afternoon followed.  When we got back to the farmhouse where we were staying, I had no choice but to go down to the creek to get cleaned up.  All week we did not have access to a hot shower.  It was still May so the creek water felt ice cold!!! Yet, despite the conditions, I hung in there.  The priest in training who got a bed out in the barn was not as gracious.  He complained daily about the sleeping conditions, lack of bathing facilities, and he couldn’t get WAIT for the week to be over so he could return to civilization.  He longed for his bed in Chicago, and to work with the homeless at the soup kitchens where he was more familiar and comfortable.

On one of the days, we went to a local funeral.  I found that odd, not sure who decided we ended up there.  I felt uncomfortable about that day.  I didn’t want to participate, and it was incredibly awkward.  I felt like I was a spectator, not a sympathizer who could relate to the families and friends that gathered to mourn the death of their loved one.  However, years later, I was grateful for the experience.  One of the other days, I worked at the local church.   One day I stayed at the farm and worked on a project there.  One of the more memorable nights, we drove a few miles down the road to a modern barn.  This barn freshly painted, clean, and inviting.  Inside were bails of hay arranged theater-style along with a raised stage and colorful lights.  We experienced an authentic Appalachian evening complete with banjo, fiddle, harmonica, and guitars.  It added to my love of the week, and I discovered the talents of the local people that before that evening, I didn’t realize came from the area.  What little I knew about bluegrass I saw on the television show, Hee Haw.  Bluegrass in a barn was one thousand times better than anything I ever saw on television.

Image by Ryan McGuire from Pixabay

When my week was over, I gained so much in a short time.  My heart grew and filled with experiences that remain with me thirty years later.  I am grateful for knowing I contributed an insulated room and warmer bed for the parents and their newborns.  I knew their firstborn child was going to have a better upbringing from having a friendlier environment in the winter.  He would be less prone to ear infections, bronchitis, and other respiratory conditions that find vulnerable infants during the winter months.

I stepped out of the comfort I knew growing up, and I am forever grateful I did.  That week in Kentucky would eventually lead to another critical decision in my life.  The choice to begin my PA career in a medically underserved region.  After graduation from the University of Wisconsin – Madison, I moved to Huntington, West Virginia, and started my career working in a rural clinic.  For years I was asked, “where are you from.”  People were curious about why I moved there.  The minute I started talking, my midwest accent would give me away.  Everyone who met me for the first time knew I was not local.  These types of greetings continued for many years.  The work and environment were great for me, and I was an asset to the community.  I thrived there for eighteen years.

I provided direct care for people of all ages.  After a generation passed, I moved to Florida, where I currently reside.  I now correct people who speak poorly of Appalachian people.  I inform them the people of Appalachia are hard workers.  When I hear someone use a derogatory term, I challenge their perception.  I advise why the stereotype is wrong and inappropriate. I also give my account of how the majority of people in Appalachia are very generous and loving people.  They are gifted as evidence of the bluegrass, country music, and famous voices who grew up in the region.  Why do I bother to speak up?   Because it is the right thing to do.  Our country must move beyond derogatory stereotypes of all kinds. 

As a health care provider, I come into contact with people from different backgrounds: taking into consideration their ability, age, ethnicity, gender identity, health status, intelligence, occupation, race, religious belief, sexual orientation, and unique health history.  I have to approach each person as an individual and treat them with dignity and respect.  When I learn about their health history, it starts the process to use my critical thinking skills and ask specific questions.  Based on their answers, I tailor further questions to discover and pick up on clues that may help to make a diagnosis. In doing so, I then use my evaluation skills to decide what treatment I am going to recommend.  I usually explain to patients why I feel the way I do and then allow the opportunity to ask questions.  If they agree with the treatment, I proceed.  If they need time to research or contemplate their options, we will schedule a follow-up appointment.  Not all treatments are pharmacological.  Sometimes the advice is prevention, exercise, nutrition, or I might give my viewpoint and then encourage them to seek another medical opinion.  I am an advocate for my patients in the best way I know-how.   I try to understand what it is like to be in their shoes, and I treat them the way I would treat my sister, father, grandmother, nephew, or spouse.  The golden rule has worked well for my patients and me for twenty-five years.   


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Long term health concerns with COVID-19 infection.

covid can also cause....

Death from COVID is not the only concern for those who get the infection.  Long-lasting effects from the virus can affect the body. Damage to the lungs for those who recover from severe COVID lung infection may lead to an increased predisposition to future lung infections.  Confusion and fatigue are symptoms people may continue to experience after recovering from the acute effects of the virus.  While many who contract COVID do improve, the long term effects of this virus are still unknown.  As a clinician and as a patient, I continue to advocate for you and recommend preventing COVID exposure.


A  virus caused me symptoms for months and may have contributed to other conditions that still bother me.   Within two years of starting my career as a PA, a colleague diagnosed me with infectious mononucleosis.  I had elevated liver enzymes, fevers, sore throat, night sweats, dehydration, and body aches.  When I saw my PA, she and her supervising doctor tested me for streptococcal throat infection, hepatitis A, B, C, tuberculosis, and HIV.  I tested negative for those infections.  A blood smear showed atypical lymphocytes.  An EBV titer blood test suggested it was the cause of my illness.  Epstein Barr is a virus that causes mild symptoms in most people.  However, some people develop more severe symptoms.  In my illness, the acute symptoms lasted three weeks.  I went on to battle postexertional exhaustion; I describe it as feeling like a rag doll.  Instead of feeling energized after a simple 15-minute walk in the park, I would experience overwhelming tiredness that lasted for days.  I knew I had to regain my strength, and it was frustrating when exercise made me feel worse.  I had no choice but to cope with chronic fatigue, which lasted more than six months.  I remember, at the time, my employer allowed me to return to work part-time for several months.  I was grateful I worked in a clinic and for a health care organization.  Had I worked for a less sympathetic employer, I could have lost my job.  It was physically not possible for me to return to full-time employment.  Chronic Fatigue Syndrome is a real condition.  My symptoms were debilitating.  To this day, some health care providers fail to recognize chronic fatigue syndrome and often tell patients that their symptoms are all in their heads.  The unbelieving clinicians cite a lack of blood tests and other organic tests as reasons to support their disbelief.  Yet, those same clinicians believe in the diagnosis of migraines even though there is a lack of blood tests and other tests to confirm migraines.  Both conditions have criteria for meeting the diagnosis and are found in populations around the globe.  Clinicians have had to be encouraged by their colleagues to believe in CFS.  Estimates suggest there are 2.5 million Americans who suffer from CFS.  People who have persistent chronic fatigue seek treatment from more than one health care provider before being diagnosed.  A  2008 survey found up to 44% of people with the diagnosis reported having to visit five or more clinicians before the determination made.  Patients also add they had to seek a different health care provider to find someone who believes them and, thus, treats their symptoms. Even if a person sees a clinician who recognizes CFS, the treatment recommendations may not be up to date.  To make matters more troubling, people with CFS battle symptoms for years before they get treatmentAnother problem with making this diagnosis is the fact that several comorbid conditions share traits with the disease.    Conditions such as fibromyalgia, IBS, and hypothyroidism have overlapping symptoms, making it difficult for even experienced clinicians to make a diagnosis.  Research for CFS continues as this condition is expensive due to costs of care and loss of productivity.

It is essential to remember some viral infections are associated with long term risks.   After an EBV diagnosis, a person has an increased risk of developing lymphoma.  Varicella virus infections can return later in life, causing shingles that may present with a variety of symptoms and possibly severe consequences.

The number of new COVID infections reached all-time highs last week in the states of Arizona, Florida, North Carolina, Oregon, and South Carolina.  As the country reopens, the virus spreads, and new infections abound.  Sign up for member-only benefits, including:

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Stay informed and stay well.

Updated on 6/6/2020 at 2:07 pm EST

National and international copyrights protect this article and  Using a web link to reference the post is acceptable.  Acknowledgment of the author appreciated.