Rural Nevada had healthcare challenges before the coronavirus.

Shortages of providers, facilities, and equipment helped earn the state a D+ grade in Rural Health Quarterly’s most recent annual report card.

Now some of the most remote communities in the nation are bracing for a pandemic for which they might not be prepared.

Dr. Daniel Spogen, chair of family and community medicine for UNR Med, recently spent several days working in Elko in far northeast Nevada. He was overseeing a medical-school-run family medicine clinic in the community, which is more than 200 miles from the nearest big city.

Spogen told State of Nevada that Elko’s 70-bed hospital typically has fewer than 20 patients but the outbreak could still tax it.

“They have a lot of capacity to add for a rural area,” he said, “but in pandemic sort of situation, you can overwhelm the resources really quickly,” he said.

In Elko’s favor, and something that benefits all of rural Nevada: Low population density could slow the spread of the coronavirus.

“One of the biggest advantages of living in a rural community is it probably won’t hit as much of the population as you would expect in a city situation,” Spogen said.

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Although the population may be smaller, Spogen said because mining is a main industry many people travel internationally.

“We have a unique situation here in Elko in that one of our major industries is the mining industry. The employees from the mining industry come from all over the world,” he said.

Spogen said when the governor first announced restrictions people in the town were resentful because they didn't think the virus would have much of an impact. That changed when the first two cases of the virus in Elko County were diagnosed.

Now, the doctor said, people are taking the virus and social distancing restrictions more seriously.

His clinic and the Northeastern Nevada Regional Hospital have set up drive-through screening facilities for people to get tested for the virus, but like many areas, Elko only had just a few testing kits.

For the last 18 months, UNR medical school residents have rotated through Elko to broaden healthcare options there and introduce new doctors to practicing in rural areas.

However, currently, students are not seeing patients because of the virus and limits on personal protective equipment. Instead, students are helping by triaging patients by phone.

Dr. Spogen said primary care doctors are vital during pandemics like this one because they're often the first ones to see patients and decide what kind of treatment they need, which is why he would like to see his rural health care program permanently funded by the state.