Paper short abstract:

Our research examines responses to the COVID-19 pandemic in rural New England. We have documented shared experiences of vulnerability and attunement to the consequences of economic precarity and social isolation. Countervailing forces have prioritized and protected vulnerable populations.

Paper long abstract:

This paper draws on ongoing research examining responses to the COVID-19 pandemic within health systems and communities in rural New England. Launched in mid-March as the region braced for an expected surge of COVID-19 cases, our research has engaged with participants (N=72) from rural hospitals, primary care clinics, mental health and substance use settings as well as social services, mutual aid groups, and town/city governments to trace in real-time the impact of the pandemic within rural Vermont and New Hampshire. Our research has documented shared experiences of vulnerability and attunement to the consequences of economic precarity and social isolation. Within this context, there is deep concern about increasing mental health needs coupled with an awareness of the fragility of rural health systems to meet these needs. Yet amid such concerns, we have documented a countervailing force that we characterize as a rural ethos -- a constellation of compassion, solidarity, and pragmatism—that manifested in rapid mobilization and the prioritization of vulnerable populations, including the elderly, persons experiencing housing and food insecurity, and those living with mental illness and/or addiction. Robust community efforts were bolstered by strong state-level responses in Vermont whereas the sentiment “we’re on our own,” prevailed in the most rural regions of New Hampshire. We explore the consequences of these divergent policy and cultural responses for health equity and for shaping possibilities for meaningful long-term recovery in rural areas.