In America's coal country, health issues are no stranger.
"The cancer rates here are so high for so many diseases," explained Dr. Teresa Tyson.
And now, the novel coronavirus is making its way into this rural part of the country.
“I feel that we have the most vulnerable population in the United States, in regard to this COVID exposure," Dr. Tyson said.
Dr. Tyson leads the Health Wagon in southwestern Virginia. The nonprofit offers free healthcare in an area Dr. Tyson says is especially at-risk for COVID-19.
“We have so many people with certain health care disparities,” she said. “We have the black lung, the coal miners pneumoconiosis, and we have population that has aged.”
Tyson says the virus has been slow to climb into the communities tucked into the mountains
"We're fortunate we didn’t have a lot of international travelers," the doctor said. “We are seeing it now.”
The Health Wagon has made a name for itself, driving mobile doctors’ offices into communities that lack other healthcare options.
For now, their buses are off the road; the quarters are too close inside to be safe in a pandemic.
However, Dr. Tyson says her team is ready.
“We truly have worked day and night to think, ‘what can we do to lessen the impact here to educate the public?’" she said.
The Health Wagon is testing for coronavirus at their clinics, utilizing telehealth and making sure patients are safe at home.
“Getting our patients medication for three months, before it even hit the region,” she said of the nonprofit’s efforts
While the virus has spread more quickly in cities than in rural areas, a University of New Hampshire study says death rates in rural counties are likely to be higher than the national average because of its older population.
While the Health Wagon carries incredible weight to keep this community safe, Dr. Tyson is putting her belief in their plan for this pandemic and the spirit of the people of Appalachia.
"I always say they are the most wonderful people in the world, and they are about community and helping others,” she said. “And we will pull through this.”