Volunteer pilots from the Boeing Employee Flying Association load boxes of surgical masks for delivery to rural communities across Washington state. (photo by: Beth Zborowski, Senior VP of Membership Engagement and Communication at the Washington State Hospital Association)

Aaron Edwards, the CEO for the Ferry County Memorial Hospital, in Republic, Washington, sat on the tarmac of Merrick Field on Thursday, looking for signs of an airplane on the horizon. 

 Edwards waited in his Toyota Tundra with Cindy Chase, his chief nursing officer, Mike Martin, his nurse manager, and a couple of boxes of pizza.

Chase and Martin were there to help him load the plane’s cargo, thousands of surgical masks, into his car. The pizzas were for the pilot. 

“He’s volunteering for this, so I wanted to give him something to say ‘Thank you,’” Edwards said. 

After all, what the pilot was carrying could save lives. 

Like their urban counterparts, rural hospitals are running low on personal protective equipment (PPE). In rural areas, the PPEs are for more than just protecting patients. With even a small surge of patients, staffing could become an issue.

“So our biggest threat honestly would be staffing,” Edwards said. “If any of our nurses or doctors got sick, probably the ship would run aground because we were short staff.” 

Ferry County lies just 30 or so miles south of the Canadian border, nestled into the Monashee Mountains of the Pacific Northwest. As of the 2010 census, the county had a population of 7,551 and its main town, Republic, had 1,730 residents. A few miles up the road is Merrick Field, just off the main highway, running parallel to Curlew Lake, and the surrounding Curlew Lake State Park.

It was there that Edwards waited for his shipment of masks. He expects the masks purchased from the Washington Hospital Association (WHA) will help for a while.

Last week, the WHA delivered 300,000 surgical masks to its members. Using volunteer pilots from the Boeing Employees’ Flying Association (BEFA), the association delivered masks to nine hospitals with the greatest need across the state. Another 900,000 are on their way, WHA President and CEO Cassie Sauer said. 

“WHA has never imported or distributed supplies to its members or other organizations, and we had no idea how to do it, but we made it happen nonetheless,” Sauer said. “This is just the first round of deliveries, and we plan to distribute the next round to more facilities as soon as possible. Our hospitals and other care providers are desperate for supplies to keep staff and patients safe – our actions were fueled by this desperation.”

Working with known contacts and Kaiser Permanente, WHA was able to negotiate purchases of the larger quantities of masks, something smaller hospitals can’t do as supplies run short. 

“We were hearing from our members that they were really worried about how they could protect their frontline staff from getting sick. Keeping those frontlines healthy has got to be our top priority,” Sauer said. 

“But, they couldn’t get the supplies. The supply chain is totally disrupted. Part of the reason that it’s disrupted is because their buys are small. You know, if you’re a supplier and you can sell to us 1 million  masks, versus selling to someone else who only wants 20,000 masks, the vendor is going to choose the 1 million mask order every time.” 

WHA was able to step in and work with distribution networks to avoid getting taken advantage of, as well. Many bad actors are out there selling napkins with two rubber bands as surgical masks or taking money and not sending anything at all, she said. 

To protect themselves, the WHA had samples of the masks sent to Sauer’s home to make sure they were buying a real product, as well as make sure that the products met testing guidelines. 

On Friday, Sauer said she received other samples to test – face shields, surgical gowns, gloves, and other protective equipment. Based on what WHA members say they need most, the organization will again purchase the needed supplies and turn around to sell them at cost to their members. 

For Edwards, that means surgical gowns. Right now, he said, he has enough for the next 15 days or so. 

Other Worries

His next biggest concern, he said, was returning “snow birds.” About a third of the town’s population has a winter home in California and Arizona, and they’re starting to come back to Ferry County. 

“So our fear is that we will have someone come back here who is infected,” he said. “But as we’ve seen with that meat packing plant and what not in the Dakotas, you know, you can have a place that, relatively speaking, is fine and you just get a few people not being careful and you get a mess.” 

That mess is something Ferry Memorial was never built to handle. The facility is not set up to handle critical respiratory patients, Edwards said. It doesn’t have an ICU. Currently, the hospital is almost full at six non-Covid-19 patients. Generally, the hospital sees an in-patient every other day, and a little more than a dozen patients seen at its clinic. 

Like many rural hospitals, an assisted living facility is connected to the main hospital. Currently, the assisted living facility houses eight patients and the hospital’s chief of staff who stays there to be nearby if he needs to provide relief to other doctors. 

To protect those in the assisted living facility, Edward’s staff has closed off access to the facility from the hospital. Limited to a regular entrance and a respiratory entrance with an outdoor, tented testing area, the hospital is working to make sure potentially Covid-19 positive patients don’t come into contact with non-Covid-19 patients. 

Right now, he said, like with the airplane, it’s a wait and watch the situation. 

With limited capacity or training in respiratory therapy or ventilation, any other time, he said, the hospital would just transfer critical patients out to surrounding hospitals. But if those hospitals can’t take patients because they’re over-run as well, his hospital would have to find solutions. 

One solution would be to book one the entirety of one of the town’s hotels just to hold Covid-19 patients in quarantine where hospital staff could monitor them. 

Already, the number of patients the hospital is ratcheting up. The clinic is now seeing more than 20 patients a day, most of those visits through telehealth. 

“We don’t know where we end up with this whole thing,” he said. “Who knows where our new normal is? No one knows what’s going to happen when and if we open (our state) back up again.”

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