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Rural hospitals may have fewer resources than their urban counterparts, but they are generally prepared to deal with the potential spread of the coronavirus, leaders in the field say.
That doesn’t mean rural healthcare workers are worry-free about the potential of the virus to affect their ability to serve patients.
The Netflix docu-series “Pandemic – How to Prevent an Outbreak” looks at “the heroes behind the efforts to contain viral outbreaks across the globe.” Released just as the coronavirus began to spread outside of China, the series pointed out some of the challenges rural hospitals face if a deadly outbreak strikes their service area. Rural hospitals would face a triple whammy, experts say – limited resources, low priority for replenishing those resources and a patient base that is more inclined to put off going to the hospital, perhaps until an illness has progressed to a dangerous level.
Holly Goracke, a physician at Duncan Regional Hospital in Duncan, Oklahoma, appeared on the series and voiced her concerns about how the small hospital where she works 72-hour shifts would handle an outbreak. At the time, Goracke was the only physician in Jefferson County, Oklahoma.
“I don’t have every resource that a large hospital has. I honestly have no idea what I would do in a situation like a pandemic,” she said in the docu-series. “We’re going to be lower on the totem pole in terms of getting replenishment of our resources. Places that have higher populations are going to be places that get that life-saving medication first… I think that we would be overwhelmed; that we wouldn’t be able to manage should a flu pandemic occur in our little county.”
Goracke has since left the hospital and could not be reached by the Daily Yonder.
On February 3, a patient thought to have the coronavirus was released after two weeks in isolation from the Regional Medical Center in Everett, Washington, about 30 miles north of Seattle.
In Ellensburg, Washington, about 130 miles to the southeast of Everett, Julie Peterson is the CEO of Kittitas Valley Healthcare, the only hospital in Kittitas County. Ellensburg is a town of 20,977 on the eastern side of the Cascade mountains and home to Central Washington University. Each year, Peterson said, the hospital deals with its fair share of emergencies, including weather conditions that may separate the hospital from other resources in the state.
On January 31, she said, a student at Central Washington went to the university’s student health center with flu-like symptoms. After questioning him, the university felt he could be infected with the virus and worked with Kittitas Valley to transfer him there and put him in “precautionary isolation.” The student, Peterson said, voluntarily admitted himself to not infect other students.
Peterson told the Daily Yonder her staff knew what to do.
“By the time I got there, my staff was already prepared,” Peterson said. “They said ‘We’ve got this. We’ve got the inventory; we’ve pulled the policy.’ They were completely on top of the situation.”
While she is by no means cavalier about the possibility of a pandemic, Peterson said she feels her staff and other rural hospitals across the country are, by and large, prepared for these kinds of situations.
Brock Slabach, senior vice president for the National Rural Health Association, said hospitals are required to have some level of emergency management planning. In many cases, to qualify for federal funding, hospitals are required to have two emergency drills per year — one of which needs to be in coordination with other local emergency agencies.
While he recognizes that hospitals train for this, Slabach said he also recognizes that there could be issues. For him, the biggest concern is surge.
Any pandemic, he said in an interview with the Daily Yonder, would send large numbers of patients to the hospital. In the past 40 years, the number of hospital beds in the U.S. has decreased from 1.5 million in 1975 to around 900,000 in 2018, he said. During that period, the U.S. population grew by more than 40 percent, according to the U.S. Census.
“It can stress our surge capacity,” he said. “It wouldn’t just be whether or not there are beds, but each of those beds would need ventilators and skilled staff to operate the ventilators. I worry that it could significantly stress our hospitals’ space, resources and staff.”
California has six confirmed cases of coronavirus. Rural hospitals there are also prepared to implement emergency protocols, said Peggy Wheeler, vice president of rural health care and governance with the California Hospital Association.
“The best way to sum it up is that our hospitals aren’t reaching out to us specifically because we’re reaching out to them,” Wheeler said in an interview with the Daily Yonder. “We’re keeping them up to date on what we know. These are things hospitals routinely plan for and train their staff for.”
Rural areas that lack hospitals, clinics and even doctors must also be part of the planning for regional and national emergencies, even though threats of a viral epidemic may be less in rural areas, said Charles Owens, executive director for the Center for Public Health Practice and Research at Georgia Southern University. .
Georgia, a state of 159 counties, has nine counties with no doctor.
“Those events can happen anywhere, but they’re more likely to happen in a larger city with airplanes flying in and out,” Owens told the Daily Yonder. “But even in our rural counties, all of our counties have ambulances and all of our hospitals are within 35 miles of one another. We have a much stronger network here where our smaller communities are close enough to a larger community that they’d be able to handle larger patient numbers.”
Erin Stewart, spokeswoman at the Georgia Hospital Association, said the organization has not heard from any of the state’s hospitals expressing concern.
Leslie Marsh, CEO of the Lexington Regional Health Center in Lexington, Nebraska, population 10,024, said that while the incidents of coronavirus in small towns are small, it can happen.
“Lexington has a diverse community, but it is composed primarily of Latinos and refugees from Somalia,” Marsh said in an email interview with the Daily Yonder. “We see very few Asians, but the University of Kearney does have an exchange program with China, so it is not out of the realm of possibility that we might eventually see someone from China or someone with who has contact with someone who has traveled to China.”
For her hospital, exposure to influenza is also a concern. Lexington Regional is seeing many patients with both influenza A and B this year, with both viruses are showing up at the same time.
“Moreover, we are running out of testing kits, and some pharmacies have exhausted their supply of adjunct therapies (like Tamiflu). So, influenza and its associated complications remain top of mind,” Marsh said. “Our infection control practitioner indicates that she is really not concerned about the coronavirus but is concerned about influenza A and B, specifically irregularities in patterns, increased rates and the associated morbidity and mortality we see with influenza.”
In Nebraska, local public health departments have begun weekly surveillance calls, she said, that inform them about any irregularities or additional information the hospital may need. Her hospital is ready to respond, if needed, she said.
And that is to be expected, California Hospital Association’s Wheeler said.
“They’ve been trained on what protocols to put into place in order to deal with any situation,” Wheeler said. “They do this every day. They put different protocols into place every day.”
What does concern Kittitas Valley Hospital CEO Peterson, though, is an influx of “the worried well.”
“I’m concerned we’ll have people showing up to our ER because they’ve got a cough, and think they’ve got coronavirus,” she said. “The recommendations for this are to stay home. I’m concerned they will come and take up resources we could use for others.”
Marsh agrees. Even though the mortality rate for the coronavirus is low, and falls below the threshold for an epidemic, as the word “pandemic” spread, she worries about the impact it will have on residents in her area.
“These notifications are coming at a fairly rapid pace and will, no doubt, add to the concern about providing care to anyone with a respiratory illness,” she said. “As the term ‘pandemic’ becomes more widely used, I think there will be an escalation of fear and provider concern; if new information becomes available our position in caring for patients will change accordingly. Even over the course of three days the number of confirmed cases in California has increased, not dramatically, but enough to give one pause for thought.”