The Hollywood vision of a pandemic’s surge typically involves hundreds of angry patients crowded into emergency rooms, screaming and pleading for help. Then the hospital staff gets overwhelmed and chaos ensues.
But the reality for the Lexington Regional Health Center in Lexington, Nebraska, was far different.
The only hospital for the town of just over 10,000, Lexington Regional works to provide a wide array of services to an incredibly diverse town.
Tara Naprstek, the hospital’s director of finance, said the community has residents who speak 40 different languages. Mostly younger and mostly Hispanic, the town’s demographics are rooted in the Tyson meatpacking plant located on the outskirts.
Providing service for more than 18,000 people in the surrounding area, the 25-bed hospital has an interpreter and systems in place to communicate with the different nationalities located in its service area.
“Besides English, the other primary languages spoken at the plant are Spanish, Somali, and Arabic,” Naprstek said. “And we have a platform that is like a telehealth platform for the other languages… We want to do the best that we can to make sure that they understand what’s going on and what we’re doing.”
Before the Covid-19 pandemic, the hospital was breaking even. Despite a few years in the red, the hospital was working its way back to being in the black. When Covid-19 hit, the effects were quick and dramatic, said Wade Eschenbrenner, the hospital’s CFO.
While hospitals in cities in New York, California, and Washington were seeing an influx of patients, by mid-March Lexington Regional wasn’t seeing any. It wasn’t until mid-April that the surge hit. When Covid-19 finally arrived, Eschenbrenner said, things looked bleak.
On April 11, two Covid-19 positive patients came to the hospital, said hospital CEO Leslie Marsh. But between April 19 and April 26, the hospital was seeing its surge – four patients a day, nearly one-sixth of its available beds.
The panicked Hollywood version was an idea still running through the community, Marsh said, but not anything close to reality.
“I tried really hard to help dispel (that stereotype) in the community because that was a narrative that was popular and being spread,” she said. “And it was unnecessarily panicking people. What it looked like for us was four people being admitted during the day. Over three weeks, I think it was on average five to eight patients a week that were always in the hospital that were Covid-19 positive… but during that week about four patients were being transferred out as well.”
While the hospital has ventilators, she said, it wasn’t equipped to handle so many Covid-19 patients at one time. Once a patient reached a certain threshold, they would be transferred to a hospital with more ability to administer to the patient’s needs.
All the while, the hospital had to deal with regular patients. One night, Marsh said, not only did the emergency department have three cases of Covid-19, but patients who had been in a two-car collision.
Through meetings on an almost daily basis, the hospital staff prepared for the worst. They put new procedures in place, sometimes changing from one day to the next based on the latest guidance from the Centers for Disease Control (CDC) and Prevention. The hospital’s leadership took stock of what they had and what they needed, Marsh said.
“From the PPE (personal protective equipment) standpoint, that was something we monitored twice daily,” she said. “A lot of the stuff was on restriction so we couldn’t necessarily get more than we had previously been getting. That was a stressful time in the backside of the hospital.”
New systems were put in place to reduce the use of PPEs, she said. And the leadership of the hospital tracked how many days of gloves they had, how many days of N-95 masks they had.
The pandemic meant re-thinking parts of the hospital too. With only three emergency department bays and two isolation rooms, the hospital staff had to figure out how to create pressure rooms and rooms specifically designed to treat Covid patients.
“You innovate on the spot and figure out what to do,” Marsh said.
The cause behind the surge looked to be the local Tyson meatpacking plant.
Lexington is home to a Tyson meatpacking plant, and the very nature of their work environment is naturally set up to spread the disease.
“They wanted to do well by their employees,” Naprstek said. “We had an entirely different experience to some of the things that I’ve read. There’s no denying that the work environment just was set up to spread infection, but as soon as they knew what to do, they worked with us. They hired social monitors to ensure employees were using sanitizer. They had signs that were spread out about the virus. They had dividers in their cafeteria. We had weekly, if not more frequent, communications with Tyson and really learned from them.”
Even though the surge subsided at the end of April, the hospital remains on alert.
Now somewhat stable financially with help from the Paycheck Protection Program and Small Business Loans, as well as money from the Coronavirus Aid, Relief and Economic Security (CARES) Act, staff is working to incorporate some of the precautions taken for Covid-19 into permanent features of the hospital.
But the future remains unclear. Like many rural hospitals, finances are a struggle. And with no projections of what virus will do in the future, it’s hard to plan financially, Eschenbrenner said.
“You know, from a planning perspective, it is a small hospital. We have more flexible budgeting type of scenarios,” he said. “So we’re always evaluating what our needs are and how those fit from a finance perspective.”