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Nov. 23, 2020, 7:50 a.m. EST

Doctors in rural hospitals speak out about COVID-19: ‘There isn’t any hospital that isn’t under siege’

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By Lauren Hughes, and Jennifer Bacani McKenney

It’s difficult to put into words how hard COVID-19 is hitting rural America’s hospitals. North Dakota has so many cases that it’s allowing asymptomatic  COVID-19-positive nurses to continue caring  for patients to keep the hospitals staffed.  Iowa  and  South Dakota  have teetered on the edge of running out of hospital capacity.

Yet in many communities, the initial cooperation and goodwill seen early in the pandemic have given way to  COVID-19 fatigue and anger , making it hard to implement and enforce public health measures,  like wearing face masks , that can reduce the disease’s spread.

Read: South Dakota emergency-room nurse says some patients insist COVID-19 isn’t real even as they’re dying from it

Rural health-care systems entered the pandemic in already  precarious financial positions . Over the years, shifting demographics, declining revenue and increasing operating expenses have  made it harder for rural hospitals to stay in business . The pandemic has made it even more difficult. In mid-March, most rural hospitals  halted elective procedures  to slow the spread of the virus, cutting their revenue further, and many have  faced price gouging  for supplies given extreme shortages.

I work with rural doctors and hospital administrators across the country as a researcher, and I see the stress they’re under from the pandemic. Here is what two of them – Konnie Martin, chief executive officer at San Luis Valley Health in Alamosa, Colorado, and Dr. Jennifer Bacani McKenney, who practices family medicine in Fredonia, Kansas – are facing. Their experiences reflect what others are going through and how  rural communities are innovating  under extraordinary pressure.

I’ll let them explain in their own words.

COVID-19 fatigue is real. It’s wearing on people. Everyone wishes we were past this. I read the other day about health care workers being the “keeper of fears.” During COVID-19, patients have disproportionately placed their fears on clinicians, many of whom experience the same fears themselves. I focus on building resilience, but it’s hard.

My hospital currently has seven patients with COVID-19 and can make room for as many as 12. Back in the spring, we converted a visiting specialist center into a  temporary respiratory clinic  to keep potentially infectious patients separate and reduce pressure on our emergency department.

It’s all about making sure we have enough staff and hospital capacity.

There isn’t any hospital that isn’t under siege, which means that getting patients to the right level of care can be a challenge. In the past few days, we have accepted three transfers from facilities that are on the front range. We’ve never had to do this before. With six ICU beds and 10 ventilators, we are trying to help others.

Influenza hasn’t arrived yet in our community, and I worry about when it comes. We have nearly 40 staff out right now on isolation or quarantine, a staggering number for a small facility. We are having to shift staffing coverage in half-day increments to keep up.

We are not at a point where we are even contemplating bringing COVID-19-positive staff back to work,  like the governor of North Dakota suggested . I hope we never get there. We are, however, considering high-risk versus low-risk exposures. If a clinician is exposed to COVID-19 during an aerosolizing medical procedure, that’s high risk. If a clinician is exposed in a classroom of 50 people who were all socially distanced and wearing masks, that’s low risk. If we face  critical workforce needs , we may bring back health-care workers that have had low-risk exposures.

We have gained a lot of knowledge this year, and we all feel wiser now, but definitely older, too.

We chose to live in a rural community because we look out for one another. Our one grocery store will deliver to your home. Our sheriff’s department will drive medications outside of city limits. If we could return to our rural values of caring for and protecting one another we would be in a better position. Somewhere along the way, these values took a back seat to politics and fear.

Wilson County , where I practice in Southeast Kansas, didn’t see its first COVID-19 case until April 15. By August, you could still count the number of cases on two hands. But by mid-November, the total was over  215 cases  in a county with a population of about 8,500 – meaning about one out of every 40 residents has been infected.

Our 25-bed critical-access hospital doesn’t have dedicated ICU beds, and it has only two ventilators. Emergency department calls are split among the five physicians in Fredonia. In addition to dealing with COVID-19 cases, we’re managing every other illness and injury that walks through the door, including strokes, heart attacks, traumatic injuries and rattlesnake bites.

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