Many rural areas avoided the worst of the pandemic in its early stages. Now, it seems the coronavirus is everywhere, straining hospitals that have fewer resources to address an ongoing health crisis.
Hospitals with fewer beds fill quickly during a pandemic. On Thursday, nearly half of the patients hospitalized at Abraham Lincoln Memorial Hospital in Lincoln were COVID-19 patients. It was soon apparent in talking with Dr. William Lytollis how busy they are. As he spoke, a medical alert blared through the speakers overhead.
"What you are hearing in the background is the ER is getting busy. We actually went to Stage 1 at 10 am. this morning,” Lytollis explained.
Stage 1 is when extra medical staff is brought to the emergency department to treat a surge in patients. Hours later, the Lincoln hospital advanced to Stage 2 of its surge plan. That's when additional beds are brought into the ER
Like most rural hospitals, Abraham Lincoln Memorial doesn't have intensive care beds, so patients with more severe symptoms are sent elsewhere. That's not always easy especially during a pandemic when bed capacity is limited nearly everywhere.
Paul Skowron is CEO of Warner Hospital in Clinton. In late November, the hospital had a patient who needed emergency care for a heart problem. The hospital was full, including all COVID beds taken. Staff called other hospitals in the region. None would take the patient.
“I think the other hospitals might have thought we were trying to transfer a COVID patient,” he mused. “We ended up having to emergency helicopter that patient to St. Louis.
“I’ve been here six years, that was only the second time we have used the helicopter.”
The patient got treatment in St. Louis and is OK. The incident shows how quickly rural hospitals can run out of space to treat patients most in need. The facilities in Clinton and Lincoln are both Critical Access Hospitals (CAH). That's a federal designation that sets different reimbursement rates to enable hospitals to provide care in rural areas.
Administrators at both facilities said it's been a challenge maintaining adequate staffing as health care workers deal with the effects of COVID personally and professionally.
Dolan Dalpoas, CEO of the Lincoln hospital, said at one point, 10% of his workforce was down.
“We ask our staff to take on multiple roles, which has been very important during this pandemic,” Dalpoas explained. “We’ve deployed physical therapists as safety monitors, because of a need there. We don’t have a large bench to draw from.”
Many rural hospitals are struggling to keep enough medical staff on hand.
Pat Schou, executive director of the Illinois Critical Access Hospital Network, said on IPR’s the 21st Show, the industry didn't anticipate how much health care staff would be sidelined either by their own COVID cases or exposure, or a case in their family. Schou said the problem is magnified in rural areas where the pay is typically less.
“There’s just no more staff available and if there are agency or additional staff, often they are attracted to a larger facility which may be able to pay a little bit more," Schou said. "That becomes a struggle.”
Skowron said his hospital is better off than most in rural areas. Employment rates in DeWitt County are strong, there are fewer Medicaid patients and there are four regional hospitals less than an hour away.
“We really have access to a lot of resources and other hospitals that work with us in partnership that more rural hospitals in southern Illinois do not have,” he said. “Some of those hospitals are 75 to 100 miles away from the next hospital.”
But that hasn't slowed rising death counts. DeWitt County ranks among the 50 in Illinois with the highest COVID death rates, so it was among the first to get vaccines. Some of Skowron's staff got inoculated on Thursday.
Skowron said he's relieved the vaccine is here, but he's worried its arrival will cause some to become lax about COVID safety. Daily coronavirus tests at the hospital are down sharply in recent weeks.
“That seems to be affecting some of the public’s attitude as to not necessarily needing the testing as much as previously,” Skowron said. “I don’t know that that’s the proper attitude, but that seems to be the mentality right now.”
Dr. Lytollis said COVID care is much better than it was in the spring. The medical community has learned through trial and error, even if options are limited. He said the steroid dexamethasone has been largely effective, the anti-viral drug remdesivir has shortened hospital stays. Lytollis said hydroxychloroquine was used more frequently early on, but hasn't worked.
The successful treatments can easily get lost in the numbers as COVID deaths escalate across the region and across the country. Lytollis said your chances of surviving the coronavirus may have improved, but more cases will lead to more deaths.
“Now, we are seeing a very large number of people with COVID, and we are seeing more deaths simply because we have such a large numerator of people who have the disease,” Lytollis said.
Logan County reported 29 COVID-related deaths as of Dec. 17. DeWitt County has had 18 deaths. In both cases, that's about one death-per-1,000 residents--more than double the death rate in McLean County and higher than Cook County that has had nearly one-quarter of all COVID deaths in the state.
There also may have been greater skepticism about the severity of the coronavirus in small towns, especially early on when large outbreaks were mostly in urban areas.
Skowron said over the summer, he was frequently asked how much money the hospital makes on COVID patients, suggesting hospitals were inflating COVID numbers.
“I stressed that, of course we get paid for COVID patients,” Skowron said. “There is a diagnosis code for every health condition We didn’t get paid any more for a COVID patient than we did for a pneumonia patient.”
Lytollis said fighting the coronavirus has been a slog these last nine months, but the vaccine is a game-changer and that brings him hope, and so do stories of personal will.
He recalled a 91-year-old woman in his care who contracted COVID. Early treatments failed. The doctor discussed end-of-life decisions with her family. The next day she got better, and she kept getting better.
Lytollis said he can't point to a specific treatment that worked, other than her determination and maybe some fresh air. Hospital staff found a way to sneak her outside to get some sunshine after she'd been stuck in a hospital bed for a month.
“We looked to make sure we weren’t violating any policies, which we were not. We put her in a wheelchair and took her outside and we called her daughter on her cell phone. Her daughter picked up and said, ‘What are you doing outside? You’re sick.’ It was just amazing.”
Lytollis said the woman has since been discharged and is doing fine. Hospital administrators know there are still many tough days ahead. But Skowron is bullish on a return to normal in 2021.
“At this point, I’m feeling that by May we’ll be able to have May Days again in Clinton very safely, and we are all going to be able to get together and go to church and not be as concerned as we are now,” he predicted.
In the meantime, the hospital officials all said the coronavirus' damage can be limited by the choices we make to protect ourselves and those around us.
Logan County reported three more coronavirus cases on Friday as Illinois' COVID death toll topped 15,000.
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