Small, Rural Hospitals Prepare For Potential COVID-19 Surge

Apr 17, 2020

Nationally, New York, South Dakota and many other states are experiencing an overwhelming number of COVID-19 patients. But Wyoming isn't projected to reach its peak number of coronavirus cases until early May.

Most hospitals in the state have been lucky enough not to experience a surge of COVID-19 cases yet and have been preparing for a while.

Tori Probst, the Vice President of Nursing at Star Valley Health in Afton, said they have stopped providing all non-essential services in the hospital, following the Centers for Disease Control's recommendation.

"We tried to transition most of our outpatient clinics into telehealth, and we're even utilizing that from a urgent care standpoint as much as possible," she said. " We're still trying to meet the needs of the community."

Small, rural hospitals need this time to prepare. They only have a handful of providers, beds, ventilators and other resources. Probst said this waiting period let's them prepare for the potential influx.

"So, we've created two more negative pressure rooms within our ER. We originally had one. So now we have a total of three in our ER," said Probst.

What that means is they have created isolated patient rooms that keeps air from traveling outside a room and possibly contaminating others.

The biggest challenge for these smaller facilities in a pandemic is keeping their health care providers healthy so they can work. Hot Springs County Memorial Hospital CEO Margie Molitor said this is a big deal.

"Our big challenge is going to be staffing because we usually have a census of five patients. So if you're surging and having very critical patients and many more patients in your beds than usual, your challenge is going to be having enough staff to take care of those patients," she said.

Part of keeping staff healthy is making sure the hospital has enough personal protective equipment (PPE) like masks and gloves. But the shortage of PPE is a national one. Everyone is scrambling to find them.

"We have to have all the proper PPE, and we have them and we're training them how to use it and having a spotter, watch them, put it on and take it off so that we can make sure that they are safe," said Molitor.

National Rural Hospital Association CEO Alan Morgan said making sure rural hospitals have enough PPE is especially important.

"If you're in a small, rural community and you've got a couple general practitioners, you cannot afford for them to go offline by becoming COVID-19 positive," he said. "I realize that access to catching gear is important for all locations, but there just is no room for error in a rural context."

Morgan said rural hospitals outside of Wyoming are already experiencing this.

"These small rural hospitals, they only have 25 beds and all of a sudden they're presented with five, 10, 30, 40 patients in the door," said Morgan. "Where they have to not only use their traditional staff but outpatient staff and staff that's not normally trained can fill in."

Unfortunately, many experts predict that this surge is not an "if," but a "when" because in general, rural demographics have a big percentage of those at risk of getting the coronavirus.

"Older, sicker, poor, much higher percentage of chronic health issues, larger percentage of obesity, hypertension, diabetes," Morgan said. "Everything that I have just said are exactly that patient demographic most at risk for COVID-19."

Small Wyoming hospitals and their populations just aren't built to weather this, "They're built for primary care. They're not built for pandemic surge issues," said Morgan.

What rural hospitals usually do is transfer patients to bigger hospitals that can handle more serious patients. This is what hospitals are doing now, but during a surge there may not be a possibility to transfer.

And if that happens, "I feel like the biggest is going to be staff," said Star Valley Health's Tori Probst. "And making sure that we have enough staff in order to care for these patients. We don't have a large pool to pull from in for lack of a better word."

Those staff may have to make some hard triage decisions, like who gets a ventilator or who doesn't. Hot Springs County Memorial CEO Margie Molitor said if residents follow the stay at home recommendations and other orders this won't have to happen.

"That will nip it in the bud right then and there, and then we don't have to worry about all the other downstream problems because we aren't socially isolated," she said.

Gov. Mark Gordon puts it more simply, we can stop Wyoming hospitals getting overloaded by staying at home.

Have a question about this story? Contact the reporter, Kamila Kudelska, at kkudelsk@uwyo.edu.