How a rural hospital in Washington tries to prepare for the coronavirus
The hospital was still waiting on a test result for its first possible case of the novel coronavirus when the staff crowded into a meeting room late last week to finalize plans for a potential outbreak. Employees at tiny Dayton General Hospital had spent the past month marshaling what few resources they could as they watched the virus spread from China to Italy to Seattle and finally toward them in rural America, which they worried was the most vulnerable place of all.
“How are we on masks and protective gear?” asked Shane McGuire, the hospital’s CEO.
“Getting low,” the supply manager said. “I can’t buy anything. Everything’s out of stock.”
“How about our staffing?” McGuire asked. “We need to make contingency plans in case some of us get exposed and need backup.”
Nobody answered, and McGuire looked around the room at his pharmacy department of one, at his 70-year-old doctor, who was working alone in the emergency room, and at his lab director, who was now also in charge of infection control.
Most people on his staff were already working multiple jobs to keep the hospital functioning. “I know we’re stretched thin as it is,” McGuire said. “We’ll improvise and make it work however we can.”
They had been doing exactly that for the past several years, somehow keeping the doors open even as America’s rural health care system collapsed all around them, with 125 other rural hospitals around the country closing for budget reasons and doctor shortages spreading across 85 percent of rural counties.
Its emergency room and nursing home were both losing more than $1 million per year. But the hospital remained the final lifeline for an aging community of about 5,000 people in a rugged corner of southeast Washington state, isolated from all other medical care by 35 miles of barley and wheat.
The employees in the meeting room took turns reviewing what they knew about the novel coronavirus. The Centers for Disease Control and Prevention said it was deadliest for the elderly, and Dayton residents were an average of 13 years older than people in the rest of the state. The virus was worse for people with underlying health issues, and, like most rural communities, Dayton had high rates of COPD, obesity, diabetes and heart disease. Experts estimated that as many as 1 million of the most vulnerable Americans might need to rely on lifesaving ventilators, and Dayton General had none.
“This is a virus that can take over and expose your weaknesses,” McGuire said, and he feared that was true for both rural residents and the beleaguered hospitals left to care for them.
The virus had just arrived in rural America, but already, small hospitals across the country had begun bumping up against the limitations of their resources. A facility in the Berkshires had lost much of its nursing staff to a 14-day quarantine And throughout the hard-hit areas of Washington state, rural hospitals with only a handful of beds had begun making plans to set up tents or rent vacant buildings in case extra space was needed.
Dayton had already closed its nursing home to visitors as a safety precaution and lined the hospital walls with its limited supply of hand-sanitizer stations. It had put signs outside the ER instructing people with flu-like symptoms to call rather than enter the building, which was what one local woman had done a few days earlier after returning from a trip abroad with a fever and a cough. Two nurses in protective gear had walked outside to the resident’s car to take a sample for coronavirus testing and had sent the test kit off to a lab in North Carolina. Three days later, they were still waiting for the results.