‘We’ll improvise’: A resource-starved rural hospital steels itself for coronavirus’s arrival
The WASHING POST | By Eli Saslow | March 14, 2020 at 6:51 p.m. MDT
DAYTON, Wash. — 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. Dayton General could no longer afford to offer obstetrics, endoscopy or surgery of any kind. 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.
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