As the coronavirus pandemic continues, some of the biggest outbreaks have been concentrated in urban areas, like New York City and Chicago. But rural America isn’t immune to the virus — and many rural areas are already dealing with a scarcity of health care.
Ferrell Hospital, in Eldorado, is bracing for coronavirus. While most of Illinois’ cases have concentrated in the Chicago area, Dr. Joseph Jackson, a physician at Ferrell, said the virus spreading to rural areas like the ones his hospital serves is inevitable.
“We've done our best to continue to stockpile PPE, ensure that we do have appropriate training on ventilators and try to ensure that all equipment is ready to go,” Jackson said.
Eldorado has a population of just under 4,000 people, but Ferrell, which has only 25 beds, doesn’t just serve the town, said Jackson.
“At first glance, when you look at who we serve, it's such a wide area and a little less dense in terms of population,” he said. “But when those numbers start to come together, there are quite a few people who depend on us.”
When you factor in surrounding areas, Ferrell serves around 50,000 people in four counties.
The hospital doesn’t have any ICU beds and only 5 ventilators. They’re what’s considered a critical access hospital, designed to stabilize patients - and then transfer them.
Jerry Kruse, dean of Southern Illinois University’s School of Medicine, said a pandemic is a unique challenge for already underserved rural areas.
“Well, critical access hospitals, by their federal definition, can only have a small number of beds and can't do high level ICU care,” Kruse said “And the ventilators they have are, solely for instant emergencies. And some ventilators that are related to some surgical cases. So they're not equipped normally, for emergencies, like, like this pandemic.
Pat Schou, director of the Illinois Critical Access Hospital Network, notes that critical access hospitals are still able to offer a lot of care for rural communities, including responding to routine medical needs and emergencies..
“They just would not do open heart surgery, neurosurgery, they don't generally do kidney transplants, things like that,” said Schou. “It’s more general surgery, general orthopedic surgery.”
Schou also say these rural hospitals are facing the same supply shortages that all medical providers are dealing with, making it difficult to build a reserve of protective equipment.
“Right now, we're low in disposable gowns. It’s very hard to get disposable gowns, some areas have a few more than others. And the price of a gown is going from 22 cents to almost $20 for a disposable gown,” Schou said.
Jackson and Kruse both noted rural areas have some advantages when it comes to social distancing — populations are less dense, and most people drive rather than rely on public transit. Still, Jackson said he worries about what will happen if the larger hospital systems in the area are overwhelmed and his hospital can’t transfer patients that need higher levels of care.
“These critical access hospitals, we're not used to taking care of critically ill patients for long periods of time,” Jackson said.
Kruse suggested hospitals should consider alternative arrangements, including how patients are transferred between systems.
“You would think about scenarios such as how can you equip the rural hospitals to handle that level of care?” Kruse offered, as an example. “Or can some of the patients in the larger hospitals be transferred to the critical access hospitals? So the larger hospitals can convert more of their beds to ICU beds and beds with ventilator capability.”
Jackson said the staff at Ferrell has been focused on making sure they’re up-to-date with training and the latest information about COVID-19.
So far, critical access hospitals in Illinois have not had to deal with an overwhelming number of patients, according to Schou.
“We're seeing that they have three, four patients, you know, we haven't seen 10 or 15. But we have seen not just one patient, they might have four or five. We have not had any that we've had to put in intensive care,” said Schou.
Still, Jackson worries about what could happen if the region is overwhelmed by COVID-19 cases in the future.
“This pandemic poses its own problems, that we may not be able to transfer. Those hospitals may be completely full, and we may need to look to keep them more in house and stabilize them and treat them to the best of our abilities,” Jackson said.
Since our interview, the area served by Ferrell has had 10 confirmed cases of COVID-19.