Dr. Kirk Tucker, chief clinical officer of Adena Health Systems in Chillicothe, Ohio, said a week before Thanksgiving that the health system's three hospitals in southern Ohio were bombarded with coronavirus patients. However it is not only the patients testing positive. Herpes has also sickened 65 of his fellow caregivers.

Recently, Tucker said, a physician there in his 60s tested positive for COVID-19 and died within 24 hours of a sudden cardiac event.

“This physician, to my knowledge, did not feel bad,” Tucker said. “As a matter of fact, I saw him the day that this happened.” Tucker said one of the many dangerous reasons for COVID-19 would be that the virus is prothrombotic, meaning it may cause blood clots.

“When you draw blood on a few of these people, n't i earlier than gets into the blood container, than it begins to turn to jello.”

A hospital nurse, eight months pregnant, was used in another hospital after testing positive for coronavirus and experiencing “failing respiratory health,” Tucker said. A couple of days later, Tucker said the nurse is “hanging inside.”

“I share these stories because people need to understand how horrible this really is,” Tucker said.

A previous day Thanksgiving, 4,449 COVID-19 patients were hospitalized in Ohio – several which had increased by a lot more than 1,400 within the previous 11 days. The state has fluctuated between 68% and 78% of their total hospital capacity during November.

“And the weird part about this wave is usually we watch what goes on within the major urban centers like Columbus to our north, and we'll sort of follow their surges,” Tucker said. “This time, it had been the reverse. We'd the very first surge.”

Chillicothe is a city of approximately 21,000 but, like many areas of the Ohio Valley, it is experiencing a rural surge of coronavirus which has gone far beyond major cities and isolated outbreaks in jails and nursing homes. That is straining small hospitals and health centers that serve those rural communities and small towns. As Dr. Tucker's experience shows, it's not just a question of available beds – hospitals could face staff shortages as more fall ill or face quarantine amid the uncontrolled spread from the virus.

“This COVID-19 is absolutely crushing, crushing the rural clinical staff in these hospitals,” Alan Morgan, CEO for that National Rural Health Association, said. “I can’t stress that enough, there’s limited ability to make errors, basically, and once you lose 10 to 15 of your nursing staff, you lose a number of your primary care physicians, you’re in crisis mode.”

Hospital Capacity

Rural hospitals already faced capacity and staffing challenges before the pandemic. Morgan said he isn't sure how rural hospitals will fare over the next couple of months, but he thinks more rural hospitals will close.

“Simply stated, rural America is really a place where those most in need of healthcare services, oftentimes possess the fewest options,” Morgan said. “And it’s only the makeup of rural America, rural America is older, sicker, poorer, it features a much higher number of elderly, many with multiple chronic health problems.”

Chillicothe's Adena Health System's three hospitals serve nine rural counties. Because the hospital system COVID-19 unit chock-full, medical staff reached to larger cities to set up transfers.

“We have previously reached now, several days, where we’ve called Columbus, Cincinnati, Dayton and none of these hospitals may take COVID patients – they're full,” Tucker said.

Although statewide hospitals haven't reached capacity, John Palmer, Director from the Ohio Hospital Association reported that some of the state's eight regions have few ICU beds available.

Elsewhere in the area hospitals are starting to consider measures to absorb the expected development in demand. The University of Kentucky's Chandler Hospital in Lexington announced it will close five of its operating rooms beginning Monday, Nov. 30. “UK HealthCare's COVID-positive patient numbers keep growing and during the last week, the total COVID census has grown above 70 patients daily,” according to a UK HealthCare pr release.

The hospital has 32 ORs and could close more if total COVID patients increase to 90.

Pikeville Medical Center CEO Donovan Blackburn echoes the same concerns for that eastern Kentucky communities served by a healthcare facility. Twenty-two individuals have died from COVID-19 at the hospital since October. The weekend before Thanksgiving the hospital's ICU was nearly at capacity.

“But what’s going to happen is that we’re going to need to start declining our very own patients, within our own region, our own service area,” Blackburn said. “And those patients are likely to end up either in another part of the state or possibly in another state as well.”

As the vacation approached, coronavirus patients occupied a lot more than 1,650 hospital beds around Kentucky, 390 of these in intensive care units. Within an email a week ago, Susan Dunlap with the Kentucky Cabinet of Health insurance and Family Services said 1,713 ICU beds have staff, but the state's total 2,066 ICU beds may be used whether staffed or otherwise.

In West Virginia, 501 COVID-19 patients were hospitalized with 144 in ICU beds on Wednesday. Based on the University of Washington's Institute for Health Metrics and Evaluation, West Virginia has a lot more than 3,000 hospital beds, and isn't at risk of nearing capacity. However, their state has 196 ICU beds available, and the IHME model predicts the demand for ICU beds in the state could surpass the state's give you a week before Christmas. The IHME data show Kentucky and Ohio may also run short of ICU beds in December if current hospitalization trends continue.

The Institute for Health Metrics and Evaluation West Virginia ICU bed data.

Sick Staff

As more healthcare workers become ill, the availability and interest in medical workers is becoming more immediate than hospital capacity issues. Retaining healthcare workers in rural settings has always been challenging, but the situation has worsened.

At Pikeville Clinic, Blackburn said, medical staff can function anywhere from 12 to 16 hour days. In addition to long work days, patients in the hospital’s ICU unit are “very sick,” he explained. To date, some employees have tested positive for the virus and also have been hospitalized, but none of them of the cases happen to be life-threatening.

To address staffing gaps in Chillicothe's Adena hospitals, Tucker said nurse practitioners using their own practice have been inspired to operate in its hospitals and several did so.

“One of these is working 7 days a week, 7 days per week, she hasn’t had a break now in I believe 3 or 4 weeks,” Tucker said. “Some of these work a full day shift in their office, by leaving their office, become scrubs after which focus on the ground at night.”

Nurses and doctors take critical steps to look after sick patients, and in an effort to streamline care an urgent situation effort to lessen paperwork has been implemented.

“We have dialed back on which is needed of nursing staff to document in the computer to streamline their jobs and obtain them at the bedside more but that just lends itself to some improvement,” Tucker said. “You can’t really safely have a nurse and ask him or her to look after 10 or 15 critically ill people, and these people that take presctiption the COVID unit are not well.”

Costly Replacements

Across the board, the U.S. needs medical workers, and oftentimes, hospitals rely on staffing agencies to locate nurses.

“Earlier within this pandemic, we're able to simply redeploy clinicians into these rural communities using their larger health systems or using their company states, we don’t obtain that ability anymore,” the Rural Health Association's Morgan said.

What nurses can be found through agencies cost hospitals much more money.

“They’re spending between four to 500% more than the things they would normally be paying to have an agency nurse,” Nancy Galvangi, president from the Kentucky Hospital Association, said. “And that is because Kentucky is within competition along with other states, other states that can pay a lot more.”

Across the Ohio Valley, hospitals anticipated $2.7 billion in losses linked to the pandemic. Galvagni said the additional costs of agency supplied nurses will increase Kentucky hospital losses.

RN Marcia Alverson, left, and Amy Richardson, right, work fitting a Powered air-purifying respirator suit on Bailey Adamson, before she enters a patients room as staff in the Albert B. Chandler Hospital work with Covid-19 patients on April 2, 2021.

“And I believe we’ve testified to the fact that these COVID patients are sick – if you look at a COVID wing, they might require more staff than the average patient, they require a lot more PPE, they require much more therapy,” Galvagni said.

Such cost increases hit especially hard at rural health facilities like Pikeville Clinic. Some time ago, CEO Blackburn said, an ICU nurse cost $68 to $78 per hour in the center, but today that cost might be between $165 and $200 per hour. On top of paying more, it might take nurses up to and including month to arrive at a new hospital, Blackburn said.

Although Kentucky hospitals received some CARES Act funding, Galvagni says more is required.

“We would like to see additional federal relief funds,” she said. “So I think that's something which we’re working closely with [Kentucky] Senator McConnell on making sure that Kentucky receives a share of these relief funds, because, you realize, we do have these losses which are out there.”

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