|
 By the time a bed opened elsewhere the following day, the young man
was near death. For a full 45 minutes, Miller and his staff
performed chest compressions in a desperate attempt to save him.
Somehow, Miller said, the patient regained a pulse, and was
dispatched in an ambulance to the larger facility about 25 miles
away. Miller then prayed with the family, whom he knew “very well”
from Lakin, a town of just a few thousand people.
“It’s truly a miracle he has survived,” Miller said.
After pounding big U.S. cities in the spring, COVID-19 now has
engulfed rural and small-town America, seeming to seep into the
country’s every nook and cranny. According to Reuters’ interviews
with more than a dozen medical care providers and public health
officials in the nation’s heartland, many hospitals are severely
lacking in beds, equipment and - most critically - clinical staff,
including specialists and nurses.
COVID-19 cases and hospitalizations are spiking nationally. But the
Midwest - encompassing a dozen states between Ohio and the Dakotas -
has been especially brutalized. Reported case rates are more than
double that of any other region in the United States, according to
the COVID Tracking Project, a volunteer-run data provider. From
mid-June to mid-November, reported cases in the Midwest rose more
than twentyfold.
For the week ending November 19, North Dakota reported an average of
1,769 daily new cases per 1 million residents, according to the
tracking project. South Dakota recorded nearly 1,500 per million
residents, Wisconsin and Nebraska around 1,200, and Kansas nearly
1,000. Even in New York’s worst week in April - with business closed
and panic gripping the public - the state never averaged more than
500 new cases per million people. California never topped 253.
Hospital officials in the Midwest told Reuters they’re at capacity
or nearly so. Most have tried to increase availability by
repurposing wings or cramming multiple patients in a single room,
and by asking staffers to work longer hours and more frequent
shifts.
Facilities like Kearny, known as “critical access” hospitals,
weren’t made for this. Often sparsely funded, they mainly provide
basic or emergency care to residents who live long distances away
from bigger medical centers. Now, “we have to plan on being able to
care for whomever comes in,” said Miller, whose specialty is family
medicine.
As cases spike in many conservative states and counties, medical
workers say they often face a challenge just in convincing patients
and local leaders that the disease should be taken seriously and
isn’t a Democrat-perpetuated hoax.
Such viewpoints flow from the top. President Donald Trump often has
held shoulder-to-shoulder rallies in the Midwest and elsewhere and
treated masks as a matter of personal choice. Although Trump was not
re-elected, about two months remain in his tenure, with little sign
of change in his coronavirus strategy, even as the crisis grows.
The White House press office did not respond to a request for
comment.
Some medical officials and hospital staffers find it hard to
reconcile laissez-faire policies with the sickness and suffering
they see.
“There’s a disconnect in the community, where we’re seeing people at
bars and restaurants, or planning Thanksgiving dinners,” said Dr.
Kelly Cawcutt, an infectious disease doctor at the University of
Nebraska Medical Center. As health workers, she said, “we feel kind
of dejected.”
All told, COVID-19 has claimed more than 256,000 lives in the United
States. The virus’ mortality rate has dropped as doctors have
learned more about the disease, and vaccines developed by Moderna
Inc, Pfizer Inc and others could hit the market early next year. In
the meantime, smaller hospitals say they are employing the same
drugs - such as remdesivir and dexamethasone - that big-city
facilities do, but don’t have the same access to ICU equipment or
specialized expertise.
With low temperatures sending people indoors and holiday travel
underway, doctors in the region aren’t expecting relief anytime
soon.
“I don’t think the worst is here yet,” Miller said.
FRIENDS AND NEIGHBORS
Hospital leaders described demoralization among staffers struggling
to reckon with overwork, grief and death.
Shortages of staff, rather than beds, are the biggest single problem
in many hospitals, the health officials said. “Just because you can
take a cot and put it in a room doesn’t mean you have the
appropriate nursing staff to care for a patient,” said Dr. Anthony
Hericks, director of critical care with Avera Health in Sioux Falls,
South Dakota.
[to top of second column] |
Nurses must observe COVID-19 patients even more closely than others, because of
the potential for rapid decline, said Melisa Hazell, a critical care nurse at
Hutchinson Regional Medical Center, in Hutchinson, Kansas. She said she recently
recovered from COVID-19 herself, returning to work as soon as she was certain
she wouldn’t spread the virus.
“I was off for 12 days,” she said. “Was I mentally and physically ready to go
back to work? No, but my teammates needed me.”
Remote hospitals don’t keep a full staff on board in the best of times. They
hire traveling nurses as the number of patients surge. Now it’s tough to find
any available.
Aya Health, a San Diego, California-based nurse staffing agency, was posting
around 14,000 open positions in the spring, said April Hansen, an executive vice
president. That number has now doubled, she said, and pay rates have shot up
with demand.
Mary Helland, a chief nursing officer with CommonSpirit Health in North Dakota,
said she has put in requests for traveling nurses for the 11 critical access
hospitals she oversees in North Dakota and Minnesota. But “bigger hospitals are
using them all up,” she said.
At Hutchinson Regional, which has 190 beds, Chief Nursing Officer Amanda Hullet
has begun taking floor shifts, even though she had long since graduated to a
desk job.
The physical and emotional fatigue is constant, Hullet said, and even harder
when the patient is a close friend or colleague.
Hullet recalled the recent deaths of local couple Bill and Judy Mason, just
weeks apart, from COVID-19. Judy had taught dance in town for decades, Hullet
said, and her students included some of the hospital’s employees.
Holly Thomas, 37, who is married to the couple’s grandson, said Judy was the
"glue" that kept the family together.
Referring to COVID-19 in the Midwest, Thomas said "we sat by idly from March to
August not seeing a whole lot." Now she hears of about two deaths a day. “My PE
teacher from high school and his wife died within 12 hours of each other, too,”
she said.
Hazell, the Hutchinson Regional nurse, encountered a patient who was a former
bowling buddy. “He’s just fantastic,” she said. “Great heart, always willing to
sit down and share a story or two.”
He’s on a ventilator now, not doing well. “Over next week or two, there’s going
to be some tough decisions,” she said.
‘FED UP’
Medical workers told Reuters that denial about the disease is frustratingly
common among public officials, community members and even patients.
One patient at SSM Health in Janesville, Wisconsin, refused to believe COVID-19
was a serious threat, even as it consumed him, said Dr. Alison Schwartz, an
infectious disease physician there. When he died, “the family did not want to
admit this patient had died of COVID, because they didn’t believe COVID kills
people,” she said.
Some Midwestern states and local jurisdictions been loath to mandate masks or
social distancing.
Nebraska Governor Pete Ricketts, a Republican, went so far as to say he would
not allow municipalities to impose mask mandates.
Ricketts’ office declined to comment, but the governor said in a Nov. 13 press
conference, “I’m against broad-based mandates in favor of educating people about
how to use masks.”
“Masks work, but they’re just one tool,” Ricketts said, urging people to also
focus on keeping their distance and avoiding large gatherings.
South Dakota Governor Kristi Noem has refused to mandate mask-wearing, and has
not imposed restrictions on businesses or public gatherings, saying she would
leave such matters to “individual responsibility.” In July, she hosted an
Independence Day celebration with Trump at Mt. Rushmore, where the crowd was
close together and many attendees were maskless.
Doctors say trying to change such behavior can feel like a hopeless task.
“Everyone [is] continuing to go about their lives,” Schwartz said, but “we sort
of feel like we’re drowning.”
(The story refiles to restore missing word in paragraph 30.)
(Nick Brown reported from New York; Callaghan O'Hare contributed reporting from
Lakin and Hutchinson, Kansas. Editing by Julie Marquis)
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