Testing: A My Linton Clinic’s Convenient Care staff worker conducts COVID-19 testing at Greene County General Hospital. “We are kind of bracing right now for the holiday impact,” said Stacy Burris, director of the GCGH foundation and community outreach. “We don’t know if it’s going to get worse or if we are going to be OK.” Submitted photo
Cara Veale, CEO of Indiana Rural Health Association
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COVID-19 is hitting hard in rural areas this fall and straining rural hospitals and acute care facilities, says the chief executive officer of the Indiana Rural Health Association.
New COVID cases in rural and small city areas of Indiana now generally outpace urban areas, with rural hospitals nearing capacity, said Cara Veale, the association’s chief executive officer. “This represents an alarming trend,” she said.
With numbers only expected to escalate over the holidays, she joined rural hospital CEOs and medical professionals across Indiana in encouraging all residents, especially rural residents, to mask up, socially distance and forego assembling together in large groups, whether friends or family.
The trend is is worsened by medical staff shortages, as many medical professionals have contracted the virus or are in quarantine after exposure.
Colleagues at rural hospitals across Indiana are “gravely concerned” about rural residents not taking appropriate steps to protect themselves or others, Veale said.
Some of the factors contributing to the problem are that those living in rural areas may have more health-related issues that heighten their risk; more rural residents smoke, have cardiac and respiratory issues, are overweight and diabetic than counterparts in urban areas.
Also, “the independent nature of many living in rural areas tends to intensify some of these risks,” Veale said. They may not like wearing masks and may not fully appreciate the risks they face by not observing safety measures.
Holiday surge and staffing concerns
Among Wabash Valley rural hospitals concerned about what might happen over the holiday period is Greene County General Hospital. While it is not at capacity, “We are kind of bracing right now for the holiday impact,” said Stacy Burris, director of the GCGH foundation and community outreach. “We don’t know if it’s going to get worse or if we are going to be OK.”
The 25-bed hospital, located in Linton, is considered a critical access hospital. While not at capacity, “We have had high community spread and we are seeing an increase in not only testing, but patients,” Burris said.
The biggest problem the hospital faces relates to staffing. “With community spread, we’re having trouble with staff quarantining as well,” she said. Staff aren’t getting exposed at the hospital; instead, they are being exposed in the community or from family.
While the hospital is not currently at capacity, “We’ve had a full COVID unit and we have had to move departments around,” Burris said. “We’ve had to, for example, shut down a portion of our hospital and move it to say an off site location so that way we can have that floor.”
The number of hospitalized patients fluctuates each day. “Every morning we meet and discuss it and decide that day what it looks like, because it’s so difficult to predict ... you have to be really flexible,” Burris said.
Hospital CEO Brenda Reetz said, “Rural hospitals typically run with very lean staffing. Having high numbers of staff out for quarantine, like we’ve had, is quite troublesome. Fortunately, we have great staff that are stepping up to that plate and doing what needs to be done during this difficult time. The pandemic has taken an emotional strain on all of us, however, as we have no idea how bad it is going to get or for how long it will last.”
Reetz uses Facebook Live once a week to give the community updates on county numbers and inform residents what is going on inside the hospital.
Last week, the CEO interviewed employees who work directly with COVID patients to get their perspective on the pandemic. The interviews can be seen on the hospital Facebook site. Reetz also might describe any operational changes because of COVID.
The maximum number of COVID patients at one time has been around 10, Burris said, although that was in spring. “We’ve not been at that level ... but we’re bracing ourselves in case we get there.”
The emergency department sees the most patients, and “they are definitely on the front lines,” she said. Those infected with COVID may go to the emergency department but aren’t necessarily admitted to the hospital.
Health officials have appealed to the community several times to wear masks, she said. “We do think it’s helping, and we do see the difference when they weren’t wearing masks in the early spring and now,” Burris said. “But with numbers rising and the community spread, we continue to ask them to please wear masks.”
She lives in Linton and believes that after making another appeal and showing community members the videos of staff and what they go through, “I think that helped.”
The community is “pretty supportive of us,” Burris said. “Everyone knows each other. Chances are you know someone who works at the hospital. You want to protect them.”
But at the same time, “We definitely have an independent spirit here. And that’s ok,” she said.
Sullivan County Community Hospital
Michelle Franklin, hospital CEO, said the community is “definitely” seeing an increase in the number of COVID tests and positive COVID cases, but that is not translating into hospitalizations. “That’s not to say Sullivan County residents aren’t going to, for instance, Terre Haute hospitals to be admitted,” she said. “That very well could be.”
While those testing positive have sought treatment, “We’ve not had that many admissions,” she said.
Data has shown that Sullivan is a “very unhealthy” county, one of the lowest ranking statewide, she said. “It would make sense you would have people who are certainly more at risk because of diabetes, obesity or other underlying chronic conditions.” Those individuals would be more likely to face hospitalization.
Late last week, the hospital had five patients on its COVID unit. It can accommodate 10 COVID patients before it needs to look at beds and how it can accommodate such an increase, Franklin said.
Typically, SCCH has two sites serving those who may have, or do have, COVID: the respiratory care clinic, which deals with flu and COVID-type symptoms; that is the primary site of service. When that is closed, people can go to the emergency department.
“We could have admissions from either one of those sites of service,” Franklin said.
In most cases, those positive for COVID can go home, and “now that we have Bamlanivimab [an antibody treatment], our providers do have the opportunity to treat people on an outpatient basis who are COVID positive,” Franklin said.
Union Hospital-Clinton
Union Hospital Clinton, like the rest of the state, has seen an increase in COVID-19 hospitalizations, said Stephanie Laws, vice president and administrator.
Its primary service regions, including Parke and Vermillion counties, have also had an increase in virus spread.
Parke County is currently at a Level 3 status [red], while Vermillion County is at a Level 2.5 [orange], according to the Indiana State Department of Health.
“Our service area population does have a higher than state average prevalence of certain underlying health conditions, such as heart disease, diabetes and stroke. They also face additional socioeconomic disparities amplified by our region’s unemployment rates, and other factors that impact the overall quality of life,” Laws said in an email.
Across many areas of the state, there are varying levels of adherence to Indiana’s mask mandate, “and Parke and Vermillion counties are no different, ... Of particular alarm, patients seem to be reluctant to engage in ongoing or routine medical care. We have seen patients present with life-threatening conditions such as heart attacks or strokes, or they are very sick from their underlying chronic conditions,” Laws said.
It is important that patients “not put off routine care, and establishing ongoing medical care from a primary care physician is very important,” Laws stated.
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