In a normal year, hospitals in rural southern Missouri see a lot of snakebites and rolled ankles.
These are ailments you experience canoeing in the early fall sun or ‘holding my beer and watching this’ at night, as an emergency doctor in the area who requested anonymity because he had not been authorized to speak on behalf of his hospital, told The Daily Beast.
“Obviously, this year is really different,” said the doctor, who noted that he outsources to several hospitals in the area, sometimes driving three hours from his home to serve rural communities. deal with COVID-19 epidemics. Although New York and Washington faced overwhelming hospitals and piles of body bags in March, the Missouri doctor told the Daily Beast he only treated a coronavirus-positive patient in May.
Things slowly picked up at first, but the past six weeks have been a test of courage for the doctor, his nurses, respiratory therapists and the staff at their facility. And no matter who wins in a presidential election that has seen few campaigns in this former swing state, the scale of the suffering and loss of life here – coupled with lingering skepticism about the pandemic – demonstrates the sheer size of the hole in which the country still has to dig itself.
“I look dirty when I walk into the gas station with a mask,” the doctor said. “It’s just unfathomable the mismatch between being one of the worst areas for COVID, when people who aren’t necessarily healthy to start with always act like there’s absolutely nothing going on.
As of Tuesday, Missouri had reported a total of 190,424 cumulative COVID-19 infections and 3,064 deaths. About 16,111 of those cases had been recorded in the past seven days, according to the state’s coronavirus dashboard. While there have been significant improvements in the state’s ability to test for the virus, its positivity rate measured over the past seven days was 28.6%. A popular threshold for a positive percentage being “too high” is 5%.
A number of other largely rural Midwestern states were struggling Tuesday, with North and South Dakota in particular emerging as nationwide hot spots. North Dakota has seen a 167% increase in cases in just one month. Nationwide, as of Tuesday alone, at least 540 new deaths and 93,581 new cases were reported. Those numbers are even more concerning when you factor in the 232,529 Americans who have already lost their lives to the virus – an amount some experts see doubling. by the end of February 2021.
And the pandemic picture is dire, even in rural areas which have failed to capture much of the national spotlight.
Missouri recorded a record number of COVID-19 hospitalizations for the fourth day in a row Sunday, when the health department reported a total of 1,649 patients hospitalized for the virus. According to reports from Saint-Louis public radio, the increase in rural cases led to the state’s figures. When small rural hospitals have to refer the majority of patients to larger hospitals in other parts of the state, things are quickly overwhelmed, said Steve Edwards, CEO of Cox Health in Springfield.
“It increased exponentially as we had worried,” Edwards told the radio station.
Even when there isn’t a pandemic ravaging the state, “it’s not unusual for people to drive 30 to 45 minutes without a hospital,” the rural doctor told The Daily Beast, noting that the problem isn’t. is not just the distance between facilities. , it is their size, their resources. As the virus has spread, more and more patients have severe cases, which means they need more and more care.
Dr. Jennifer Horney, founding director and professor of the Epidemiology program at the University of Delaware, said years of changes in federal and state health policies have weakened a health care infrastructure in many parts of the country.
Missouri is one of them.
“In all kinds of disasters and emergencies, there is a kind of perceived wisdom that rural people are somehow more resilient and if something goes wrong they can come together and help each other,” said Horney. “But resilience cannot overcome not having access to health care.”
“Since 2010, 133 rural hospitals have closed,” Horney added, referring to a study by the Center for Health Services Research at the University of North Carolina. Seven of those closures occurred in Missouri alone, and a detailed analysis of the UNC study map shows those hospitals had a total of 348 beds.
The National Association of Rural Hospitals said the closures were the result of the state’s decision not to expand Medicaid, a joint policy initiative in GOP-dominated states during the Obamacare era. In August, voters in the state notably passed a voting initiative approving the extension of Medicaid to about 230,000 of its poorest residents.
As for these rural hospitals which have to deal with an unprecedented and deadly pandemic: “We are seeing sicker and more intensive patients,” said the emergency doctor.
“The problem with these small hospitals is not the number of people coming in – it’s that if we have a really sick patient, all of my resources are blocked there,” he continued. “If I have to put someone on a fan, everyone is put on the back burner. It puts a strain on the system by clogging things up. “
“I have seven rooms in my emergency department, and only three are set up to treat potential COVID patients, with doors that will close completely,” he added. “I have to put anyone who has any of these symptoms in these rooms.” Apart from the rooms, there are also no cardiologists or trauma specialists in small rural hospitals, he said.
“Anyone who needs to go to intensive care has to go to another hospital later,” but it has become increasingly difficult for the doctor and his staff to spend hours on the phone finding beds for transfers, did he declare. “It is extremely difficult to find a place for these people. We are considering sending them out at four, five, six or seven.
Sure enough, Richard Liekweg, president and CEO of BJC HealthCare in St. Louis, said there were “virtually no beds” available for patients to be transferred to his hospital system, which had 205 patients on Monday. COVID-19, according to Saint-Louis post-expedition.
“We are re-evaluating whether we are going to have to start canceling elective procedures again in order to account for what we believe will continue to be a gradual increase in the number of COVID patients at a time when our staff, like everyone else, is completely exhausted, ”Liekweg told the newspaper.
In another tragic step, Franklin County officials said on Sunday that an eighth-grade boy died of complications from the virus, making Peyton Baumgarth the first miner in the state to be killed by the disease, as the Post-shipment reported.
Baumgarth, a student at Washington Middle School outside of St. Louis, last attended the school on October 22 and began quarantine last week, according to the newspaper. Her family asked district officials to remind the public to “wear masks, wash their hands frequently and follow directions.” COVID-19 is real and they want to remind students and parents to take these precautions inside and outside of school. “
Although GOP Governor Mike Parson himself obtained COVID-19, his state does not have a mask order. And with many local governments refusing to tax theirs, it’s hard to imagine residents in many counties following these guidelines.
At least some of the data shows the consequences of this lack of compliance. About 40% of those hospitalized in Springfield are residents of the city’s surrounding county, St. Louis Public Radio reported. But the remaining 60%, according to county data, was transferred from all over southern Missouri – an area that widely recommends, but does not require, face masks and sees limited compliance.
“It just won’t be fixed until more people take it seriously,” the emergency doctor said. “When you know the consequences of this action and you keep doing it anyway, it just makes me want to scream.
Horney echoed many other experts in saying that studies are now clear on the effectiveness of mask orders, even in rural areas where officials may worry about compliance.
“The counties in Kansas where they had mask warrants, they had fewer cases,” Horney said. “And they are similar in every way.”
But there has to be a willingness on the part of local leaders to impose such orders – this is unlikely to happen overnight, even if a new president is elected, and even if the Democratic presidential candidate Joe Biden has said he supports a national mask mandate.
It is also far from clear that the politicization of such public health measures, and the erosion of trust in institutions like the Centers for Disease Control and Prevention, can even be reversed.
For his part, the emergency doctor blamed at least these two obstacles on the direction of President Trump’s pandemic, despite his popularity in rural America, including rural Missouri: “Unfortunately, we elected a copy. sensitive to The power of positive thinking for president. “
Late Tuesday, it was not yet clear whether the country had re-elected him.
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