Georgia’s (USA) rural hospitals were already strained. Then coronavirus came

What it’s like on the rural front line in the world’s richest country. 

“We have a perfectly coordinated and fine tuned plan at the White House for our attack on CoronaVirus. We moved VERY early to close borders to certain areas, which was a Godsend. V.P. is doing a great job. The Fake News Media is doing everything possible to make us look bad. Sad!” [Tweet from Donald Trump, 8 March 2020]

Khushbu Shah  www.theguardian.com

A row of pillows sat below a makeshift wooden slab standing in as a desk for Dr Enrique Lopez in his utility room. His blue plaid pajamas were flanked by masks and a thin pallet where he sleeps, separate from his family so as to avoid spreading the coronavirus.

He hasn’t hugged his four-year-old daughter in two weeks, afraid for her wellbeing after he began his 14-hour days treating the dozens of patients who have tested positive for coronavirus in Dougherty county in south-west Georgia.

“We are trying to figure how to not bring the enemy home [and] how to live our lives,” he said.

Phoebe Putney Memorial hospital in Albany, Georgia, where Lopez works in one of the three ICU-turned-Covid units, has more than 1,000 people awaiting test results for the coronavirus. More than 600 people have tested positive for the virus at the hospital – and so have a number of the staff. More than a quarter of the state’s deaths are in this rural county of 80,000.

“This is unprecedented. I mean, we have been humbled in a way that we could have never imagined,” said Lopez, who is one of the doctors operating the Covid-19 unit. “The fact is that we serve such an enormous population.”

The coronavirus pandemic spreading exponentially across the world is pushing hospitals in rural Georgia, already limited in resources and staff, to the brink. In the past decade, seven hospitals in rural communities have closed across the state, with 2019 being the worst year in seeing closures nationwide, according to a report from Chartis Center for Rural Health. It has left tens of thousands of Georgians without access to medical care in their communities.

Dougherty is already strained, with only 50 ICU beds in the entire county, according to data compiled by Kaiser Health News. Of the 38 beds at Phoebe Putney Memorial, 35 were filled with Covid-19 patients one Monday evening in March, a spokesperson for the hospital told the Guardian.

The hospital has two drive-thrus to test those potentially infected. Phoebe Putney Memorial is also surrounded by four counties with no hospital. Even before potential cases of coronavirus appeared in the community three weeks ago, healthcare struggles were commonplace in the majority African American county, like they are in much of rural America.

The county commissioner in Dougherty has asked residents to shelter-in-place, similar to mandates issued in California and New York, as medical staff at the hospital work long hours with shortages of N95 masks, ventilators, dialysis machines, medication and even nursing staff.

As the tally of cases spike each day, rural counties like this one in Georgia struggle to take care of the hundreds of people who worry they may have the coronavirus. Many of them are already dealing with serious health issues. A third of the population lives in poverty and the median income is just over $37,000.

“The patients have multiple comorbidities [and] they don’t have enough money for their heart failure medications, they’re on dialysis [and] with their strong religious beliefs they want everything to be done. And it is, it’s an enormous amount of work, even before this,” said Lopez.

The third ICU at Phoebe Putney, the surgical care unit, has now become the third Covid unit, said Dr Steven Kitchen, chief medical officer at Phoebe Putney.

“A matter of great concern is Phoebe Putney is approaching its capacity,” said Bo Dorough, the Albany mayor, in a recent live-streamed press conference as the county commissioner, Christopher Cohilas, pleaded with people to stop holding large cookouts during the shelter-in-place. The Centers for Disease Control and Prevention (CDC) sent a medical officer to the hospital to investigate the explosion of cases in the county.

As his colleagues who test positive are quarantined, Lopez and others continue on for the community.

“It’s a very dark time in our history, and it’s going to go down in the history books but, you know, it’s bringing out the best in all of us. The fact that we stand together. And we’re fighting for our own patients [and] we’re fighting for our lives.”

Dr James Black, the medical director for emergency medicine, who is operating the Covid-19 command center, said volunteers have mobilized to sew hundreds of mask covers due to the N95 mask shortage because there is no way to restock supplies for the dozens of staff working around the clock.

On the hospital’s Facebook page, someone from the official account posted instructions to sew together makeshift mask covers from linens.

Even the chief medical officer pushes around a cart full of treats and food and goes to every unit, whether a coronavirus unit or not, to raise spirits, Lopez said. “It’s amazing,” he added.

Lopez continues to report to work, sleeping in a cramped section of his home, living in isolation as he continues to treat patients, speaking to his family through the door, he says, replaying those hours of work at night. “I can’t sleep. I lie there thinking to myself, others have died fighting this thing. Am I next?” he asks.

 

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