Three Rivers, a small hospital, in a remote area of Washington state near the border with Canada had exactly nine days left before it would run out of money to pay its staff and be forced to close. That same day, its CEO learned the hospital likely had its first coronavirus patient. The hospital serves about 15,000 people scattered over 2,500 sq miles (about 6,400 sq km), according to hospital CEO Scott Graham. Its surrounding towns are tiny: one or two grocery stores, one gas station. “We think of it as more frontier than rural,” Graham said. Three Rivers hospital had scraped by for years with a smaller-than-optimal staff and careful economizing, he said. Then, Washington became the first state with a confirmed case of coronavirus, and a confirmed coronavirus death.
Amid the coronavirus pandemic, rural hospitals play a critical role. As urban hospitals brace for a wave of seriously ill coronavirus patients, Three Rivers has been planning to use its beds to take in the overflow of other patients from those larger hospitals, helping the state hospital system as a whole stay afloat, Graham said. While Three Rivers could provide about one or two patients with ventilators, Graham said, it does not have a formal ICU, or staff trained to work with ICU patients. But it will help take in and stabilize more seriously ill coronavirus patients before sending them to a larger hospital, with more advanced equipment, about an hour away. It can only do any of these things if its own doors stay open.
On 20 March, the state’s hospital association wrote governor Jay Inslee, warning that five rural hospitals, including Three Rivers, were “facing imminent closure”.
The coronavirus pandemic has put a strain even on the wealthier parts of America’s vast, fragmented healthcare system: there are not enough beds, not enough ventilators, not enough protective equipment. But in rural communities, the stakes are different: not whether there will be enough beds at the local hospital, but whether the local hospital will be able to stay open at all. Losing a hospital is a serious blow to rural communities, whose residents are disproportionately older, and often struggle with existing health conditions.
Rural hospitals in the United States have been operating paycheck to paycheck for years, never making enough money to save up for an emergency. George Pink, the deputy director of North Carolina Rural Health Research program at the University of North Carolina at Chapel Hill.
“If a hospital misses payroll once, that can be the death knell,” Pink said. “You’re telling the community and the vendors and the staff that you’re on the ropes.”Now, the pandemic is threatening the survival of many rural hospitals, which would leave communities particularly vulnerable to the impact of the virus with fewer hospital beds and fewer options. At least three rural hospitals have already announced abrupt closures in recent weeks, including one in Wellington, Kansas, and two in West Virginia, leaving local residents and healthcare providers scrambling to make new plans for the pandemic. At least 128 rural hospitals have shut down in the past decade alone.