Coronavirus hits rural Kansas, Missouri towns. Many don’t have a single hospital bed
The first novel coronavirus case in Jackson County, Kansas, about 30 miles north of Topeka, was confirmed Thursday.
Though the news came with few details about the patient or how the person contracted it, one thing was certain:
Coronavirus has arrived in rural Kansas, which has been depleted of the crucial resources that will be needed if the outbreak spirals.
After decades of declining population, many parts of Kansas and Missouri are left with few or no hospitals to treat patients suffering from COVID-19.
Eleven of Kansas’ 105 counties have no hospital at all, according to a data analysis released Friday by Kaiser Health News. The picture is even more grim in Missouri, where 44 of the state’s 114 counties are without a hospital.
And more than half the counties in both states have no ICU beds, the analysis found.
“This is just another example of geography determining access to health care,” Arthur Caplan, a bioethics professor at NYU Langone Medical Center, told Kaiser Health News when learning about the findings.
Interviews with rural health and safety officials in both states revealed a widespread lack of resources, supplies and preparedness for the pending crisis of coronavirus cases — and some lingering skepticism about the scope of the threat.
In Johnson County, the most populous and affluent county in Kansas, officials announced testing would be reduced because it had reached the point where the virus was spreading by community transmission. That move was aimed at preserving the limited test kits. The Kansas Department of Health and Environment said Friday that the state’s supply was “precariously low” and could run out over the weekend.
Rural areas, which tend to have older and more at-risk populations, have special challenges when it comes to testing.
Officials in Reynolds County, Missouri, with fewer than 7,000 people in the Ozark Foothills region of the state, told The Star that the nearest testing sites would likely be two hours away in St. Louis or Cape Girardeau.
And Putnam County in north-central Missouri had two testing kits at its health department earlier this week for the county of about 5,000 residents, according to health administrator Joetta Hunt.
“I assume that if we use them, they would be replenished,” Hunt said. “But I don’t know the logistics of that.”
She said Putnam County Memorial Hospital, a 15-bed critical access facility in Unionville, may have more test kits; officials there could not be reached for comment.
There have been no cases so far in Putnam County, where Hunt noted much of the population is age 65 and older.
“That is another challenge for us getting the tools that we need,” she said. “We are concerned but we are trying.”
U.S. Rep. Emanuel Cleaver, a Democrat from Kansas City, said rural parts of Missouri already have a shortage of nurses. After a conference call with Missouri hospitals and health centers on Thursday, he said he planned to go to local media to ask for retired nurses to pitch in.
“Right now we’re in an avalanche of challenges,” he said, “and we’re trying to think of everything we can.”
Cleaver, whose district includes several rural counties in addition to most of Kansas City, said the government’s response to the crisis must be equitable for rural Americans.
“When people start talking about the supply line, they’re talking about supply to Dallas and Houston and New York City… they’re not talking about Mayview,” he told The Star on Friday. “They’re going to be left out if we don’t respond pervasively.”
Kansas’ ‘oldest’ county
The Buffalo Roam Steakhouse in Mankato, Kansas, remains open for now, though the buffet is closed and business is way down.
“We’re staying open as long as we can,” said Tiffany Hollerich, whose family owns the restaurant on U.S. 36.
Mankato is the county seat of Jewell County, which has the highest percentage of elderly residents in Kansas: Nearly 30 percent of its 2,850 residents are age 65 or older. The median age is 53, compared to 38 in Johnson County.
Coronavirus affects the elderly particularly hard. The U.S. Centers for Disease Control and Prevention reports that 80% of Americans who have died from COVID-19 have been age 65 or older.
Though isolated from large urban areas — the nearest city of any size, Hastings, Nebraska (population about 25,000) is more than an hour’s drive to the north — Jewell County residents are taking the threat seriously.
Locals understand the challenge that they’re facing. With 25 beds, Jewell County Hospital is preparing for the worst.
But it will be hobbled in the fight.
Only six of its 25 beds are available for treating acute patients at any one time. The rest are occupied by people in need of long-term care.
There are no doctors on staff day to day. They both commute regularly from a town 30 minutes away. And there is only one ventilator, a recent cast-off from the emergency services agency that hospital staff are only now learning how to use.
“We definitely have limited resources,” nurse practitioner Dawn Steinman said. “But we’re trying to be very proactive.”
These small hospitals are interconnected with larger metropolitan hospitals across the region.
The large hospitals should be ready to assist the smaller ones with triaging patients, KDHE said in a 2009 report outlining plans for a public health emergency. While cities can expect an influx of patients from outlying areas, the plan also calls for an export of less critically ill patients to smaller hospitals. It says that big hospitals must use the same set of clinical criteria for patients coming in from smaller communities when rationing care during a crisis to prevent “geographic disparity.”
KDHE on Wednesday said hospitals reported that there were 168 ventilators available across the state, with hundreds more currently in use. Well over half of those that are available are located in Kansas City and south-central Kansas, which includes Wichita.
In Jewell County’s north-central Kansas region, only seven ventilators were available.
Should the local hospital’s limited resources become overwhelmed, Steinman said, it would likely transport patients to nearby Belleville, Kansas, or transfer them by helicopter to Hastings or Salina, Kansas.
“If someone is bad enough,” she said, help would be 30 minutes to an hour away.
Mixed threat assessment
Rural Kansas may have one advantage against the virus.
“Coronavirus does well when people are crowded together,” said KDHE Secretary Lee Norman. “With less population, you would expect less per capita number of illnesses.”
Because of those dynamics, Lee described western Kansas as “a little different ballgame.”
“They’ve been a little harder to engage in this discussion, feeling that that will protect them,” he said. “I think it will protect them to a degree.”
But Norman said testing could be delayed in the western half of the state, because the samples so far have been sent back to labs in Topeka.
Rural communities in the more populated areas of the state have problems of their own. In the past 10 years, at least seven rural hospitals have been closed in Kansas and another seven in Missouri, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.
Brian Depew, executive director of the Center for Rural Affairs in Lyons, Nebraska, said those closures look foolish now, “when we’re potentially seeing a national hike in hospital bed demand and usage.”
He said the failure of some states to pass Medicaid expansion could ultimately worsen the problem in rural areas. Despite years of attempts, both Kansas and Missouri have failed to expand the health insurance program for the poor.
“If people don’t have access to health insurance, they’re less likely to seek care,” Depew said. “And that can contribute to the spread of COVID-19.”
Independence, Kansas, a town of 8,700 in the southeast part of the state, has been without a hospital since 2015. Andy Taylor, editor of the Montgomery County Chronicle there, said he’s watched three hospitals close over the past three decades within his coverage area, which spans over four counties. That’s left tens of thousands of residents with only a few hospitals. Many must venture to metropolitan areas for more complex care.
“And I worry if this pandemic were to get out of hand, the hospitals simply couldn’t handle treating hundreds of people,” he said. “There’s just no way.”
Last week, Montgomery County Emergency Management Director Rick Whitson warned of “a far more nefarious and evil epidemic out there and it’s called fear and panic!”
“I am not supposed to say this but I must, unless there is a dramatic shift for the worst, (and I doubt it) when this is past we will reflect on it and shake our heads, realizing that it was a ridiculously disproportionate overall response to the threat,” Whitson said in a March 12 post on his public Facebook page that was shared more than 900 times.
His comments drew plenty of praise, but also some sharp criticism.
“As a medical professional it’s appalling to see your posts and how you appear to think you know more than the CDC,” one woman wrote. “I’ll be praying for the citizens of Montgomery County.”
One week later, Whitson himself urged locals to pray. As coronavirus cases were announced in nearby Cherokee and Linn counties, he said his county wouldn’t be far behind. He quoted the Bible — Matthew 10:28-31 — and urged people to take precautions, but warned again against panic.
“If you don’t have your priorities in order, get them in order, not because of this situation but because your eternal future is at stake,” he wrote on Thursday. “Be the spiritual leader in your household. If your life reflects these priorities, God, Family, friends, self, what’s the worst that could happen? ...We’ll get through this!”
The Star’s Steve Vockrodt, Mike Hendricks, Bryan Lowry and Nicole Asbury contributed to this story.
This story was originally published March 21, 2020 at 5:00 AM.
