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Looking Back: When One Rural Hospital In Nevada Reached 144% Capacity

A close up of a hospital bed with a blue sheet is in focus with a second hospital bed out of focus in the background. The photo is eye-level with the hospital beds.
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COVID-19 hospitalizations have been steadily declining since early January. But, during their peak, many hospitals in Northern Nevada neared capacity and some surpassed that capacity, including one rural hospital in Churchill County. KUNR’s Lucia Starbuck talked to Sam Metz with the Associated Press to look back at what we’ve learned.

Lucia Starbuck: Through your reporting, you looked at hospitalizations in rural counties in Northern Nevada. What issues do rural hospitals face that their counterparts in Reno and Las Vegas may not face?

Sam Metz: In Nevada, there are a lot of counties with less than 25 hospital beds. I think there are nine counties with only one hospital and less than 25 hospital beds. So, what that means is, they have a very small margin for error in scenarios like a COVID outbreak. One of the things that these hospitals also really rely on is transfers. If you’re a small rural hospital, you often need to transfer your patients to a bigger hospital, like when you’re at full capacity. But, there was a point in December when everyone was nearing their full capacity. It was hard for some of those hospitals to accept patients from rural hospitals. So, that created some gut-wrenching decisions. In December, I profiled Banner Churchill, which is a hospital in Fallon with 25 licensed hospital beds. On December 9, Banner Churchill was treating 36 patients, or 144% of its licensed capacity, including five patients in the ICU.

Starbuck: Wow. When you say a hospital has surpassed more than 140% capacity, what does that look like on the ground?

Metz: I’m glad you asked that because it doesn’t necessarily mean that there were people on gurneys in the hallway. It means that they had to change the physical makeup of the hospital as the pandemic surged in that county. They were able to turn a sleep study room into an extra ICU. They needed to take part of their ER and cordon it off to make a COVID unit. They needed to add new staff, and that’s very competitive trying to find new staff during the pandemic. When you’re at 144%, when you have so few people, it’s not like you’re adding a hundred extra beds. When your capacity starts small, you’re having to add maybe a dozen more beds.

Starbuck: Were there disparities for hospitals in rural counties even before the pandemic?

Metz: Definitely. Throughout the country, I would say in recent decades, rural hospitals have been closing and that’s been a huge problem. Rural areas tend to be older, sicker and poorer than urban areas and that leaves those communities particularly vulnerable to the coronavirus. These hospitals, their profit margins were very small to begin with. They’re canceling elective surgeries, and that’s been very difficult. Banner Churchill, the hospital that I profiled, actually had more hospital beds years ago and shrunk its capacity.

Starbuck: And you talked to the chief medical officer there. What were some of his conversations with some of his patients while this was happening?

Metz: Dr. Aikin recounted this one scenario where he was taking care of a patient. She needed to be hospitalized for respiratory problems and breathing for COVID-19, and her husband or partner was suspicious that the virus was a hoax and is yelling at Dr. Aikin about his wife needing to be hospitalized. I think COVID skepticism is pretty prevalent in some of these communities. So, when there’s an outbreak that affects the hospital, doctors and nurses confront that. Often the people treating patients know the people that they’re treating. They’re their former babysitter, their high school teacher, their neighbor. They respect these people deeply and they want to treat them.

Starbuck: Did Dr. Aikin comment how that impacted them as a provider?

Metz: I asked that, and he said it doesn’t impact the health care providers. They’re very committed to offering treatment and treating people at the highest levels of care that they can provide, regardless. They really want to convince people who need to be treated to stay hospitalized, particularly at this time, because there was a chance that if someone didn’t agree to stay in the hospital, that they wouldn’t have a bed for them if their condition deteriorated and they tried to come back.

Starbuck: That just seems incredibly stressful.

Metz: You’re trying to prepare for [the] worst-case scenario when you’re in a pretty bad case scenario. Thankfully, when I was interviewing Dr. Aikin and talking to other rural hospital administrators, they were pretty optimistic that they were going to be able to handle the pandemic and the surge. And thankfully, our hospitalization rates in Nevada have decreased and they ended up being right.

Read more reporting on rural hospitalizations by Sam Metz here.

Metz is covering the Nevada Legislature for the Associated Press. Metz and Lucia Starbuck are both corps members with Report for America, an initiative of the GroundTruth Project.

Lucia Starbuck is a corps member with Report for America focusing on community reporting and the impacts of the COVID-19 pandemic. Local community issues are her passion, including the affordable housing crisis, homelessness, a lack of access to healthcare, protests and challenges facing vulnerable communities in northern Nevada.
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