On any normal morning for the past three decades or so, the handful of doctors at Wray Community District Hospital would gather for about an hour to talk about the state of affairs at their small medical facility that serves a vast stretch of the plains spanning Colorado’s northeastern border.
The conversation would normally sidetrack into sports or happenings around town. But these days there isn’t time for light-hearted distractions or pleasantries.
The hospital is doing its best to prepare for what its medical staff worries will be a surge of patients sick with the new coronavirus and trying to find a way to prevent their tiny facility — which is actually fairly robust for the rural reaches of Colorado — from being overrun.
“If we start getting a whole bunch of illness within our staff,” said Dr. Lindsey Paulson, who has worked in Wray for a decade, “I think then we’re sort of sunk.”
Staff and supplies are limited. COVID-19, the disease caused by the coronavirus, has made it difficult to transfer patients to bigger hospitals.
And financial difficulties loom, as fewer patients show up seeking care for routine ailments during the pandemic. People are afraid to visit doctors and become sick, including patients who typically travel to Wray from Nebraska and Kansas for care but now fear they’ll be ordered to quarantine if they visit Colorado. And, because the broader public is staying at home, they aren’t engaged in the normal day-to-day activities that sometimes lead to emergency visits.
“The take-home point is that rural areas, obviously, were going to struggle medically,” Paulson said. “We’re also going to struggle economically. So that is very much part of what a rural physician has to deal with on a day-to-day basis.”
The situation in Wray is emblematic of what’s being experienced by rural hospitals, which are critical to their communities, across Colorado. Already in a fragile state, the facilities are finding that the coronavirus threatens to disrupt the delicate balance of survival they use to keep their doors open in small towns like Craig, Hugo and Gunnison.
“The hospital experiences and circumstances are not all the same,” said Julie Lonborg, vice president of communications and media relations at the Colorado Hospital Association. “(But) all of the hospitals, urban and rural, have faced challenges.”
But rural facilities are feeling the pinch of a massive public health crisis more than others. The problems befalling all hospitals — space, supplies, staffing and spending — are exacerbated when you’re cut off from population centers.
“Rural does what rural always does,” Lonborg said, “which is to figure it out.”
Hospitals in eastern Colorado have banded together to share staff and supplies should it come to that. Lincoln Health Community Hospital, in Hugo, southeast of Limon, has been admitting a handful of recovering coronavirus patients from Greeley, 146 miles to the northwest, to boost the bottom line and relieve pressure on Weld County’s hard-hit health care system.
In Gunnison, another area of the state with a high infection rate, the hospital is expecting a 29% drop in revenue because elective procedures, which usually drive income, have been cut. The $2 trillion federal coronavirus stimulus package provided $540,000 in help, but the hospital is taking a $14 million budget hit.
“It’s very helpful. That is not an insignificant amount of money,” Lonborg said. “(But) it’s insufficient.”
Scott Bookman, the state’s coronavirus incident commander, said officials are in constant contact with hospitals across Colorado, including rural ones, to make sure they aren’t being overrun. “At this point,” he said Wednesday, “we are not aware of any being overwhelmed by the number of patients that they are seeing.”
Wray’s medical staff is made up of three family physicians, a general surgeon, two family medicine residents and two physician assistants.
There is a nursing staff, including two nurse anesthetists who can oversee critical care and intubations, but Paulson said keeping the roster full is a challenge on a regular day. That’s because attracting skilled workers to a rural area, and then retaining them, is immensely difficult in any field.
“We definitely have the staff available, but it is pretty fragile,” she said. “One cog in the wheel goes and it all goes. We are working to keep everyone healthy in the whole town so we don’t get to that point.”
There are two or three ventilators in the hospital and personal protective equipment — like masks, face shields and gowns — aren’t plentiful. Paulson said she has been using the same mask and leaving it in a room with an ultraviolet sterilizer to keep it clean.
There are 15 total beds available, but only two rooms are currently set up for critical care.
So far, coronavirus hasn’t really been a problem. There have been only three cases in Yuma County, where Wray, the county seat, sits a few miles from the Kansas border about a three-hour drive from Denver. No cases have been treated at the hospital in Wray.
But nearby Morgan County, to the west, has one of the highest per capita rates of infections in Colorado, as does Weld County. The sense is that the virus is coming. The question is when.
Paulson is most worried about the virus making its way into the senior population in Wray and the surrounding areas. She says most people in that group get their news from a weekly newspaper, meaning they may not be getting the most up-to-date information on the virus and how to avoid it.
There’s also a fairly large nursing home in Wray, which poses a major outbreak threat. Dozens of such facilities across Colorado have seen outbreaks, and roughly 200 residents of nursing homes and senior care centers have been killed by coronavirus.
Additionally, most people are still working because their businesses — like agriculture and oil and gas — are essential and thus are exempt from Gov. Jared Polis’ stay-at-home order. In rural areas, there aren’t many jobs that fall into the nonessential category.
And then there are the mental health risks that come with being in an underserved area. Kids don’t have the outlet of sports because school is shut down. Families are feeling the financial pinch. “Rural areas are already really hurting for mental health on a regular day,” Paulson said. “Those resources are just extremely limited in a crisis.”
Wray is used to sending its most complicated patients to more robust hospitals, where there are more supplies and a broader base of expertise, in an emergency. And the fastest way to do that is by helicopter since the aircraft can land right at the parking lot outside the emergency room and whisk people away to Greeley or Denver.
But Flight for Life isn’t allowing coroanvirus patients to be transferred in its helicopters because of the risk of infection to pilots and flight nurses. Instead they are using airplanes.
While the planes fly faster than a helicopter, patients must be driven to and from the aircraft in a ground ambulance. That can significantly delay a transfer.
There’s also a risk to ground ambulance workers. Wray really doesn’t have many to spare.
And hanging over all of the patient concerns are the financial ones, which haven’t presented themselves yet but are a major threat. Asked about how her hospital will manage, Paulson said “that’s a good question.” Emergency room patients and people seeking everyday care drive revenue, and lately their numbers have fallen dramatically.
“It’s going to be a huge problem,” she said. “We’re seeing just a fraction of the patients that we’re used to seeing. I normally see 18-20 patients a day. I’m seeing eight — maybe — on a good day. We’ll normally see four to 12 emergency room patients in one day. We’ve (been seeing) maybe two.”
For the time being, Paulson and the other doctors and nurses in Wray are keeping their heads down and focusing on the task at hand. They’re trying to prepare and waiting for the shoe to drop.
“It’s just a matter of time,” Paulson said.