Video of an empty downtown Reno on March 29, 2020.

Reno Gazette Journal

When Timaree Koscik’s husband Tom fell from the couple’s roof in Tonopah, Nevada, and broke his heels, she knew what to do.

“It was like, ‘Well, put him in the car and take him to Bishop. »» The nearest hospital is in Bishop, California, 185 km away.

“You just do what you have to do,” she said.

The remoteness of Tonopah, a population of 2,200, now looks like a buffer against the coronavirus pandemic. It is more than 200 miles from the soaring suitcases in Las Vegas. On Thursday, there was only one case in all of 18,000 square miles in County Nye.

“Honestly, I think we are better here in the middle of nowhere than in the cities,” said Koscik.

But she knows it’s a false sense of security. Anyone with COVID-19 can be hundreds of miles from the nearest open hospital bed, ventilator, or isolation room.

The Navajo Nation Police Service set up checkpoints near the community of Chilchinbeto, Arizona in response to the increase in positive cases of COVID-19. (Photo: Office of the President and Vice-President of the Navajo Nation)

In Tonopah, patients should go to Bishop, but only until the 25 beds in this hospital are full.

Rural communities in the United States may be among the most vulnerable during an epidemic.

Americans in urban and suburban areas live, on average, about 8 kilometers from the nearest hospital, according to 2018 Pew Research Center data. For rural residents, it’s an average of 16 kilometers.

But many cities are twice as much or less.

An analysis by the Republic of Arizona on rural communities nationwide shows that 1.1 million people live in rural communities at least 30 kilometers from the nearest hospital. A quarter of these residents are 60 years of age or older, which places them in the age groups most at risk for the disease.

A wave of severe cases in these small towns may require stabilization and patient transportation, one by one, tens or hundreds of kilometers.

For many of these communities, the risks have worsened in recent years, as their own local hospitals have closed. In some, however, retirement homes have remained, concentrating the most vulnerable away from the best care.

These same small towns may be more skeptical of the coronavirus threat and more resistant to official calls to close businesses or stop operations to slow the threat.

Almost all states have at least one location more than 30 kilometers from acute care. But three western states – Texas, California and Arizona – account for almost a third of Americans in nearby hospitalless communities.

In Morenci, Arizona, a perched urban site is home to employees of the country’s largest copper mine. There is no hospital in Morenci, its twin city of Clifton or anywhere in Greenlee County.

But for most of the 1,500 residents of Morenci, the red-roofed building at the top of the hill looks like a hospital, said Dr. Jonathan Manwaring, the clinic’s chief medical officer. It’s not. It is a clinic to provide family medicine care and overnight emergency care. The clinic’s parent company, Gila Health Resources, also operates a five-unit ambulance system for the county.

He has no emergency room or hospital bed. It has no fans.

“We are essentially a large doctor’s office with 24-hour urgent care that takes in all new arrivals, stabilizes and transports themselves,” said Manwaring.

The nearest hospital is in Safford, more than 65 km away, with 49 beds.

Arizona health officials confirmed the first case of COVID-19 in Greenlee County on Monday.

Losing hospitals for years

Long before the arrival of the new coronavirus, rural America was already in a slow health crisis.

In the past 10 years, 126 rural hospitals have closed, according to the University of North Carolina’s rural health research program. Research has cited a number of factors for decline: declining rural populations, consolidation of the hospital industry, states forgoing Medicaid expansion under the Affordable Care Act and the tendency of residents to seek hospital care elsewhere.

“Long distances from anywhere, buildings in physical decline, no doctors – it’s really hard to make a (rural) healthcare business financially viable,” said George Pink, professor at the University of North Carolina at Chapel Hill researching rural hospitals.

And when a rural hospital closes, the effects are felt beyond the immediate community.

The March 2016 closure of the Reynolds County Southeast Health Center in Ellington, Missouri, population 925, left seven communities without a hospital within 30 kilometers, including other small towns like Piedmont and Van Buren. Each of these rural communities has a nursing home.

On Saturday, an Ellington resident, nestled among the Ozarks in the 3 million acre Mark Twain National Forest, tested positive for the new coronavirus, and at least two others are awaiting test results. Meanwhile, Reynolds County health department officials have collected supplies for an outbreak, and others are taking precautions to prevent the spread of the disease.

The city’s retirement home is closed to visitors.

Paula Dement runs a nutrition center for the elderly where meals are served on weekdays and residents socialize around bluegrass shows and bingo. Instead, the center started picking up meals at the curb this week.

“I did it for the safety of the elderly, they are part of a high-risk group,” said Dement. “Even if they can’t go out and socialize, we’re an hour from any major hospital: Poplar Bluff is an hour, Farmington is an hour.”

The financial burden of a coronavirus epidemic will put even more pressure on the remaining rural hospitals, some of which fear may lead to further closings. More than 800 rural hospitals are currently losing money.

Going into the COVID-19 crisis, Pink said he was more concerned about the remaining 2,000 rural hospitals than the communities where the hospital had already closed. Communities where hospitals have closed have learned to adapt, unlike places that still have their hospitals.

Congress passed a bill last week that includes $ 275 million for rural and critical access hospitals as well as telehealth, but after funding is cut, the future of many rural hospitals remains uncertain.

In a letter to congressional leaders asking for help in dealing with the epidemic, the American Hospital Association said that “some facilities and practices are capable of absorbing significant losses for some time, but others , such as rural settlements, are not. “

Tribal lands face “state of inequality”

The Navajo Nation saw its number of confirmed cases of coronavirus reach over 100 in late March.

The epicenter of the epidemic is Chilchinbeto, a community of 900 people located approximately 25 miles from the nearest grocery store – and the hospital.

The Republic analyzes that half of the 74 communities in the 27,000 square mile Navajo Reservation, which touches parts of Arizona, New Mexico and Utah, are more than 30 kilometers from the city. nearest hospital. Other Arizona tribes – Fort Apache, Havasupai, Hualapai, Tohono O’odham – all have communities far from hospitals.

In Supai, the Grand Canyon community that houses the Havasupai tribe, there is a doctor, a nurse and no ventilator, said tribal councilor Ophelia Watahomigie-Corliss. The tribe has closed public access to its famous trail and waterfalls, but a dilapidated clinic is being rebuilt.

“I doubt our tribe will be alone in this state of iniquity,” said Watahomigie-Corliss.

Nationally, 295 communities on tribal land are located more than 30 kilometers from the nearest hospital, including seven communities in the Kiowa-Comanche Apache-Fort Sill community in Oklahoma.

On the Cheyenne River reservation in South Dakota, the Cheyenne River hospital closed, leaving four communities with no hospitals nearby.

In response to the Navajo Nation epidemic, tribal leaders quickly issued home stay orders and travel restrictions for the entire reserve. “Help beat the virus by staying at home,” said Navajo Nation president Jonathan Nez in a written statement. “To avoid a massive public health crisis, everyone must stay at home unless you need food, medicine, or other essentials.”

These measures could be crucial. In the Navajo Nation, there are only 13 intensive care beds in the three major hospitals run by Indian health services, according to Dr. Loretta Christensen, chief medical officer of health for the Navajo Area Indian Health Service.

Christensen said that in a generalized epidemic that filled intensive care, the health agency would first use its more than 50 isolation beds, then convert health clinics and small patient service units that are more stable or at the end of their quarantine.

So far, patients with severe cases have been flown to hospitals in Phoenix, Albuquerque and Flagstaff. But Christensen said that at some point, hospitals in these cities could reach their maximum capacity, and so could their system.

“Tendency” not to trust government


Poster thumbnails

Show captions

Other rural communities have been slow to adopt measures to stem the spread of the virus, even if they have minimal access to hospital care.

When the governor of Nevada, Steve Sisolak, called for the closure of all non-essential businesses in the state in an attempt to stop the spread of COVID-19, the city of Reno was already in the midst of its own closure. Police and code enforcement officers in the medium-sized city have sent out warnings about fines and license revocations for those who do not comply. Local authorities in Las Vegas were slower to act, but casinos began closing the Strip before the governor’s order was issued.

The state’s rural counties were also less receptive to the Democratic governor’s call.

In White Pine County, which is home to about 9,700 people in the eastern end of the state, the sheriff asked Facebook to tell business owners to ignore Sisolak. Sheriff Scott Henriod retraced his steps when Sisolak signed a decree demanding the closings.

In Elko County, in the northeast corner of the state, Sheriff Aitor Narvaiza lambasted Sisolak on Facebook.

“Now, because of the coronavirus, Las Vegas and Reno are losing their ass in revenue,” he writes. “As far as I’m concerned, Las Vegas gets what it deserves.”

He has since abolished the post and has also promised to carry out the Sisolak closure order.

No sheriff responded to requests for comment.

Nicole Baldwin, the White Pine County Clerk, admitted that many people in the rural town of Ely felt that the closure orders were excessive.


Poster thumbnails

Show captions

“We are four hours from anywhere,” said Baldwin. “And we’re not on a highway, so we feel like we’re on an island here. However, in the same breath, we recognize the severity of the virus, and it’s spreading quickly. We have vulnerable people that we want to keep it protected. “

Scott Lewis, director of emergency management for Nye County, which includes Tonopah, acknowledged that a cultural aversion to government mandates in rural Nevada can complicate the response to the epidemic.

“Generally speaking, there may be a tendency not to trust the government,” he said. “But when you realize that this is a potentially serious problem for Nye County, you see a cooperative spirit. We just have to be diligent in remembering to take all the necessary precautions.”

The disease has already reached distant cities.

In Beatty, Nevada, another city gas station en route to Las Vegas, a man with no known travel history and no known contact with someone with coronavirus has tested positive. As in Tonopah, the nearest hospital to Beatty is more than an hour away. Sixteen other rural residents of Nevada tested positive.

“Wherever you live, you never know where that potential risk could come from,” said Lewis.

As of March 20, only 119 of the 240 beds in rural acute care hospitals were open, according to data from the Nevada Hospital Association. Only 8 of the 20 intensive care rooms were available.

The good news about the fans: The 33 in rural Nevada were available as of March 20. The bad news: they are scattered across a state more than twice the size of Pennsylvania.

Lewis said the absence of a hospital in Tonopah is not a complicating factor in those early days of the spread. People with symptoms of coronavirus are asked to call their doctor and not to go to the hospital.

But if coronavirus patients begin to experience severe respiratory symptoms associated with the infection, they must rely on a volunteer ambulance service to transport them to distant hospitals.

The question now is whether a bed will even be available to them.

“We have advanced paramedics in town 365 days a year and can help make the patient safer,” said Karmin Greber, president of the northern Nye County hospital district. “But now it’s about finding a place to receive them.”

Republic journalist Alden Woods contributed.

Read or share this story: