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Here’s what it looks like inside a rural Idaho hospital fighting to survive COVID-19

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Posted at 1:27 PM, Nov 18, 2020
and last updated 2020-11-18 16:06:55-05

This article was originally published by Nicole Foy in the Idaho Statesman.

The pace of the pandemic has been unrelenting for months, but the last few weeks have been the worst of all for the staff at Minidoka Memorial Hospital.

In October, the hospital hit an all-time high of transfers. So many patients were arriving at the Rupert hospital in need of intensive care — Minidoka Memorial only has space for three COVID-19 patients, and doesn’t have an ICU — that some were being transferred to other hospitals at the same time. The fallout of a “devastating” COVID-19 outbreak at the hospital’s own assisted living facility flooded the hospital suddenly with seriously ill patients, and would eventually account for 27 coronavirus cases and five deaths as of Nov. 13, according to the Idaho Department of Health and Welfare.

And on one day alone, seven hospital staff tested positive for COVID-19 before 10 a.m. — creating a grand total of 19 staff members out sick one day. By that point, it was clear that the coronavirus pandemic was operating in full force in the small agricultural communities that usually send their patients to the 17-bed hospital.

“It was like the first time we had gone from just treating COVID patients ... to OK, now this is really affecting our staff,” said Tom Murphy, the CEO of Minidoka Memorial Hospital.

Every week, Idaho breaks newly-created records for coronavirus case counts, the number of Idahoans hospitalized with COVID-19 and increasingly, the number of COVID-19 deaths reported in a single day. The sustained surge in cases, dwindling number of available beds across the state and the public’s apparent disinterest in wearing masks, especially in the Magic Valley region, creates another staff consensus: the last few weeks likely won’t be the worst.

That’s because flu season has only just barely begun, family Thanksgiving gatherings are less than two weeks away, with Christmas and New Year’s following after.

“People don’t want to wear the masks,” said Kim Vega, hospital spokeswoman and the emergency management coordinator for Minidoka County. She, like Murphy, has been urging public officials to take action on a mask mandate to help stem the tide of cases in the region. “They just won’t. You’ll see far more people without masks, than with them.”

“THIS IS THE HOT SPOT.”

One way the coronavirus isn’t like the flu? Paramedics and EMTs never had to modify one of their ambulances to protect EMTs during a particularly bad flu season. First responders are handling patients as if they have coronavirus by default, but the ambulance meant to transport serious COVID-19 patients needing the kind of oxygen treatments that can easily aerosolize the virus in a small space and expose health care workers is covered with plastic on almost every surface. There’s an extra barrier between the front seat and the back, reducing the personal protective equipment the drivers need to wear.

A hazmat situation might prompt such precautions, emergency medical services director Mark Phillips said, but not the flu. Additionally, Idaho usually has 50 to 60 flu deaths every year. As of Nov. 17, more than 770 Idahoans have died from COVID-19.

“There is a potential that you’re going to have a problem with it,” Phillips said. “That’s our business, is those folks who are having problems with it.”

The influx of COVID-19 in the Magic Valley region, particularly in Cassia and Minidoka counties, is straining even the best efforts of first responders like Phillips. The number of patients needing to be transported to other hospitals each month has doubled. Last month, 44 patients needed to be transported to other hospitals — and 90% of those patients had COVID-19, Phillips said. By Nov. 12, two members of Phillips’ crew were out sick with COVID-19, too.

Transfers aren’t incredibly unusual for Minidoka. Even before COVID, more serious patients who required intensive care were normally transferred to hospitals like St. Luke’s Magic Valley in Twin Falls. And from the beginning of the pandemic, they’ve transferred the most serious COVID patients there, too, keeping the less severe cases in Rupert that they can care for. The most serious patients get taken to another hospital in a helicopter.

The concern, Phillips said, is when his busy EMT crew can no longer easily reach the only hospitals with room for patients. They can feasibly transport patients to hospitals in Boise or to the Eastern Idaho Medical Center in Idaho Falls, but what happens when the only hospitals with beds are out of state — and the helicopters can’t take patients because of inclement weather?

“Winter is coming and when the helicopters can’t fly, it will be us who will be taking these folks,” Phillips said.

Dr. James Torres usually works at St. Luke’s Wood River Valley in Ketchum, where he treated patients through Idaho’s first serious coronavirus hotspot back in the spring. On Thursday, he was working his monthly shift in Minidoka Memorial’s emergency room — and trying to find beds for patients.

Despite diverting all children needing hospitalization to Boise, canceling elective surgeries and straining under record numbers of COVID patients, St. Luke’s Magic Valley was still accepting some patients from Minidoka. But the margins are getting thinner. Right now, Torres said, he finds himself sending patients to available beds in the Pocatello or Idaho Falls hospitals.

“In March, the Wood River Valley was the hot spot. Now, I think this is the hot spot,” Torres said. “The numbers are similarly higher and the net effect is the hospitals are getting full, which is the dangerous thing. We’re going to be stuck trying to figure out where to send these patients.”

CARING FOR COVID-19 PATIENTS IN A FULL HOSPITAL

Like most rural hospitals, Minidoka Memorial only has so much room for COVID patients. They’ve been able to carve out three dedicated beds for hospitalized COVID-19 patients, the units zipped up and barricaded from the medical floor in such a way that prevents the unit’s air from being exchanged with the rest of the air on the floor. One of the beds is briefly open on Thursday, and a glimpse inside shows a spartan environment. Few surfaces to clean. The curtains are thrown away after each patient.

Charge nurse Kaylee Tracy said one of the reasons the last few weeks have been so difficult for Minidoka Memorial staff is that it seems like many patients are waiting too long to come to the hospital.

“We’ve had a lot of higher acuity patients, and they’ve been just really, really sick,” said Tracy, who both treats COVID patients, other hospitalized patients on the medical floor and assists in the ER. “And so it’s trying to keep the families informed, trying to keep the doctors informed, the patients well, and along with the staff ... We’ve been working overtime, working really hard. It does get stressful on the staff as well.”

To bridge the gap between patients and the families who can’t see them, staff members like Tracy encourage family members to call and FaceTime for updates, repositioning beds so patients can see family out the window or providing diligent updates at all times of the day.

Melissa Bedke, a registered nurse and the medical floor manager, said it’s still difficult to tell and remind families that they can’t join their COVID-positive loved ones in the hospital. Without the proper precautions, it wouldn’t be safe for the nurses caring for them, either.

“The hardest thing for nursing is, you jump in and take care of the patients,” Bedke said. “It’s really hard to take a step back and say ‘Wait, I’ve got to get this stuff on.’”

Rural hospitals like Minidoka Memorial still can’t rely on a steady flow of the resources they need. Most weeks, laboratory manager Bart Hanson is just trying to make sure he has enough testing kits to meet the demand of patients that need testing and keep the hospital running.

“This has been the most difficult thing I’ve ever done in the 28 years I’ve been in lab science,” Hanson said. “I have never experienced anything like this ... That’s probably one of the things I spent most of my time on — trying to figure out where we can get enough test kits to make it through another week.”

‘THERE’S JUST NOWHERE TO RUN.’

By 3 p.m. Thursday, Murphy had just finished the bleak round robin call with health leaders from the Magic Valley and the eastern side of the state. There wasn’t much good news from anyone.

“I see us reaching a point where there is not enough capacity because we have this huge backlash against mandates … of doing some of these things that could help,” Murphy said. “We have an unwillingness of any officials anywhere, whether state or regional to really adopt mask mandates. And we’re such a mobile community...so it has to be a regional or statewide effort.”

The following day, during his Friday press conference, Gov. Brad Little moved Idaho back to a modified Stage 2, but declined to issue a statewide mask order. Gatherings of more than 10 people are not allowed, but that doesn’t apply to schools, businesses or churches. Half the state’s population is already under a mask order, Little said, and people need to be convinced, not mandated.

The public health district covering Minidoka County and the other seven counties in their region still hasn’t passed a mask mandate. The city councils of nearby Twin Falls and Jerome both tabled measures to consider mask mandates when met with strong pushback from their own community members.

In the emergency department, nurse Kelsey Phillips has been seeing seriously ill patients of all ages. People in their 40s, 50s and 60s with serious COVID-19 symptoms. A few children under the age of 10 who need care. People checking in family members, only to admit they also need care themselves.

The waiting room is closed, but they’ve occasionally had beds lined up in the hallway of the emergency department to allow patients to get oxygen while they wait to be admitted. Those who don’t need oxygen wait in the car, with nurses like Phillips running back and forth to check on them. Although hospital staff try to assure the community that the hospital is still a safe place to seek help and care, some patients appear to be delaying help or procedures they need, exacerbating medical conditions.

Getting someone to the cardiologists or other specialists they need in an emergency didn’t used to be this difficult, Phillips said.

“It’s worrisome for us,” said Phillips, who is married to EMS director Mark Phillips. “Because we worry about those patients who need to get to those specialists quickly. They’re time-sensitive emergencies.”

Around 5 p.m. a helicopter arrived to airlift a patient who had a heart attack. That Thursday, St. Luke’s Magic Valley still had room for him — just barely. By the following Monday, hospital representatives reported at a Twin Falls City Council meeting they were diverting ICU patients again.

“There’s just nowhere to hide, there’s nowhere to run,” Murphy said. “It’s not like it’s just localized here. You can send your overflow to a neighboring hospital, but we’re all in it now.”