'It’s A Critical Situation': How A COVID-19 Surge Is Hitting One Small Idaho Hospital
Minidoka Memorial is a 17-bed county-owned hospital in Rupert, along the Snake River Plain. Emergency physician Dr. David Wageman took his shift there last week.
“He had, in the span of 12 hours, four COVID-positive patients that needed to be admitted to a higher level of care,” said the hospital’s CEO Tom Murphy. Minidoka’s three-bed COVID-19 unit was full that night. So, Wageman began calling up other facilities, looking for bed space.
He was on the phone for hours and finally was able to get one person to the hospital in Pocatello, two to Burley and one to Twin Falls, but only after that hospital discharged a patient.
“It is a critical situation,” Murphy said. “Our staff are worn out, we’re tired and we care and that’s why we’re hanging in there.”
Hospitals across south central Idaho have been overwhelmed in the past few weeks by a surge in COVID-19 patients needing care. COVID-19 hospitalizations have increased by 90% since the beginning of the month, according to the Idaho Department of Health and Welfare.
The same is true at Minidoka Memorial. The hospital has been caring for coronavirus patients for a while — even taking some overflow patients from St. Luke’s Magic Valley during Blaine County’s surge in early spring — but for most of the pandemic, the Minidoka hospital has had just one bed dedicated for coronavirus patients.
Minidoka has been used to sending patients to other facilities like St. Luke’s in Twin Falls. But as case numbers rose after Labor Day, Minidoka converted two more coronavirus beds, leaving seven medical beds and another seven for surgeries. For the past few weeks, all three COVID-19 beds have been full most of the time.
The limited capacity means most rural hospitals are used to sending people to bigger facilities in cities in serious situations.
“They’re just not designed for 24-7 care,” said Dr. John McCarthy, a physician in Spokane, Wash. and the assistant dean of the University of Washington Medical School’s rural programs. McCarthy said doctors at these tiny hospitals are used to thinking on their feet, but they rely on being able to transfer patients to city hospitals.
“If you can’t transfer your patient who’s going to need neonatal intubation and you don’t have the care team to deal with that, the patient will suffer as a result of that,” he said.
Normally things work out OK, and patients get where they need to go. But now hospitals in many Mountain West cities, which typically take them, are filling up because of COVID-19, cutting off that lifeline.
Physical Distancing Challenges
In the small, agricultural community of Minidoka, COVID-19 spread quickly, starting with a few food processing facilities in the spring.
“The first people I knew who were positive were two of our migrant — a grandmother and grandfather of one of our migrant students here,” said Jamie Garza, the migrant education coordinator and English language learning specialist for the Minidoka County School District.
Most of the people Garza knows who got COVID-19 are Hispanic, she said. Nearly half of Minidoka’s COVID-19 cases have been in the Hispanic or Latino communities, but Hispanic and Latino people make up about 35% of the county population.
In the 500 or so migrant families Garza works with each year, there’s usually someone employed in the food sector.
“It makes it harder to social distance in the line of work that a lot of our parents do,” Garza said.
Garza said when someone in one of the migrant families she works with is feeling sick, they want to get tested and see if they have the virus so they won’t spread it to other family members.
And even though most parents had to continue working while schools were shut down in the spring, her families were, at first, apprehensive about sending their kids to school in the fall, for fear that they'd get sick. Most stuck with the in-person option, but now Minidoka schools are on a two-week break — with no virtual schooling — as a result of the public health district moving the county to the red risk level.
Garza got COVID-19 herself earlier this month, as did her two kids, likely from school-related activities.
Mask Use Is 'Poor'
The doctors at Minidoka Memorial often treat their family, friends and neighbors. In the last month, they’ve watched the virus make its way to every segment of the population — about 5% of Minidoka residents have tested positive for COVID-19, according to state data — and they thought that might make a difference in how people behave.
The thinking goes, if you know someone who’s had the virus, maybe they were even hospitalized, you’d begin to take it more seriously — wear a mask. So far, that hasn’t happened. Murphy, the CEO, said resident mask use is still “poor.” Hospital staff said they’re often the only ones in the grocery store with masks.
And though overall awareness about the virus is up, Murphy said it hasn’t changed the minds of elected officials.
“What we’re still seeing is a real hesitation or lack of willingness to do anything to take any real action,” Murphy said.
Sometimes he’ll get his hopes up during a virtual meeting, thinking some board might finally institute a mask mandate, only to log off after another “no” vote.
“I should be spending 70% of my time thinking about the next year,” he said, “the next two years or the next three years and planning for our business. And right now, I spend the day thinking about the next day.”
Where Will They Go?
The most immediate concerns are space and staff. Last week Minidoka had 24 staff out quarantining or sick with COVID-19.
“We don’t have a very deep bench,” he said. For example, if the two surgeons are out at the same time, there would be no surgeries.
Normally, that’s not a problem and patients can go elsewhere. But now the whole region’s medical facilities are taxed. And it affects more than just COVID-19 patients.
This week, someone came to the emergency room after a bad multi-vehicle crash.
“We realized that they had maybe a tear or some sort of internal injury that needed a higher level of care,” Murphy said.
The patient went to the University of Utah hospital, but that option might not be available for much longer. Utah warned surrounding states like Idaho that it might not be able to admit out-of-state patients soon.
“If we don’t have the capacity — we don’t have a bed here — we don’t have a bed in Twin, or Pocatello, or Idaho Falls and we can’t transfer to Utah,” he said, “what do those folks do that need more than just oxygen treatment? I don’t know. I’m very fearful for the future and what lies ahead if we can’t curb the pandemic.”
If hospitalizations increase by just 10%, Murphy said, hospitals could need to ration care and decide who gets a bed and who doesn’t.
Find reporter Rachel Cohen on Twitter @racheld_cohen
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