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Collisions with COVID: PPE in Rural hospitals

Courtesy/Creative Commons
When the coronavirus hit, many hospitals in the rural region of Huron county were not equipped for the amount of supplies they ended up needing.

Hospital workers are the ones in need of Personal Protective Equipment that, according to Thumb hospitals, was in short supply during the early stages of the pandemic.

When the coronavirus hit, many hospitals in the rural region of Huron county were not equipped for the amount of supplies they ended up needing.

“Some of our cleaning supplies, we had to switch because we can’t get them anymore,” Danielle Blaine, Director of Marketing at Hills and Dales General Hospital in Cass City, said.

She said obtaining PPE was very difficult early on.

“We had a lot of trouble and a lot of time was spent trying to secure supplies.”

Blaine said they were able to secure some supplies through a regional healthcare group, but their normal vendors didn’t have enough to go around and eventually production stopped altogether.

“Everybody wanted everything, and they just didn’t have enough. And then manufacturing was shut down, so they weren’t making those supplies so it took a little bit of time for them to get caught back up to the need,” she said.  

Tuscola county has been among the hardest hit of Michigan’s thumb counties. As of Monday, they had reported 246 COVID cases and 27 deaths. But those numbers are low compared to neighboring Genesee county, which has seen nearly ten-times as many cases and deaths.

Dave Wohl is Vice President of Population Health, also with Hills and Dales. He said it’s understandable urban hospitals get the larger share of PPE.

“There wasn’t a lot of covid up here in the rural areas, so rightly so, the priority for supplies should have been diverted toward the hotspots,” he said.

Though, as coronavirus cases begin showing up in communities that were previously unaffected, Wohl said hospital admissions could rise. He said by nature, rural hospitals cover large geographic regions thus patients come from far away, and so do supplies.

“In a rural area, we’re responsible sometimes for as many people but they’re so far away that we don’t have the staffing the larger hospitals do and we definitely don’t have the supply chain,” he said. “We are measuring our PPE every day.”

Huron county has so far had just over 100 coronavirus cases and three deaths. Clark Ramsey is the Manager of Marketing, Communications and Business Development at Scheurer Hospital in Pigeon. He said they were in a good position at the start of the pandemic.

“Our manager of emergency preparedness had us in a strong position so that when we needed, we could open up the war chest and we had a lot of PPE on hand so that we could move forward with the proper precautions,” he said.

However, as time persisted, the number of cases increased, and supply availability decreased. Ramsey said about 80% of the nation’s PPE originates from China and because of the initial outbreak in that region, exports came to a quick halt.

“When the shutdown began, there were a lot of unknowns at that point, so it was really all hands-on deck, where can we get these supplies from any possible corner of the world we can get them,” Ramsey said.  

The Thumb region is not alone in its struggles as other rural areas have shared similar disparities. Dr. Joe Santangelo, Chief Quality and Safety Officer for Munson Healthcare in northern Michigan said PPE supplies are limited and some completely out of stock.

“For some supplies it’s just a matter of cost and that’s something we can work through… but some items we can’t even get at all no matter what the price.”

Many rural hospitals used grants to purchase PPE and loans to cover other expenses allowing several to remain financially stable. Nonetheless, some government officials think Michigan was severely underfunded by the federal government.

In a report by US Senator Gary Peters from the Senate Committee on Homeland Security and Governmental Affairs, Michigan was found to be one of five states hit the hardest by the virus but federally funded the least.

Michigan, New Jersey, Massachusetts, and Pennsylvania had between 20,000-50,000 coronavirus cases and received approximately $20,000-$60,000 per state. New York, being an outlier, had 170,000 cases and received $10,000.

Conversely, Hawaii, Montana, North Dakota, Wyoming, and Alaska had 200-400 coronavirus cases and received $260,000-$330,000 in each state.

Peters also referenced a 2019 analysis that showed about 80% of rural hospitals in the state were at high risk of closing. Now, about a year later, several hospitals are experiencing high capacities.

As cases begin to rise again, some hospitals said they are prepared though concerns remain. Dr. Santangelo said supplies are always a concern at Munson Health as they expect increasingly more patients.

“We know that we have more cases coming… how do we manage the supply we have without knowing when we’re going to get more,” he said.

Ramsey at Scheurer Hospital said he is confident they have enough supplies. He said many new companies began to create more supply for the world and so moving forward, this will continue to help.

“We had a large mass of new manufacturers go online with much larger capacities to produce resources and protective equipment of sorts, so we certainly feel that we do have enough resources on hands.”

Wohl from Hills & Dales said they are maintaining enough PPE but avoiding overstock as they expire after about a year.

“I don't think any real facility is in a position financially to keep a huge stockpile and gamble,” he said. “It's great if you need it but if you don't need it then you waste a lot of money and our margin is so thin right now that a warehouse full of PPE that we throw away could be three or four employees' jobs.”

In areas like the Thumb, community members often volunteer to help serve local businesses, in this case, it was hospitals. Ramsey said Scheurer received some of this kindness.

“We had an army of sewers from across the region sew about 3,000 masks for us out of cloth, and anything else that we possibly could find,” he said. “We were able to kind of get through that critical mass because during that same time we were reaching out to local manufacturers and local industry and just being able to manufacture shields at a local basis here.”

Wohl from Hills & Dales said the community of Cass City has been incredibly supportive through the process as well.

“They have been making masks and donating different protective equipment or even bringing goodies in every now and then.”

Wohl said they are thankful for that support that comes with living in a rural community.

Supply concerns linger in some rural hospitals, but as they have a chance to restock — and learn more about the coronavirus — many said they feel better prepared for a possible second wave of the pandemic.

Aurora is a photojournalist major and an undecided minor going into her sophomore year at Central Michigan University. After college, she hopes to work as a photojournalist.
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