While Louisiana’s rapid escalation of coronavirus cases remains concentrated in the New Orleans area, there are ramifications for rural hospitals as state officials plan for extreme demands on the health care system.
As urban intensive care units fill up, for example, smaller hospitals may be called on to take people who need inpatient service but do not require life-saving care, said Jerry Phillips, executive director of the Rural Hospital Coalition of Louisiana. Meanwhile, if the new coronavirus fans out across the state as expected, hospitals in small towns and sparsely populated areas may need to transfer patients with severe symptoms to stretched-thin ICUs in the cities.
“It’s a balancing act for both urban and rural,” Phillips said. “Obviously a hospital that is completely full won’t be able to take additional patients.”
Phillips said that staffing, equipment and bed capacity are typically at fixed levels at rural hospitals, defined in state law as those with no more than 60 beds in cities and parishes of certain sizes. Some have small intensive-care units, some don’t have any. Some have ventilators, which are critical in stabilizing patients with severe cases, and some do not.
“They are very much willing to help, but how much can they?” Phillips said. “If you don’t have ICUs and ventilators, you can’t treat this virus if you have got infections. A lot of them don’t have those.”
Phillips said the rural hospital coalition is working closely with state officials on plans for allocating resources, but that each individual hospital will determine what they can contribute. Many of the state’s 50 rural hospitals are supported with local property taxes, which residents approved to ensure they have a nearby facility when emergencies arise.
“They need to make sure they have capacity for all needs. They wouldn’t want to have overflow into their hospitals when the local community needs their support,” Phillips said.
The number of known cases in Louisiana stood at 196 on Tuesday evening, just eight days after the state’s first positive test result. State and local officials have since banned gatherings of more than 50 people, closed public schools and ordered bars, restaurants, theaters and gyms to temporarily shut down.
The World Health Organization predicts that as many as 20% of those infected with the new coronavirus will need hospitalization, and Joseph Kanter, an assistant state health officer, said roughly one-third of hospitalized patients will need intensive care.
Predicting the coming surge in demand for hospital services is difficult, since Kanter said there is no reliable way to forecast the number of cases Louisiana might see, though officials in other states have done so.
“It just becomes very challenging when you try to and model based on the information out there, which is in international experience and not directly relateable to us,” Kanter said.
Kanter said hospitals should shift resources and staff away from elective procedures and outpatient services to focus on acute care, adding that those able to add second beds in what are now single-bed rooms should do so. The state is not presently forcing such adjustments, but “we are certainly discussing that,” Kanter said.
Such mandates, if they are issued, may be difficult for rural hospitals to meet.
“Larger hospitals, if they need to, they can close a floor down and move staffing around to accommodate the increase. What we have is what we have. We don’t have additional personnel to pull from,” said Cindy Juneau, chief nursing officer at Avoyelles Hospital.
Juneau said her hospital has 22 staffed beds, including two for intensive care. Additionally, the hospital has five ventilators, which Juneau said is unusual for a hospital of that size.
There are 2,320 ventilators across the state, according to the Department of Health, putting it on par with the national per-capita average, as illustrated in a February study by Johns Hopkins University. The study estimated there are 160,000 full-service and emergency ventilators in the United States.
State heath officials on Tuesday could not provide an estimate of the number of ventilators that will be needed. Projections are being worked out based on the restrictions that have been imposed, officials said.
St. Martin Hospital, with 14 staffed beds in Breaux Bridge, has three ventilators available for emergency use, said Glenn Dailey, the chief operating officer. The hospital has no ICU, Dailey said, but a respiratory therapist and the nursing staff can tend to patients on ventilators while searching for transfer options.
St. Martin Hospital is in the Lafayette General Health System, headquartered in neighboring Lafayette Parish. The hospital is already accustomed to receiving non-critical patients from Lafayette General Medical Center, the system’s flagship hospital 11 miles away, Dailey said. It will continue doing so as coronavirus-related demands increase, while also serving the general population — to the extent possible.
“If someone comes in, it doesn’t matter what it is. If we have a bed available, we will take that patient,” Dailey said. “The problem with us is we are limited to only 14 beds.”