Rural patients can't get transfers to overcrowded hospitals

Skyrocketing Covid-19 hospitalizations mean hospitals nationwide are running out of beds. That's hurting not just Covid patients, but rural patients with other serious ailments who would customarily be transferred to larger regional hospitals.

For example, Zac Oakes of Russell Springs, Ky., told WLEX-TV in Lexington that it took a week to move his grandfather to a larger hospital. His grandfather does not have Covid-19 and does not need an intensive care unit, but it was almost impossible to find a bed, he said.

"These hospitals don't have room, and if they don't have room for somebody who needs medical care quickly, I mean that can be a matter of life or death for some people and it's very frightening that we're at that point," Oakes told reporter Austin Pollack.

That could be deadly for time-sensitive issues such as strokes; rural residents are at a higher risk for them, and rural survival rates are worse in part because rural hospitals don't quickly transfer patients to bigger hospitals that have more specialists and newer treatments. 

Last fall, some states created a system where urban hospitals would send less-critical patients to rural hospitals to make room for critical rural Covid patients; other states and regions could make such arrangements.

In the meantime, large safety-net hospitals are routinely forced to turn down rural patients. Chief Medical Officer Dr. Catherine O'Neal at Our Lady of the Lake Regional Medical Center in Baton Rouge told MSNBC's Rachel Maddow this weekend that Covid-19 patients have taken up 68 of their 90 ICU beds, and that more Covid patients are occupying beds elsewhere in the hospital.

"What we're also seeing now is a waiting list of people who need an ICU bed, and people calling and begging, 'Please put our patient that we can't take care of in our small hospital in your regional medical center.' And we say no. We say no every day to about 25 to 30 patients who want an ICU bed but we don't have any room for them," O'Neal told Maddow. "And that is our job; we're the safety net for the hospital as the largest hospital in the state. We're supposed to take these difficult patients, and we haven't been able to do that in about a month. So all of those people have waited for care, or have driven hours and hours with their disease to hospitals in Houston, hospitals in New Orleans, hospitals in Mississippi that are now also saying no because they are full as well."

Federal relief teams are trying to ease the burden on hospitals by offering outpatient monoclonal-antibody therapy, which can make the disease less serious, but many hospitals are still overrun. O'Neal said her hospital is "creating beds" by asking employees to care for critical patients who had never done so before, "but all that does is leave another person behind," she said. "What you really have to do is stem the tide. This is not a disease where we can take more and more Covid patients without leaving somebody off. The only way to truly create capacity again and undo that gridlock is to stem the tide, and the only way we're going to see that happen is through vaccination.

O'Neal said this fourth wave of the pandemic is not only bringing more hospitalizations, but younger patients. "We have teenagers coming into the ICU to tell their parents goodbye. We have teenagers FaceTiming with their parents to tell them goodbye because they have Covid and can't come to the hospital," she said. "We never saw that amount of young death before. We have people stacking up for care, which we've never had to do. We made it work in previous surges. It was hard, it was taxing, but we made it happen. And now we can't make it happen anymore. We can't just make a bed. We can't make another nurse. It's impossible to do, and we've tried. We tried for the last month, we sounded this alarm a month ago, and this point we do our best every day but we know that people don't get the care they need, we know that people are dying, and we're gonna take care of the person in front of us because that's what health-care workers do, and we're gonna depend on everybody else to do their part to stem the tide. We can't do it for them."