With Record Cases, Governors Warn Of Health Care Shortages : Consider This from NPR The governors of North Dakota, Ohio and Utah all delivered the same message this week: hospital resources normally used for patients with heart attacks, strokes or emergency trauma will soon be overrun by patients with COVID-19.

KCUR's Alex Smith reports on rural hospitals that are already at capacity, forcing them to transfer patients to city hospitals.

Lydia Mobley, a traveling nurse working in central Michigan, says she sees multiple patients every shift who say they regret not taking the coronavirus more seriously.

In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

Hospitals Pushed To The Brink, Governors Warn Of Health Care Shortages

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It's not just about hospital beds. You need staff to tend to those beds, too.


SHANKAR KURRA: You know, it's - mathematics of infection are very clear. You have a community-wide outbreak right now.

CORNISH: Dr. Shankar Kurra is the VP of medical affairs at Monument Health Rapid City Hospital. That's in South Dakota. And that state is one of many where hospital staffing is getting to be a real concern. Kurra told NPR this week his hospital has space for more beds, but they may soon need more staff. And the plan for that?


KURRA: We can shut down our ambulatory services and then repurpose those staff and even our more non-critical areas such as ORs that are not trauma and not essential emergency procedures, those areas can be repurposed. Staff there can be repurposed to take care of our COVID surge.

CORNISH: Hospital resources that normally go to other things might be needed for COVID.


DOUG BURGUM: If you're not a believer in COVID....

CORNISH: It's the same story in North Dakota.


BURGUM: ...Hopefully that you'll understand that other things actually are real.

CORNISH: The state's Republican governor, Doug Burgum, said hospitals are weeks from being overwhelmed.


BURGUM: Heart disease is real. Diabetes is real. Cancer is real. Stroke is real.

CORNISH: The Republican governor of Ohio, Mike DeWine...


MIKE DEWINE: We will not be able to provide appropriate care for all the Ohioans who need it.

CORNISH: ...Had the same message this week.


DEWINE: All those Ohioans who require other emergency care, things such as accidents and strokes and heart attacks.

CORNISH: Ditto from the Republican governor of Utah...


GARY HERBERT: Our hospitals are full.

CORNISH: ...Gary Herbert.


HERBERT: This threatens patients who rely on hospital care from everything from COVID-19 to emergencies like heart attacks, strokes, surgeries and trauma.

CORNISH: CONSIDER THIS - with record high cases and hospitals pushed to the brink, the divide over whether to take the virus seriously is only making things worse. From NPR, I'm Audie Cornish. It's Thursday, November 12.


CORNISH: It's CONSIDER THIS FROM NPR. Wednesday was another record, more than 144,000 cases of coronavirus reported in the U.S. and nearly 1,600 Americans dead. That's the most in a single day since May. Depending on when you're listening to this, the U.S. may have already topped both those numbers.


UNIDENTIFIED GROUP: I pledge allegiance to the flag of the United States of America.

CORNISH: One scene that says a lot about where we are right now played out in a city council meeting this week in Sioux Falls, S.D.


PAUL TENHAKEN: OK, so that's a tie. So my tie-breaking vote will determine this action.

CORNISH: Mayor Paul TenHaken was the deciding vote on whether to impose a citywide mask mandate.


TENHAKEN: First, I want to go on record and say that I obviously believe in masks.

CORNISH: TenHaken, who had a mask on himself, talked about the importance of social distancing and mask wearing. But then he said this...


TENHAKEN: I believe the small uptick in compliance - we'll see - we see from this or we will see are not worth the community division that this will create.

CORNISH: He voted against the mandate.


TENHAKEN: I know how emotional this topic is. I cannot overstate how emotional this is. And there's no winners tonight in this vote. There's no winners. This sucks to be in this position. So what can we do if we don't pass an ordinance? We can do these things that we know will slow the spread of this virus right now, and that's the things I just laid out. So my official vote on this is a no. And that item fails 5-4. Next item.


CORNISH: South Dakota, along with Idaho, Wyoming and North Dakota are some of the states seeing the most new cases right now.


ANDREW PAVIA: Because of the local politics, they're probably not as drastic as firm measures as we really needed to turn the tide.

CORNISH: Dr. Andrew Pavia is head of infectious diseases at the University of Utah Hospital. He told NPR those states have generally not put many public health restrictions in place. There's also not much enforcement on large gatherings.


PAVIA: So I think the situation in two to four weeks is going to be grim.


CORNISH: As more hospitals reach capacity, what options do health officials have? Well, some rural hospitals are sending patients to cities for treatment. And now some of those hospitals are buckling under the added strain. Here's reporter Alex Smith with NPR member station KCUR in Missouri.


ALEX SMITH: Registered nurse Pascaline Muhindura has spent the last eight months treating covid-19 patients. She works at Research Medical Center in Kansas City, Mo. But when she returns home to her small town outside of the city, she's often stunned by what she sees, like on a recent stop for carryout.

PASCALINE MUHINDURA: No one in the entire restaurant was wearing a mask. And there was no social distancing. It was like I had to get out because I almost had a panic attack. I was like, what is going on with people? Like, why are we still doing this?

SMITH: Kansas City has a mask mandate, which isn't the case in many smaller communities nearby. They don't require masks. In the last few months, a lot of rural counties in both Kansas and Missouri have seen some of the highest rates of COVID-19 in the country. And in both states, in three out of four counties, there isn't a single intensive care ***

SMITH: unit. So when people in those places get critically ill, they're sent to city hospitals. Dr. Marc Larsen leads COVID-19 treatment at St. Luke's Health System in Kansas City, where a recent count showed a quarter of the hospitalized COVID-19 patients came from outside of the metro.

MARC LARSEN: So not only are we seeing an uptick in those patients in our hospital from the rural community, they're sicker when we get them because they're able to handle, you know, the less sick patients. And we get the sicker - the sickest of the sick.

REX ARCHER: You know, we've had this huge swing that's occurred because they're not wearing masks.

SMITH: Dr. Rex Archer is the head of Kansas City's Health Department. He warns that the city's 33 hospitals are put at risk by the influx of rural patients.

ARCHER: And, yes, that's putting pressure on our hospitals, which is, you know, unfair to our residents that might be denied an ICU bed.

SMITH: Hospital leaders have pleaded with Missouri's governor, Mike Parson, a Republican, and with Kansas's conservative legislature to implement statewide mask requirements but had no luck. Meanwhile, local cases in Kansas City have started picking up again, too. And an average of 160 people are being admitted to hospitals with COVID-19 each day. Nurse Pascaline Muhindura says that bed space isn't the only hospital resource that's running out. As patient counts continue to climb, she and fellow hospital workers are struggling with anxiety and depression.

MUHINDURA: The hospitals are not fine because people taking care of these patients are on the brink. We are tired.

SMITH: And trendlines indicate the latest surge is only going to get worse.


CORNISH: Alex Smith with NPR member station KCUR in Kansas City.


CORNISH: Moving patients isn't the only adjustment hospitals are being forced to make.


LYDIA MOBLEY: I'm a - in the COVID ICU. And they are expanding that currently because they need more ICU beds for COVID.


CORNISH: Navy veteran Lydia Mobley is a travel nurse. Normally, that means she's contracted to work in a different hospital every few months. She was hired at her current hospital in central Michigan to support the COVID ward. Her contract runs until January.


MOBLEY: But you always have the option to re-extend as long as the hospital still has a need because before COVID, they wouldn't always continue to have needs. But obviously with COVID, I fully anticipate them still having a need.

CORNISH: If that's the case, Mobley said she'll stay. We spoke about why and what makes her work so challenging right now.


MOBLEY: The world needs nurses right now. And as a nurse and having my licenses and - I need the help.

CORNISH: All right. So you have this gig as a traveling nurse, which means you move between hospitals. When I think of Michigan, this is a state that saw a lot of protests when the shutdown orders came from the Democratic governor. What are you seeing when you're walking in to work, right? I mean, are people wearing masks? Do you see social distancing?

MOBLEY: Definitely. Definitely. There's a lot more need for people to do a lot more because no, unfortunately, there's a lot of people that still don't wear masks. There's a lot of people - it's really hard to watch because at the hospital, a lot of times when they're, you know, the step-down unit before they're intubated - which means put on a ventilator because they can't breathe on their own - when they're still struggling to breathe and they're saying, well, I didn't know COVID was real. And I wish I'd worn a mask. And then it's already too late. But it's very sad because it's not a moment - you can see the regret, you know, obviously, as they're struggling to breathe and it's finally hitting them that this is real. It's really hard. It's really hard to watch.

CORNISH: How common is that? I mean, how common do you encounter patients who didn't take the warning seriously?

MOBLEY: Every shift, multiple patients. Every shift, multiple patients. There's - speaking on the phone to their family members because there's a lot of elderly patients, obviously, although it's not all elderly patients. It's people in their 40s and 50s. And those are the ones I hear the regret from. We get a lot of elderly patients who had it probably transmitted from their families. And their families on the phone are very remorseful about not doing more to keep their family members safe.

CORNISH: What advice have you gotten from your colleagues who have been treating this disease since the spring?

MOBLEY: To be very honest with you, just survive. That's what they tell me a lot like, because unfortunately, we can't give the level of care that we could give when the staffing ratios were better. And a lot of them said we've just been trying to survive, like, keep the patients alive and keep ourselves alive. A lot of them talk about how don't ever run into a room without your PPE, even if that patient is coding, which is hard because that's your first instinct as a nurse. But again, at the end of the day, we still have to protect ourselves. I'm told over and over again, don't just go running in there without that even if things are very serious for the patient.

CORNISH: How do your workers, your co-workers seem in terms of burnout?

MOBLEY: Very burned out. Very burned out. It's similar to combat fatigue. That's - there's irritability. Obviously, you're tired. But you're just doing the best that you can to try to cope, to try to get through it. I think the way we get through it is just together, you know, the camaraderie and having a shoulder to lean on and someone to talk to and just knowing that it's a tough time. But we're going to - we're getting through it together. And you're not alone.

CORNISH: Lydia Mobley, a COVID ICU nurse. She's currently working at a hospital in central Michigan.


CORNISH: You're listening to CONSIDER THIS FROM NPR. I'm Audie Cornish.

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