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The Washington PostDemocracy Dies in Darkness

Bracing for coronavirus, cash-strapped rural hospitals buy masks from hardware stores

Rural hospitals are removed from virus threat in population centers, but more exposed to supply-chain ripple effects

The hallway leading to the dormant surgery wing of the Fairfax Community Hospital in Oklahoma. (Michael S. Williamson/The Washington Post)

Routine care and elective surgeries — such as knee replacements and gallbladder removal — could be scaled back if the coronavirus spawns a pandemic, hospital executives are warning, delivering economic shocks to the hospital system beyond the immediate challenges of protecting health-care workers and dealing with those stricken with the virus.

Rural hospitals could bear the early brunt. They sit furthest from international airports and urban hubs where outbreaks are more likely, but they are at the tail end of supply chains for vital medical goods such as protective masks and gowns.

In addition to preparing for victims and the demands of protecting health-care workers from infection, fragile hospital networks also are readying for disruptions to the bottom line. If the spreading coronavirus puts heavy demand on health systems, billable work that keeps revenue flowing on a weekly basis to hospitals small and large will be curtailed, executives said.

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The hospital industry warned policymakers this week that Congress needs to quickly pass emergency funding for the crisis and direct some of the funding to plug anticipated gaps in hospital operating budgets. In the event of widespread sickness, costs would soar for isolation rooms for infected patients, equipment, and training.

Rural facilities, far from medical warehouses, are feeling the effects first as the health systems has begun rationing certain supplies. The likelihood of a coronavirus victim showing up in the emergency room remains low in these places but the possibility of economic ripple effects are real.

“Leaders at rural hospitals are anxious in part because their profit margins are already near zero,’’ said David Ridley, a professor specializing in health sector management at Duke University’s Fuqua School of Business. “A major disruption would put them in the red.’’

At the national level, the American Hospital Association is warning that budgets of hospitals that operate on extremely thin margins are going to be tested to the limits by the crisis. Curtailing elective surgeries is a big danger, it said. The association sent a letter to House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.) calling for speedy approval of emergency funding specifically targeted to bolstering the crisis response for cash-strapped hospitals.
“As the shortage of medical supplies grows, extraordinary steps to preserve (protective personal equipment), including canceling elective surgeries and other procedures, may need to occur,’’ the association said. “Such cancellations could be devastating to hospitals, physicians and nurses already at financial risk.’’

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Large distributors of critical medical supplies have frozen shipments and supplies are on back order. Small hospitals in places like Wisconsin and Texas report that their storeroom shelves are emptying of protective masks and gowns. If they run out, the routine business of caring for patients will have to be curtailed, they warned.

Protective clothing for doctors and staff who perform outpatient surgeries in Baldwin, Wis., will run out in a matter of weeks, said Alison Page, chief executive of Western Wisconsin Health, a 15-bed hospital serving the tiny community off Interstate 94.

Page’s husband brought in spare sterile gowns from a dental office, and another person contributed a batch of gowns donated by a local veterinarian. Once those run out, the hospital may have to curtail elective surgeries, she said. The storeroom is empty of protective N95 masks; what supply the hospital has is in cabinets in individual departments.

“If we don’t do surgery in this building, then we can’t make any money,’’ Page said, which could mean layoffs.

The most remote emergency room: life and death in rural America

Because of the looming threat of a coronavirus epidemic, large suppliers of masks and gowns are blocking or limiting new provider orders, called “allocation.’’ It means they are not able to order any more masks or other gear than they used previously.

In Clifton, Tex., leaders from the community hospital scoured local hardware stores and scooped up the town’s entire supply of N95 protective masks, which can protect health-care workers from airborne virus transmission but also are routinely used in construction and maintenance work.

“The hospital having masks, to protect my employees from other sicknesses, is more important than people mowing their yards right now,’’ said Adam Willmann, chief executive of the 25-bed facility Goodall-Witcher Healthcare. The purchases bolstered a supply of roughly 115 masks with an additional 20, he said.

He blamed “mass hysteria’’ for creating a run on masks: “We’ve gotten to the point where there is going to be a shortage and we’re trying to do everything we can to get ahead of it.’’

Another Texas hospital shut out by its supplier went on Amazon and found the price had spiked from the usual 6 cents per mask to 85 cents, and shipments were back-ordered.

Many third-party vendors listing N95 masks on Amazon on Friday reported that supplies were not available. One vendor listed five masks for $174.99. Another listed five masks for $189.99.

Amid the market gyrations, health officials have stressed that masks should be reserved for health-care workers and people who are infected with virus. Amazon linked to a CDC website that advised “CDC does NOT currently recommend the general public use face masks.’’

Coronavirus: What you need to know

Where do things stand? See the latest covid numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people.

The state of public health: Conservative and libertarian forces have defanged much of the nation’s public health system through legislation and litigation as the world staggers into the fourth year of covid.

Grief and the pandemic: A Washington Post reporter covered the coronavirus — and then endured the death of her mother from covid-19. She offers a window into grief and resilience.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

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