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COVID-19 threatens health of rural hospitals

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Dayton General Hospital

Radiology at Dayton General hands off a portable X-ray to staff fully geared in personal protective equipment. The portable X-ray unit is easier to wipe down and sanitize than if the patient were in the X-ray room itself, hospital CEO Shane McGuire said.

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DAYTON — When the doctor is ready to see you at Dayton General Hospital, in some cases he arrives on wheels in the form of cart-mounted video communications.

The telehealth cart is one way the rural hospital has been providing care while cutting back on the use of its decreasing supply of personal protective equipment. It’s also a way to allow a provider to speak with an isolated patient without exposing the doctor.

Strategies like this are how Dayton General continues to offer care as a critical access hospital during what could be a devastating time for the hospital.

To prepare for a potential surge of COVID-19 patients in the community or from other hospitals in the region, Dayton General has stopped all nonessential, nonemergency services, CEO Shane McGuire said.

It has reduced physical therapy, reduced clinic and limited radiology and lab services, McGuire said.

The eye on COVID-19 is critical for a county where the average age is 50 and an estimated 30% of residents are 65 or older, McGuire said. So it makes sense to reduce services to focus on the pandemic, he said.

But at a time when the hospital is incurring what it expects to be its most intense costs of the year, its revenue stream is also reduced to its lowest.

“It’s the reality of rural health care,” McGuire lamented. “If you let up and stop paying attention even for a minute you’re going to sink.”

In a Port of Columbia Economic Development Steering Committee conference call attended one week ago by U.S. Rep. Cathy McMorris Rodgers, McGuire outlined the state of the hospital and how the coronavirus could lead to the closure of more rural facilities.

“There’s already a number of critical access hospitals failing,” McGuire said. “They’re struggling over normal circumstances.”

According to the Cecil G. Sheps Center for Health Services Research, 126 rural hospitals across the country have shuttered since 2010.

Decreasing Medicare reimbursements and higher paying private insurance have contributed to the financial hardship of rural hospitals across the country.

McMorris Rodgers said the health care crisis has quickly led to an economic emergency.

“Clearly our lives have changed dramatically in a short amount of time,” she said.

As she vowed to continue working on assistance to medical facilities and businesses everywhere, she said this is “a time for American resiliency.”

“We’re going to get through this together,” she said.

Columbia County has had one positive confirmed case of COVID-19. That resident came off quarantine a week ago, Columbia County Public Health Administrator Martha Lanman said in the same conference call.

The case was handled in the most ideal way: the patient had been traveling and was instructed to be tested as soon as landing at home. From the airport, the patient drove straight to the hospital, was swabbed in the parking lot and immediately quarantined at home, awaiting results.

McGuire said patients coming to the hospital for testing are largely confined to their vehicles. Calling ahead is critical to the process. Since symptoms are also similar to the flu, health care professionals may test for a multitude of illnesses, including RSV, Influenza A, Influenza B and COVID-19.

“If it wasn’t as contagious as it is, we’d probably be holding them,” McGuire said.

Those with symptoms are tracked from their homes. Even taking temperatures, though, has become trickier.

A week ago the hospital had already run out of plastic protectors for the probes and couldn’t get more. Staff switched to forehead probes, which are not as accurate, McGuire said.

“That’s going to run out,” he said. “How do I pivot?”

The facility was facing an “ever dwindling” supply of masks, hair bonnets and hand sanitizer. McGuire said a couple of small shipments have since arrived, but patient census was going to remain reduced to save them.

“I could get more test kits than PPE right now,” McGuire said.

Vicki Hillhouse can be reached at or 509-526-8321.

Vicki covers business and economic development, including tourism, the Port of Walla Walla and the Strictly Business column, as well as features. She has been reporting for the Union-Bulletin since late 2001.

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