Brad Huerta found himself vacuuming the halls of his rural Idaho hospital last week.
As the CEO of Lost Rivers Medical Center, in Arco, Idaho, it’s not his normal job, nor is it normal for the maintenance staff to be directing traffic of patients coming in with symptoms outside, or having the emergency department doctors take on extra shifts to fill in as nurses.
But rural hospitals trying to stay afloat in the middle of the coronavirus pandemic are a long way from normal. Often underfunded, understaffed and undersupplied, they’re now facing the looming impacts of COVID-19.
"A lot of small hospitals, they may have 15 to 20 days cash on hand. They're trying to make payroll when things are good. Being asked to lay out all this additional expense while at the same time, enacting infection control measures and limit our regular operations… coronavirus is taxing us to the absolute limit," Huerta said.
Because rural areas have so far been largely spared the infection rates found in major cities like New York, health care providers in smaller communities have had more time to prepare. But with limited financial resources, the impact may still be devastating.
"Think about what this is going to be in the long term impact to our operations at our hospital… while we understand federal relief is coming to our industry, it may only cover a small percentage of the significant losses," Angie Foster, the Chief Nursing Officer at Evanston Regional Hospital in Wyoming said.
Last week, President Donald Trump signed into law the CARES Act, the largest emergency stimulus package in U.S. history. Approximately $100 billion of the $2 trillion package will go toward hospitals' financial needs, with an additional $1.32 billion for community health centers, but it is not clear how those funds will be allocated.
"We don't want more than our fair share, we just don't want to be forgotten," Dr. Mark Bolton, Medical Director at Lost Rivers Medical Center, said.
Several rural hospitals and community health centers that spoke with NBC warned that the funding may not be enough to cover the loss of revenue and it is inevitable that some will be forced to close.
"Even before all this happened, we had a rural hospital crisis in America," Beth O’Connor, director of the Virginia Rural Health Association said, noting over 100 rural hospitals have closed in the last decade. "This situation is going to compound that and make it that much worse."
The impacts on rural communities without these crucial hospitals will be enormous. For many areas, these facilities are the only medical care available within hours of driving.
Foster said a lot of their patients travel "over 45 to 60, 70 miles to access health care… At times, some of those people haven’t sought health care their entire lives and sometimes they’re only coming in before this when they were severely ill."
Preparing for a potential spike has led to some creative problem solving within staff and support from the local communities.
Paula Tomko, CEO of Central Virginia Health Services, put out a call over Facebook for hand sanitizer donations and ended up picking one up from a neighbor.
Many have also turned to telehealth services, where providers can reach patients via video chat. The new stimulus package lifted restrictions on which facilities can utilize telehealth appointments.
But relying on telehealth relies on strong broadband and many rural patients can’t access the service due to poor internet connection or none at all.
"Many of our rural families, and even many of our rural hospitals and clinics, don’t have the bandwidth that they need to be able to participate in telehealth service," O’Connor said, "So when you have something like this pandemic when you would prefer to see someone virtually, it’s just not possible."