When the patient arrived in Nashville, the swelling in his abdomen had cut off circulation to his legs. He was immediately sent to the operating room, where he died on the table.
“We have a residency program at Guyana, on the coast of South America,” Russ said. “These are the types of things that [I see] when I go down and work in Guyana. We see this for the Amerindian population that are coming out of the villages and need a canoe to get, you know, to a hospital. This isn’t the type of thing that we’re used to seeing in the United States.”
Tennessee lost over 1,200 staffed hospital beds between 2010 and 2020 despite a population that grew by over half a million, according to the American Hospital Directory and census data. Mississippi, with the most Covid-19 deaths per capita, lost over 1,100 beds over that decade. Alabama, second only to Mississippi in per-capita deaths from the virus, lost over 800.
Those beds would have been critical to statewide systems under the stress of the pandemic, according to doctors and hospital officials. Smaller hospitals often send their most serious patients to larger hospitals, usually in urban areas, for higher levels of specialized care. But large hospitals also send patients to smaller hospitals when they can get the same level of care — especially if staffed beds are in short supply. Without rural hospitals, urban centers were swamped with patients, making transfers more difficult and higher levels of care less accessible.
In Florida, where there have been fewer closures, Tallahassee Memorial Health was able to alleviate the crowding caused by Covid-19 by training staff at smaller hospitals to treat cases that would usually require a higher level of care. Nearby rural hospitals proved to be the key to treating patients through the pandemic.
“We need every single one of them,” Lauren Faison-Clark, administrator for regional development, population health and telemedicine at Tallahassee Memorial HealthCare, said of rural hospitals. “We don’t want everybody coming to Tallahassee for health care.”
If the region had seen significant closures leading up to 2020, Faison-Clark said, Tallahassee hospitals would have likely seen overflowing emergency rooms with beds in hallways and worse outcomes for many patients.
In Mississippi, where officials told drivers to be cautious on the road because of the extreme shortage of beds, closures did lead to a breakdown in levels of care.
“The entire system clogged up,” said Claude Brunson, executive director of the Mississippi State Medical Association. “Without a doubt, there are some patients who died because we did get bottlenecked and couldn’t establish a very good flow of care across the system — because we had lost the numbers of beds that we truly did need.”
In central Tennessee, transfers became such a critical issue that hospitals, including Vanderbilt’s, created a transfer coordination center to maximize the efficiency of the system. But not every state or region has even that advantage.
“We have gotten calls all summer long from Georgia, Alabama, Kentucky, Virginia, West Virginia,” Russ said of Vanderbilt. “Oftentimes, these are small rural hospitals that have called over 50 big hospitals in the Southeast trying to get care for their patient and have been unsuccessful.”
No open beds
In Brownsville, Andrea Bond Johnson — who locally operates an insurance company and ran for the state house — saw the limits of the hospital system first-hand when her parents were ill and waiting for results from their Covid tests.
Her 86-year-old mother was getting weaker, having to take breaks to rest when walking between the bedroom and the kitchen.
“Annie, come here,” her mom yelled from her bedroom. “Something is wrong with my heart.”
Fearing a heart attack, Johnson called 911. Fortunately, they lived near the EMS facility in town. Even more important — and not always the case — there was an ambulance available.