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For as long as it’s been around, Siler City has been the epitome of small-town America.
Chartered in 1887, the town — current population about 7,800 — has been home to Main Street merchants and agricultural workers. In the 1960s, it enjoyed 90 minutes of fame on three episodes of “The Andy Griffith Show.”
With work at the area’s poultry processing plant drawing an influx of Latinos, a new definition of small-town USA emerged in the early 2000s. Siler City’s first predominantly Latino high school soccer team hustled its way to a state championship. Immigrants now comprise about half the town’s population.
But innocence in rural America is turning into hard facts as Siler City’s residents, new and old, cast a wary eye on COVID-19, the disease caused by the new coronavirus.
Chatham Hospital, a 25-bed critical access facility, is the town’s first line of defense.
With a 10-bed emergency department and a four-bed intensive care unit, Chatham Hospital is part of the 11-hospital nonprofit UNC Health Care system, whose campus in Chapel Hill is 45 minutes away. Chatham provides medical, surgical, pediatric and emergency services along with outpatient services that include cardiac and pulmonary rehabilitation.
According to 2017 census estimates, about one-quarter of Chatham County’s population is age 65 and older, the demographic group most vulnerable to COVID-19.
Stretching supplies at hospitals
As the number of positive cases of the disease climbs in North Carolina, rural hospitals like Chatham are preparing for the worst and hoping for something less than that.
Dr. Jeffrey Strickler, a 17-year veteran of UNC Health Care who is Chatham Hospital’s president, said the hospital has already received a state waiver so it can adjust bed space in anticipation of additional demand.
“This plan will enable us to double our ICU capability. This doubling is matching projections on expected patient surge,” Strickler said.
The state’s waiver allows the hospital to use preoperative, postoperative and operating room beds for any inpatient admissions, and any of the beds can be used as ICU beds as necessary.
Chatham’s supply of personal protective gear — face guards, masks, gloves and gowns that help keep physicians and nurses healthy — is “adequate,” Strickler said.
Like all hospitals, Chatham is trying to conserve as much protective equipment as possible.
“We have more than one week of use on-site with another cache of supply stored off-site,” Strickler said in an email exchange with Carolina Public Press. Beyond that, he said, the hospital can receive additional gear from a central warehouse operated by UNC Health.
Recently, Samaritan’s Purse, the faith-based charity headed by Franklin Graham, donated 10,000 masks to UNC Health as part of 55,000 masks that it provided to hospitals statewide.
In addition, Chatham is asking physicians to engage in telemedicine, allowing doctors and patients to stay at home and remain safe.
“We are working with UNC Health to see if this capability can be increased,” Strickler noted.
Ventilators — the single most important piece of equipment for a critical COVID-19 patient — have his full attention.
“We have several ready for use and have the ability to use ventilators from our operating room. This number would probably be adequate for our needs,” he estimated.
But if critical cases mount at Chatham and with a helicopter based on the grounds, “Patients that require the most intensive critical care could be transferred to UNC Medical Center in Chapel Hill.”
The financial cost of coronavirus for hospitals
Last month, when the N.C. Department of Health and Human Services asked hospitals to postpone elective surgeries due to an uptick in COVID-19 cases, hospital executives realized there would be a price to pay for the greater good.
“Chatham Hospital has followed the guidance of UNC Health to stop elective surgeries in an effort to minimize contact for patients, families and visitors, and conserve resources,” Strickler said.
“We remain able to perform urgent surgery, but that volume for a rural hospital is negligible.
“This loss of procedure volume will ultimately represent a significant reduction in revenue for a hospital already operating on a negative margin. It is only through the investment by UNC Health in this community that we are able to remain in place to serve our residents.”
“UNC Health is committed to keeping Chatham Hospital operating and continuing to provide much-needed medical care for all residents of that region,” spokesperson Alan Wolf said.
Wolf said UNC Health is looking at ways to expand services in Siler City, including “bringing back maternity services and delivering babies at the hospital later this year.”
Rural hospitals in NC
Other rural hospitals in North Carolina have been less fortunate than Chatham.
Since 2005, 11 rural hospitals with a total of 361 beds have closed, according to data from The Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill.
Nationally, during the same period, 170 rural hospitals shut down.
According to the center’s research, reasons for these shutdowns vary by location but include lost population within a service area, a reduction in revenue-producing inpatient stays as a result of changes in technology, the bypassing of community hospitals by some patients in favor of more regional ones and the exclusion of some rural hospitals by larger health systems when making referrals.
To the west of Siler City, Randolph Health, an independent community hospital in Asheboro, is the latest facility facing such challenges.
In March, the 145-bed hospital filed for Chapter 11 bankruptcy protection to soften the impact of its debt load, allow it to reorganize and pave the way for a future partnership or acquisition. The hospital and its outpatient services remain open.
Randolph Health’s financial woes, which go back several years, are exacerbated by the mandate to postpone elective surgeries.
Randolph is waiting on approval of a $20 million loan from the state’s Rural Health Stabilization Program as it moves through bankruptcy.
The view from the west
As Chatham Hospital and Randolph Health navigate coronavirus in the Piedmont, a locally owned independent hospital in North Carolina’s foothills also grapples with the pandemic.
Michelle Fortune, CEO of St. Luke’s Hospital in the Polk County town of Columbus, echoed Strickler’s comment that some small-town hospitals may be skating on thin financial ice.
“I have heard from colleagues across the country in other critical access hospitals that they fear they may fall into bankruptcy or closure if the financial losses continue for an extended period of time,” Fortune said.
“Critical access hospitals like ours operate on a thin or negative operating margin on a usual basis,” she added. “The elimination of elective procedures has a large negative impact on facilities like ours.”
St. Luke’s uses Charlotte-based Atrium Health for volume purchasing, provider and payer contracting, and other resources.
For the moment, St. Luke’s is asking businesses with personal protective gear to donate some of their stock and is expanding the number of telemedicine visits it makes with patients.
It is also filing a waiver request with the state to increase its ICU capacity.
“What is known is that if the curve is not flattened, we are headed in a direction that indicates nationally we will greatly strain all of our health care resources,” Fortune said.
Editor’s note: This article, which features the hospital in Siler City, was developed in collaboration with The Chatham News & Record as part of Carolina Public Press’ Emergency News Team initiative.