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Just a matter of time: Hospital-poor rural Missouri braces for the coronavirus
JUST A MATTER OF TIME

Just a matter of time: Hospital-poor rural Missouri braces for the coronavirus

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ELLINGTON, Mo. — There has always been a trade-off in Reynolds County, where it is as rugged as it is isolated. Residents often drive long distances to buy new boots, phones and cars. Then they get to leave the bustle behind and retreat back to their way of life in the Mark Twain National Forest and other woods.

“That is my church sometimes,” Frances Vermillion, director of the Reynolds County Health Center, a public clinic, said of the rivers and trees.

The coronavirus threat has thrown a wrench into the sense of peace where the biggest town in the county, Ellington, has 987 people. They can’t just leave the city behind them on this one.

Frances Vermillion is the director of the Reynolds County Health Center, a public clinic in tiny Centerville, Missouri. Photo taken March 26, …

Each trip to a regional center like Salem, Poplar Bluff and Farmington increases the risk of bringing infection back home. Though test results have been slow to come back, there have been no reported cases of COVID-19 in Reynolds County.

Vermillion thinks it’s just a matter of time because, as remote as it is, residents do travel to places that are scrambling to contain the virus, including the St. Louis area, which had reported roughly 500 positive cases and six deaths as of Saturday evening.

“Even though we are little old country people, we still go places,” she said. “We won’t be immune. We have people that cruise. We have people that go to Florida for spring training. Right now we just need to be careful of who we are with and our surroundings.”

On Wednesday, announcing a request for federal disaster assistance, Republican Gov. Mike Parson said he foresees statewide impact.

“Although it is continuing to develop, it’s already clear the COVID-19 pandemic will have a more sweeping impact on the entire state of Missouri than any other previous disaster that has affected our citizens,” Parson said in a news release. “There is an urgent need for federal assistance to help Missouri families meet today’s challenges and the many more that we will face.”

While the independent spirit of people in places like this will likely slow the spread of disease — many refuse to go to the hospital unless it’s dire — they are also poised to possibly suffer because they don’t have a close option anymore.

Southeast Health Center of Reynolds County closed in 2016. Missouri Highlands Health Care still has a network of federally funded clinics, but no hospital beds exist anymore.

“It’s just a way of life down here,” said Kim Corder, 69, owner of Ellington Auto Supply.

Joe Loyd, presiding commissioner of Reynolds County, also focused on the positive.

“I would feel better if we did have a hospital, but the situation is what it is and we are just going to deal with it,” he said. “That is just kind of the trade-off of living where we live.”

According to news reports at the time of the closing in 2016, Southeast Health had owned the hospital just since 2013 and had recently found out from state Medicaid officials that the previous owner, Advanced Healthcare Management Services LLC, owed $6 million and that patient loads were slim.

The building hunkers on the edge of Ellington as a reminder of what once was. Built in 1978, it’s empty and falling apart. Should anyone be confused about whether it’s in operation, a sign at the former emergency room redirects people to the nearest hospitals, which are about an hour away.

Nearest hospital: 44½ miles away

An emergency room door at the former Southeast Health Center of Reynolds County on Thursday, March 26, 2020, in Ellington, Missouri. After it closed in 2016, there were no more hospital beds left in the rural county. As the sign says, the nearest hospital is about an hour away. Photo by Jesse Bogan, jbogan@post-dispatch.com

Inside the front doorway, another sign hangs for nobody to see. Stop the spread of germs, it encourages: “WASH your hands!”

‘Time is a factor’

Fifteen hospitals have closed in Missouri since 2014; a third of them were in southeastern counties: Reynolds, Ripley, Dunklin, Butler and St. Francois.

“You have to have a game plan, where you are going to go,” said Kim Hughes, interim director of the Dunklin County Health Department in Kennett, a city of 11,400 that lost Twin Rivers Regional Medical Center in 2018.

She said not having a hospital in the immediate area brings anxiety.

“I have a mother that had a stroke several years ago,” she said. “If we hadn’t had a community hospital, she may not have been here today or been able to speak. Time is a factor.”

Ambulance crews feel the stress.

David Joiner, executive director of the Ripley County Ambulance District in Doniphan, said not having a hospital there has made it much more difficult because all of his patients must be transported at least 30 miles to the nearest facility, which is usually Poplar Bluff Regional Medical Center.

“Poplar Bluff is having their own issues, as several months ago St. Francis HealthCare System shut down the only other public hospital in the Poplar Bluff area,” he said.

John J. Pershing VA Medical Center is also in Poplar Bluff, but Joiner said he can’t transport people there, even veterans, because the facility has only an urgent care, not an emergency department.

“Our biggest concern so far during the COVID-19 crisis has been safety of our personnel,” he said. “Fortunately, to date we have not had any patients who have tested positive, but a few that have been symptomatic and tested negative.”

Joiner said they are treating each patient with telltale symptoms as if they have the virus. That means using masks and other personal protective equipment, or PPE, for short.

“The downside is that we, like many services, have worried about having enough PPE to protect our staff,” he said.

Poplar Bluff Regional Medical Center, which is leaned on to pick up a lot of slack in the area, declined to say how many ICU beds and ventilators it has, or whether it is pursuing more.

“Our hospital continually works to be prepared for all types of infectious diseases such as measles, flu or new viruses like coronavirus,” Chief Executive Bryan Bateman said through a spokeswoman. “We are taking proactive steps to prepare for the protection of patients, our caregivers and the community, and monitoring ongoing COVID-19 updates from the Centers for Disease Control and Prevention.”

Unnerving

Monitoring the statistics can make most people anxious, but without any confirmed cases in Reynolds County, there seems to be less immediacy.

“When you pull out of your driveway at 3:30 in the morning and you don’t get back until 6:30 or 7 in the evening, at my age, you don’t have much energy to go anywhere else,” Dan Chitwood, 46, owner of CCC Logging, said of his effort to avoid crowds, which meant continuing to cut and haul timber.

Shawn McMurry, 50, on the left, and Dan Chitwood, 46, owner of CCC Logging, take a short break in the Dollar General parking lot on Thursday, …

One couple, Johnell and Floyd Smith, thought their 100 acres would be a good buffer.

“We live in the woods,” said Johnell, 56. “We aren’t around people.”

“We do social distancing every day,” added Floyd, 70.

At that moment, they were both en route to help a stranger whose vehicle was stuck in a gravel creek crossing.

Lee Foster, 55, continues to work as a mechanic in a lead mine.

“We are maintaining our distance as much as possible,” he said of being underground during his 4 a.m. to 2 p.m. shift.

On the home front, he and his wife, Pam, have been watching grandchildren the past couple of weeks, so their two daughters can focus on being a nurse and physician assistant near Springfield, which has logged positive cases of COVID-19.

Time with the grandparents

Lee Foster, 55, pitches to his grandson, Mason Baker, 8, on Thursday, March 26, 2020, at a park in Ellington, Missouri, while Pam Foster, 54, plays volleyball with her granddaughter, Addison Baker, 11, in the outfield. The grandchildren were staying with Lee and Pam while their mother was busy at work as a physician assistant. Photo by Jesse Bogan, jbogan@post-dispatch.com

Loyd, presiding commissioner in Reynolds County, said the biggest problem they’ve had is misinformation posted on social media.

“People are taking it a lot more seriously than they did three weeks ago,” he said.

He said many residents are staying home and respecting requests for social distancing. Some businesses have cut back services. The pharmacy is only drive-thru. There’s a drop box for mail at the county courthouse in Centerville; appointments are needed, if anybody needs to come inside. The only nursing home in the county isn’t allowing visitors.

Should health emergencies arise, residents will continue to rely on their own vehicles and emergency services to get where they need to go. If regional hospitals get backed up, Loyd said school buildings in each town could possibly serve as makeshift overflows.

The former hospital, which closed in 2016, isn’t a viable option. It’s falling apart and may have mold. Regardless, Vermillion, the county public health director, sees another obstacle.

Shut down in 2016

The former Southeast Health Center of Reynolds County on Thursday, March 26, 2020, in Ellington, Missouri. After it closed in 2016, there were no more hospital beds left in the rural county. The nearest hospital is about an hour away. Photo by Jesse Bogan, jbogan@post-dispatch.com

“You still need to have the workforce. We’d need nurses and nurse aides and kitchen and housekeeping — all that stuff,” she said of housing sick people.

She said waiting for the coronavirus to reach the remote area is unnerving for her and others.

“This really makes my stomach hurt,” she said. “Of course, I have never experienced anything like this. No one has.”

The 65-year-old yearned for a time when the phones would stop ringing and there would be a chance for another Sunday drive through the country, where the forsythia bushes are in bloom and clean air blows through the trees.

A few days later, the first positive case of COVID-19 was reported by her counterpart in neighboring Carter County — population 6,200.

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