When the patient arrived in Nashville, the swelling in his abdomen had cut off the circulation to his legs. He was immediately sent to the operating room, where he died on the table.
“We have a residency program in Guyana on the coast of South America,” Russ said. “It’s the kind of thing that [I see] when I go down and work in Guyana. We see this for the Indian people who are coming out of the villages and need a canoe to get, you know, to a hospital. That’s not the kind of thing we’re used to seeing in the United States. “
Tennessee lost over 1,200 manned 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 per capita, lost over 1,100 beds during that decade. Alabama, second only to the Mississippi in deaths per capita per capita from the virus, lost over 800.
These beds would have been critical for nationwide 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 a higher level of specialized care. But large hospitals also send patients to smaller hospitals when they can get the same level of care – especially if there is a shortage of staffed beds. Without rural hospitals, urban centers were flooded 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 congestion caused by Covid-19 by training staff in smaller hospitals to treat cases that would normally require a higher level of care. Nearby hospitals proved to be the key to treating patients through the pandemic.
“We need every single one of them,” Lauren Faison-Clark, regional development, population health and telemedicine administrator at Tallahassee Memorial HealthCare, said of rural hospitals. “We do not want everyone to come to Tallahassee for health care.”
If the region had seen significant closures by 2020, Faison-Clark said, Tallahassee hospitals would likely have seen overcrowded emergency rooms with beds in hallways and worse outcomes for many patients.
In Mississippi, where officials told drivers to be careful on the road due to the extreme shortage of beds, closures led to a breakdown in care levels.
“The whole system was clogged,” said Claude Brunson, executive director of the Mississippi State Medical Association. “Without a doubt, there are some patients who died because we got bottlenecks and could not establish a very good flow of care across the system – because we had lost the number of beds we really needed.”
In central Tennessee, transfers became such a critical issue that hospitals, including Vanderbilts, set up a transfer coordination center to maximize the efficiency of the system. But not every state or region even has that advantage.
“We’ve been getting calls all summer from Georgia, Alabama, Kentucky, Virginia, West Virginia,” Russ said of Vanderbilt. “Often, these are small hospitals in the countryside that have called over 50 large hospitals in the southeastern part of the attempt to get care for their patient and have been unsuccessful.”
No open beds
In Brownsville, Andrea Bond Johnson – who locally runs an insurance company and ran for State House – saw the limits of the hospital system first hand when her parents were ill, waiting for results from their Covid tests.
Her 86-year-old mother became weaker and had to take breaks to rest as she walked between the bedroom and the kitchen.
“Annie, come here,” cried her mother from her bedroom. “There’s something wrong with my heart.”
Fearing a heart attack, Johnson called 911. Fortunately, they lived near the EMS facility in town. More importantly – and not always the case – there was an ambulance available.