COVID-19 has worsened rural health problems in Texas, providers say

Since the start of the COVID-19 pandemic, healthcare systems and hospitals in rural Texas have had to scramble to meet the needs of patients with limited resources, said Lorenzo Serrano, CEO of Winkler County Memorial Hospital, during from a Wednesday panel with health care providers moderated by Texas Tribune CEO Evan Smith.

“The standard of care in rural hospitals — it’s the same as your urban markets,” Serrano said. “We just have to figure out how to do this with less staff, less resources, less financial resources.”

Winkler County Memorial Hospital has nearly 100 employees and serves a county population of approximately 9,000 Texans. The hospital was already facing staffing shortages that the pandemic has exacerbated, Serrano added. He said the hospital had incentivized staff to work double time by agreeing to match pay rates offered by recruitment agencies.

At Coryell Health in Gatesville, tertiary facilities to which doctors often transferred patients were also facing staffing shortages, exacerbating the overall pressure on resources, said Diedra Wuenschel, doctor of osteopathic medicine.

“They run out of beds when they’re understaffed, which means we have to keep patients we wouldn’t normally keep in our rural communities and look after them,” she said.

At the height of the pandemic, there were no beds available in intensive care units, Wuenschel said.

On top of that, medical providers have been strained. Serrano said Winkler County Memorial Hospital also had to respond to “heavy” reporting requests from government officials at the state and federal levels. Wuenschel was getting calls from local schools and daycare centers asking if their COVID-19 measurements indicated they should stop operations.

“I was the one helping them decide if the daycare should close. We were helping everyone navigate it,” Wuenschel said. “It was our job to help them keep everyone in the school district safe as well.”

Health systems have also had to review some of their operations in response to the pandemic. Winkler County Memorial Hospital, for example, has set up drive-thru clinics and a telehealth system to mitigate the spread of the virus, Serrano explained.

But telehealth has worked to some degree, Serrano said. Some communities did not have sufficient broadband access.

“We tried to do telehealth in the traditional way. Unfortunately, we quickly realized that it just wasn’t going to work,” he said. “So we moved to just phone visits.”

The pandemic has also affected the net result of suppliers. From 2020 to 2021, Winkler County Memorial Hospital experienced an approximately $4 million decline in patient care revenue. Federal funding through the CARES Act and state-level grants have helped rural health care providers make up for lost revenue.

Health care leaders said another challenge was addressing vaccine hesitancy in rural communities. Grady “Sam” Hogue, acting chief of the Department of Primary Care and Population Health at Texas A&M College of Medicine, said vaccination efforts have been met with skepticism, especially among black and Latino Texans, because of distrust of institutions.

Providers have tried to counter this mistrust by visiting religious spaces. Hogue, for example, visited an immunization clinic at an African-American Baptist church.

“If you ask them, ‘Why do you get vaccinated?’ the vast majority were receiving the vaccine because their loved ones had died. I can’t tell you how painful it was,” Hogue said. “We need to regain the trust of our patients. We must listen to them, not dictate to them. We need doctors leading health care, not politicians.

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