• Written by Lauren Hughes, Physician, Associate Professor of Family Medicine, University of Colorado Anschutz Medical Campus

It’s difficult to put into words how hard COVID-19 is hitting rural America’s hospitals. North Dakota has so many cases, it’s allowing asymptomatic COVID-19-positive nurses to continue caring[1] for patients to keep the hospitals staffed. Iowa[2] and South Dakota[3] have teetered on the edge of running out of hospital capacity.

Yet in many communities, the initial cooperation and goodwill seen early in the pandemic have given way to COVID-19 fatigue and anger[4], making it hard to implement and enforce public health measures, like wearing face masks[5], that can reduce the disease’s spread.

Rural health care systems entered the pandemic in already precarious financial positions[6]. Over the years, shifting demographics, declining revenue and increasing operating expenses have made it harder for rural hospitals to stay [7]in business[8]. The pandemic has made it even more difficult. In mid-March, most rural hospitals halted elective procedures[9] to slow the spread of the virus, cutting their revenue further, and many have faced price gouging[10] for supplies given extreme shortages.

I work with rural doctors and hospital administrators across the country as a researcher, and I see the stress they’re under from the pandemic. Here is what two of them – Konnie Martin, chief executive officer at San Luis Valley Health in Alamosa, Colorado, and Dr. Jennifer Bacani McKenney, who practices family medicine in Fredonia, Kansas – are facing. Their experiences reflect what others are going through and how rural communities are innovating[11] under extraordinary pressure.

I’ll let them explain in their own words.

Konnie Martin, Alamosa, Colorado

COVID-19 fatigue is real. It’s wearing on people. Everyone wishes we were past this. I read the other day about health care workers being the “keeper of fears.” During COVID-19, patients have disproportionately placed their fears on clinicians, many of whom experience the same fears themselves. I focus on building resilience, but it’s hard.

My hospital currently has seven patients with COVID-19 and can make room for as many as 12. Back in the spring, we converted a visiting specialist center into a temporary respiratory clinic[12] to keep potentially infectious patients separate and reduce pressure on our emergency department.

It’s all about making sure we have enough staff and hospital capacity.

There isn’t any hospital that isn’t under siege, which means that getting patients to the right level of care can be a challenge. In the past few days, we have accepted three transfers from facilities that are on the front range. We’ve never had to do this before. With six ICU beds and 10 ventilators, we are trying to help others.

Konnie Martin Konnie Martin, CEO of San Luis Valley Health. Courtesy of Konnie Martin, Author provided

Influenza hasn’t arrived yet in our community, and I worry about when it comes. We have nearly 40 staff out right now on isolation or quarantine, a staggering number for a small facility. We are having to shift staffing coverage in half-day increments to keep up.

We are not at a point where we are even contemplating bringing COVID-19-positive staff back to work, like the governor of North Dakota suggested[13]. I hope we never get there. We are, however, considering high-risk versus low-risk exposures. If a clinician is exposed to COVID-19 during an aerosolizing medical procedure, that’s high risk. If a clinician is exposed in a classroom of 50 people who were all socially distanced and wearing masks, that’s low risk. If we face critical workforce needs[14], we may bring back health care workers that have had low-risk exposures.

We have gained a lot of knowledge this year, and we all feel wiser now, but definitely older, too.

Dr. Jennifer Bacani McKenney, Fredonia, Kansas

We chose to live in a rural community because we look out for one another. Our one grocery store will deliver to your home. Our sheriff’s department will drive medications outside of city limits. If we could return to our rural values of caring for and protecting one another we would be in a better position. Somewhere along the way, these values took a back seat to politics and fear.

Wilson County[15], where I practice in Southeast Kansas, didn’t see its first COVID-19 case until April 15. By August, you could still count the number of cases on two hands. But by mid-November, the total was over 215 cases[16] in a county with a population of about 8,500 – meaning about one out of every 40 residents has been infected.

Our 25-bed critical-access hospital doesn’t have dedicated ICU beds, and it has only two ventilators. Emergency department calls are split among the five physicians in Fredonia. In addition to dealing with COVID-19 cases, we’re managing every other illness and injury that walks through the door, including strokes, heart attacks, traumatic injuries and rattlesnake bites.

We have sectioned off a hallway of rooms for suspected COVID-19 cases. Without an ICU, however, we have to rely on other hospitals. Recently, my partner had to transfer a patient who had a gastrointestinal bleed. She had to call 11 different hospitals to find one that could take the patient.

I feel lucky to have on-site testing in the hospital lab. But like many of my rural peers, getting enough face masks and other personal protective equipment early on was tough.

Rural hospitals are under siege from COVID-19 – here's what doctors are facing, in their own words Dr. Jennifer Bacani McKenney. Courtesy of Dr. Jennifer Bacani McKenney, Author provided

The community is tired, frustrated and stubborn. Politicians talk about relying on personal responsibility[17] to end the pandemic, but I don’t see a majority of people wearing masks in public spaces despite pleas from health professionals. Some people are scared. Others act as if COVID-19 doesn’t exist.

Politics is making things harder. I have been Wilson County’s health officer[18] for the past eight years. This year, county commissioners gained more control[19] over COVID-19 health decisions.

When I proposed a mask mandate early in the pandemic, one county commissioner argued it would violate his rights. Another commissioner balked at one of my reports, saying I had no right to tell schools how to evaluate kids before they can return to sports, despite the health risks.[20]

I recently proposed a new mask mandate given our rising numbers[21]. I explained that masks would not only save lives, they would help businesses stay open and keep employees at work. The commissioners voted it down 3-0.

Preparing for the next pandemic

We live in an interconnected world where commerce and people cross state and national borders, and with that comes the risk of new diseases. America will face another pandemic in the future[22].

Rural health care delivery systems can leverage lessons from COVID-19 to prepare. Among other things, their emergency preparedness “tabletop exercises[23]” can include planning for infectious disease outbreaks, in addition to fire and floods; mass casualty incidents; and chemical spills.

They can permanently diversify supply chain options from other industries, such as construction and agriculture, to help ensure access to needed supplies[24]. To avoid staff and supply shortages, they can create regional rural health care networks[25] for swapping staff, conducting testing and acquiring supplies.

Meanwhile, rural doctors and health care administrators are being as flexible and resourceful as they can in the face of adversity.

[Understand new developments in science, health and technology, each week. Subscribe to The Conversation’s science newsletter[26].]


  1. ^ COVID-19-positive nurses to continue caring (
  2. ^ Iowa (
  3. ^ South Dakota (
  4. ^ COVID-19 fatigue and anger (
  5. ^ like wearing face masks (
  6. ^ precarious financial positions (
  7. ^ made it harder for rural hospitals to stay (
  8. ^ in business (
  9. ^ halted elective procedures (
  10. ^ faced price gouging (
  11. ^ rural communities are innovating (
  12. ^ temporary respiratory clinic (
  13. ^ like the governor of North Dakota suggested (
  14. ^ critical workforce needs (
  15. ^ Wilson County (
  16. ^ 215 cases (
  17. ^ relying on personal responsibility (
  18. ^ Wilson County’s health officer (
  19. ^ gained more control (
  20. ^ despite the health risks. (
  21. ^ our rising numbers (
  22. ^ another pandemic in the future (
  23. ^ tabletop exercises (
  24. ^ ensure access to needed supplies (
  25. ^ regional rural health care networks (
  26. ^ Subscribe to The Conversation’s science newsletter (

Authors: Lauren Hughes, Physician, Associate Professor of Family Medicine, University of Colorado Anschutz Medical Campus

Read more

Metropolitan republishes selected articles from The Conversation USA with permission

Visit The Conversation to see more

Entertainment News


DIVAS Simply Singing!, the longest consecutive running musical AIDS benefit in the United States, hits a major milestone in 2020, hosting its 30th annual fundraiser for The D.I.V.A. Foundation as a virtual event and on Saturday, December 5th on K...

News Co - avatar News Co


“Together” As the go-to special show and traveling drummer for Chuck Berry for many years, Michael Mesey had a blast creating explosive moments on stage with the legendary musical pioneer all over the country. Yet one of his most cherished me...

News Co - avatar News Co

Actress Paris Hepburn Fights Through Covid Crisis

The entertainment industry has been hard hit in 2019 as we all know.  Since Covid-19 started entering the US in January 2019, one by one, movie studios, talent agencies, actors, crews and everything else associated with the entertainment industry...

News Co - avatar News Co

Why You Should Explore Your Creativity

You might think that you weren’t fortunate enough to be gifted at birth with creativity. You might say, “Oh, my brother got the creative genes, and I didn’t,” or “Why would I want to be creative”? Someone once asked me that last question, to whi...

Angela Predhomme - avatar Angela Predhomme

What does being the Happiness Warrior mean to me?

I’ve always felt I’ve had an innate need to set things right. If I see someone or something struggling, my nature is to help. I want them to feel good about themselves and their abilities but most importantly to find the best solution that make...

Eric North aka “The Happiness Warrior” - avatar Eric North aka “The Happiness Warrior”


Ben Kingsley's character Cosmo in the 1992 cult classic Sneakers prophetically quipped , The world doesn't operate on reality, but on perception of reality. Those words have come to roost in this year 2020 as we find ourselves living in a world ...

Brandyn Cross - avatar Brandyn Cross

Metropolitan Business News

5 Key Factors To Starting A Website

Every business needs a website to be successful. However, this is a challenge for many due to the lack of coding and designing skills. The good news is, you do have a way around this—hire a deve...

News Co - avatar News Co

So You Want To Be A Project Manager? Here's What You Must Do

Project management is often a popular choice for people looking to make a mark in the organizations they work for. It's a great choice as well. If you hate monotony, love getting people and res...

News Co - avatar News Co

How to Deliver the Perfect Elevator Pitch

Do you struggle with explaining your career with professional or personal contacts, and you want to make a lasting impression? Whether you're looking for a job or building up your network, a wel...

Adam Jacobs - avatar Adam Jacobs

Three Asian Countries That are Leaders in Outsourcing

Would it surprise you to know that three of the top five ranked countries for ease of doing business are in Asia? Would it surprise you more to know that India and China aren’t even in the top 3...

Adam Jacobs - avatar Adam Jacobs

FCB and oOh! help Kiwis vote with dynamic campaign for Electoral Commission

oOh!media and FCB NZ are helping Kiwi voters exercise their democratic rights this general election, via a localised dynamic Out of Home campaign for the New Zealand Electoral Commission. The c...

Lighthouse Communications. - avatar Lighthouse Communications.


In 2019, just as his multi-faceted career was taking off, Thorn Castillo heard Robert Downey Jr. offer a sage bit of advice during an interview on photographer/director Sam Jones’ acclaimed multi-...

News Company - avatar News Company

Writers Wanted

News Co Media Group

Content & Technology Connecting Global Audiences

More Information - Less Opinion