Rural Hospitals under COVID:
Caught in a Vise Grip

Sep 27, 2021

Illinois’ downstate hospital region had ZERO intensive care beds available in mid-September. Hospitals are full, caring for COVID patients sick with the Delta variant. The region has 22 hospitals, with 88 ICU beds, to serve a population of 440,000.

Normally, if one hospital fills up, a patient will be transferred to another nearby. But with all of the area’s hospitals full, doctors and nurses must take other measures. Doctors at Franklin Hospital in rural Benton had to put one patient on a ventilator in the ER. Other patients end up in hospitals hundreds of miles away.

Staffing has been an acute problem. For example, Franklin Hospital has 16 beds, but it can only staff six of them! The media carps endlessly that vaccination is lowest in this portion of the state. True perhaps, but it’s only half of the story.

Further downriver, in Mississippi, 771 medical-surgical and 235 intensive care unit beds went unused in August due to a lack of staff to work them, according to the Mississippi Clarion-Ledger. All this while hospitals around the state filled beyond capacity from the latest surge in Covid patients.

Nurses nationwide have suffered severe burnout, from the pandemic. "[The work] looks heroic," said Nichole Atherton, a nurse who quit from a Gulfport hospital. "But that’s not what it is. It’s sweaty and hard and chaotic and bloody. And it’s hard to live in this every day and then go home and live a normal life." Many nurses eligible for retirement have decided to get out. Add to that the fact that many hospital staff have had to take time off to quarantine or have caught COVID themselves. Over 3,600 healthcare workers, among them 1,200 nurses, died of COVID in the pandemic’s first year in this country.

The nursing shortage existed well before the pandemic. Hospitals have taken up the “Lean Production” model used in the auto industry—where a bed not filled with a patient is a bed that’s not making money. Nurses were made to work long hours with high patient ratios, as part of the drive to bring in revenue.

A “lean” system is not one with any slack to accommodate even a minor crisis—much less a global pandemic. Thus huge gaps opened up under COVID. Large hospitals have been filling these gaps by hiring temporary nurses through staffing agencies. Nurses with any freedom snap up these positions. Small rural hospitals don’t have the money to pay for travel positions—they are left with fewer nurses who are more overworked.

The breach has been partly filled by emergency measures. Illinois’ state government sent 100 healthcare workers to its southern hospitals. Tennessee deployed 200 national guard medics to overwhelmed hospitals. Mississippi is paying millions of dollars to engage 1,100 contract hospital workers. But these healthcare systems were already in dire straits before the pandemic.

More than 100 rural hospitals closed between 2013 and the beginning of 2020. One in four rural facilities is at risk of closure. And many of the beds that do exist are not staffed.

In this society, healthcare is treated as a commodity, that is, a means to make profit: for hospital and healthcare companies, for medical practices, for pharmaceutical companies. There is much more money to be made serving patients who are well off and healthy. In this society, rural areas have lower population, with people who have less money, and are less healthy. But the system sets up healthcare institutions to find the most money for the least expense. Given that, rural healthcare can only be neglected, ignored by this system—how could it be otherwise under capitalism?

COVID has shone a spotlight on the situation of healthcare in this country. It has thrown into bright relief the gap between healthcare for the wealthy and that for the working class. This capitalist society will not, cannot care for the health needs of working people.