Then last week, other large American cities, including Detroit, New Orleans, Chicago and Atlanta, saw the giant wave crash over them. The endless stream of new, very sick patients. The lack of tests, masks, gowns and ventilators.
The hope that the outbreak might be just an urban phenomenon seemed plausible for a brief moment. Indeed, last Monday plans for an Easter “re-opening for business” were floated, until reality dashed the plan on March 29.
The outbreak there revealed a likely problem for the next wave of affected areas. Unlike the large cities — Seattle and New York City among them — Albany has just one hospital network. It has strained to meet the challenge and marshaled forces from the region. Yet other cities and towns now feeling the early surge of cases may lack specialists, intensive care beds, a cadre of well-trained nurses and a full-time municipal government capable of coordinating a community-wide response.
Across the Mississippi River sits Jackson, Mississippi, a city of about 170,000 and the state capital.
The appearance of so many cases in so many towns points to the next crisis for health care delivery. Hospitals in rural areas generally provide basic emergency and medical-surgical care, then refer more complex patients or those needing higher-tech care to a large city, often one with a medical school. If the large city finds itself overmatched by a certain problem, it will in turn arrange transfer to a regional super-specialty medical center.
This system is held together by ambulances, helicopters, airplanes, goodwill — and the assumption that there will always be capacity at the next level hospital.
The Covid-19 pandemic has changed that. A hospital like Cleveland Area Hospital might soon reach out to a medical center in Oklahoma City or Tulsa to transfer a Covid-19 patient in need of ICU care. But the ICUs in those large medical centers will likely soon be full of patients with Covid-19 — and their outreach to super-specialty institutions in Houston or Dallas will in short order produce the same problem of ICU gridlock.
This may mean that medical personnel at small community hospitals with nowhere else to turn will be left managing critically ill patients using equipment they are not familiar with, all the while worrying that they might catch the infection from the patient.
As has been said, the pandemic is revealing the many strengths and weaknesses of the US health care system. It is a tragedy that major cities are overwhelmed — treating too many patients with too little equipment and protection.
Yet the disruption of the well-established chain of care that goes from community hospital to local major medical center, then to regional super-specialty care may result in the largest tragedy of all.