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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Vaccine Supply Concerns And Double Shifts: The View From One Rural Hospital

Courtesy of Scotland County Hospital
Scotland County Hospital in Memphis, Missouri serves a four-county area in the northeastern corner of the state.

As vaccine distribution gets going, some rural hospitals are facing uncertainty when it comes to immunizing their staff. Dr. Randy Tobler, the CEO of Scotland County Hospital in rural northeastern Missouri, initially didn't expect to receive the shipment of the Moderna vaccine he ordered for his staff. While it ultimately showed up this week, he fears other rural providers won't be as lucky. 


Randy Tobler: Last night, there was an urgent message that went out through the Department of Health and Senior Services that said that requests that had been made by hospitals like ours for the Moderna vaccine were not going to be honored because they got less shipment than they thought they were going to get from the feds. And so they had to then re-allocate, and because roughly four percent of the cases are in nursing homes and long-term care facilities, yet those patients account for 50 percent of the deaths in the state, they wanted to re-allocate the limited supplies to those areas. We'd made a request for a hundred doses a few weeks ago. Based on the latest information in the call we had today, we understood that nothing was going to be shipped to anyone who had requested it. And lo and behold around 3:30 this afternoon, all 100 doses arrived. And I think what happened was probably they were already in transit through the supply chain, through the distributor. It was a fairly complicated and sort of difficult process to sign up. Apparently our team did a good job of that so we slipped in under the wire before they cut off any further requests being honored. And we were told that we didn't need to return it. They weren't going to claw it back, which I'm very thankful for. So a number of us received our vaccinations this evening, but I know there's an awful lot of CEOs around the state that did not receive their vaccines, especially in the safetynet, rural areas, so I'm really concerned about them. 

Health & Wealth: And so with the delays and shortages, I understand one of the strategies you're pursuing is monoclonal antibodies. Can you explain what they are and how they fit into your plans? 

RT: These are the antibodies that are injected to help coat the virus and reduce the viral load so that the body can take care of it. And it really does very effectively — not 100 percent — but very effectively reduce the progression of the disease in eligible patients that would be at higher risk of going to the hospital or getting admitted and getting on a ventilator and ultimately dying. So in those high-risk people, those over 65 or those under 65 that have comorbidities, it really is helpful to give them an infusion. It only takes about an hour, and then we watch them for another hour and send them home. And we've given about I think a dozen and a half of the doses — everything we've gotten, we get a weekly allocation. Everything we've received we've given and to my knowledge none have been admitted. 

H&W: Earlier in the fall, a lot of the state saw a surge in new COVID-19 cases and hospitalizations. How did that play out for your hospital. 

RT: Yeah I think, when there was a collective peak, I mean our peak was essentially colliding with a prolonged peak and surge we saw in the metropolitan areas along Highway 70. Blessing Hospital where we’re an affiliate of theirs, they were filled, as were our tertiary care referrals, on at least one occasion I know of, and I think there were two others when I was out of town that were challenging for us. We needed to either transfer patients who had deteriorated under our care in the ICU, and we were up to a max — at one point we had seven confirmed cases and one person under investigation in our makeshift isolation are that we had developed way back in the spring and never really tapped in to any great extent, just periodically. But I heard of and can confirm at least one, but I think there were two or three more where there was no room in the inn, in our traditional referral locations. So I know one patient got transferred up to Cedar Rapids to get care, another to Iowa City. So it was quite critical there at one point where we had to step up and give care at a higher level and for a longer time than we ever would've imagined, and then ultimately when we just were out of resources to care for these folks, we had to transfer them to atypical receiving sites for us. 

H&W: I don't want to take up much more of your time but I did want to ask what Christmas will look like at your hospital. 

RT: Tonight I know we're struggling because we have a full house because it's holidays and because people get sick for other reasons and so do their kids. We're desperately trying to locate a nurse because we only have one for our twelve patients. There was a time when, during that surge that surge where because of staffing issues, we were thinking and making contingency plans for having to transfer admitted patients that we otherwise would have been able to take care of, resource-wise, but we didn't have the human resources. The analogy that I've used with staffing in rural hospitals, and this is chronic, has been like a person who has congestive heart failure or has coronary artery disease and they struggle from a cardiac standpoint, and then 'oh by the way, we're going to put you on a stress treadmill test.' And that's what's happened here. 

Sebastián Martínez Valdivia was a health reporter at KBIA and is documentary filmmaker who focuses on access to care in rural and immigrant communities. A native Spanish speaker and lifelong Missouri resident, Sebastián is interested in the often overlooked and under-covered world of immigrant life in the rural midwest. He has a bachelor's degree in broadcast journalism from the University of Missouri and a master's degree in documentary journalism at the same institution. Aside from public health, his other interests include conservation, climate change and ecology.
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