"We're fighting a global pandemic in the dark": The coronavirus challenge in rural Colorado

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Posted at 2:09 PM, Mar 31, 2020
and last updated 2020-03-31 16:39:40-04

LA PLATA COUNTY, Colo. — More people were tested for the coronavirus in rural southwestern Colorado on Tuesday, but the overall lack of tests available has left officials unsure how much COVID-19 has spread in the community, where hospital capacity is limited to just dozens of beds.

"We're fighting a global pandemic in the dark," said Liane Jollon, the executive director of San Juan Basin Public Health, which serves about 70,000 residents in Archuleta and La Plata counties, including Pagosa Springs and Durango.

As of Tuesday, there were 23 coronavirus cases in La Plata County and one in Archuleta County.

But testing has been rare in the area, and officials have said the actual number of coronavirus cases is likely higher.

"We've been fairly certain we've had widespread community infection for a while now," said La Plata County Commissioner Gwen Lachelt, who represents the county on the San Juan Basin Public Health board. "We absolutely have to have adequate community-wide testing available as soon as possible."

At first, testing was limited to those with a travel history. Now, the tests are being reserved for those deemed high-risk.

Drive-through testing was held at Pagosa Springs Medical Center on Tuesday, but only about 30-40 tests were available and the kits were limited to healthcare or long-term care workers, first responders, older adults and those with underlying health conditions.

Similar criteria were required for a drive-through testing facility at the La Plata County Fairgrounds on March 20 and 21, when about 100 tests were administered.

Jollon said San Juan Basin Public Health has received about 100 test kits from the Colorado Department of Public Health and Environment and the remaining 30-40 kits from healthcare providers in the area, in an effort to consolidate testing.

But more tests are needed, Jollon said, and delays in lab processing has led to difficulties getting quick results. When a positive result is received, the health department works on tracing who the patient has contacted, including family members.

Another concern in the San Juan Basin has been the outbreak of coronavirus cases in the nearby Navajo Nation. Fifteen cases have been identified in San Juan County, New Mexico, across the state border from La Plata County, and Jollon said the communities are close enough that some residents travel back and forth for work.

The fear from San Juan Basin officials centers on what might happen if the San Juan Basin sees a surge in patients in coming weeks. Jollon said it appears the San Juan Basin's expected peak for cases — the "curve" formed as cases increase — could happen after the peak of cases in more populous areas of the state and in other mountain towns.

If that happened, healthcare resources across the state would already be tied up, leaving San Juan Basin providers to shoulder the burden on their own. Two hospitals serve the two counties: Mercy Regional Medical Center in Durango, with 82 licensed beds, and Pagosa Springs Medical Center, with 11 beds.

"If the healthcare need surges past our capacity, we will have no options," Jollon said.

Adding to the strain on rural hospitals is the lack of elective surgeries, most of which were put on hold amid the coronavirus outbreak. Many rural hospitals in Colorado were already operating on negative margins before the outbreak, according to the Colorado Hospital Association, and elective surgeries are an important revenue source. Hospitals are also spending more money on coronavirus preparedness.

"The combination of that lost revenue and increased spending has been incredibly difficult for a number of hospitals," the Colorado Hospital Association said in a statement.

Lachelt pleaded with Coloradans to abide by the statewide stay-at-home order issued last week, including residents who might want to visit public lands in the Durango area.

"If we don't slow the spread, we will absolutely, overnight, overwhelm our hospital bed situation," Lachelt said. "Take this seriously. The life you're saving may be your own."

San Juan Basin Public Health is working with the hospitals to take inventory of personal protective equipment and plan staffing, if cases surge. The department is also monitoring residential facilities and working a call center for residents with questions about the virus.

"We're planning for a medical surge, also in the dark," Jollon said. "The key right now for disease control is testing."