In a rural Pennsylvania community, the struggle isn’t just about a deadly virus. It involves hospital cuts, vaccine fears and sometimes a few miracles.
Dennis Reigel was dying when a nurse called his wife Susan in October, suggesting she should come soon to UPMC Hamot Hospital in Erie.
When she arrived the next morning with other family members, the 72-year-old Mr. Reigel was lethargic, his eyes yellow. Dr. Asif Shakoor asked to see the family outside the intensive care unit.
“He said, ‘It’s not working,’” Ms. Reigel recalled the doctor telling her. “COVID is taking over his lungs. He’s drowning in his fluids. We have to make a decision.”
The decision was whether to connect the struggling patient to a breathing machine to push oxygen directly into his damaged lungs. Even with the intubation, there was no guarantee he would live.
“I told him, no, Denny didn’t want that,” said Ms. Reigel, 63, his wife of 22 years. “I said, OK, just make him comfortable. I was scared, I was scared. I told everybody it’s in God’s hands.”
Two relatives had already died from the disease, one of whom had gotten a COVID-19 vaccine. Neither of the Reigels had been vaccinated.
Ms. Reigel broke down with her family. The doctor cried with them in the hall.
A public health crisis
COVID-19 is on a rampage again across the country, surging along with the return of cold weather. Heavily forested McKean County where the Reigels live is at higher risk of sickness and death from the disease than more urban parts of the state. An older population and shrinking medical resources are partly to blame.
Plus, less than half those eligible in McKean County have been vaccinated against COVID-19.
It’s creating an often unnoticed, slow moving public health crisis in northwest Pennsylvania, three hours from Pittsburgh.
“This part of the state is so overlooked — no decent highways, no internet,” said Marty Wilder, the retired managing editor of a local newspaper, the Bradford Era, who lives in Corydon Township, population 266. “We’re very isolated.”
McKean County, with its hunting camps, hand-painted bait and tackle shop signs and twisting roads, has a do-it-yourself vibe that was born in the county’s earliest days two centuries ago. Even today, distrust of big government is the rule in little towns dotting the region, along with a belief in looking out for your neighbor.
Have your car break down on the side of the road and you can be assured someone will soon stop to help, Ms. Wilder said. A neighbor recently stopped by uninvited to plow her driveway after a snowstorm.
But small town life is also a complicating factor when it comes to the coronavirus, a new study found.
For the week ending Dec. 1, COVID-19 incidence and mortality rates were far higher in nonmetropolitan than metro areas of Pennsylvania, according to the Rural Policy Research Institute at the University of Iowa. During that period, the number of deaths from COVID-19 since April 2020 were 30% higher in rural compared to urban parts of the state, a disparity found nationwide.
Shrinking access to medical care, populations that tend to be older and sicker, and lower rates of vaccination account for the differences in rates, according to the research institute.
Like surrounding Warren and Potter counties along the New York border, McKean’s population skews older and more impoverished than Pennsylvania overall — 20% are age 65 or older, compared to 18.7% in Pennsylvania, and the county poverty rate is 16.8% compared to 12.8% statewide, according to the Centers for Disease Control and Prevention.
Last year, rural America was mostly insulated from COVID-19. Now, the virus has seeped into small towns where many people still wonder whether vaccines are the right call.
“Right now, small towns are in hunger games for who will survive,” said Margie Satterwhite Brown, 53, an adjunct professor at the University of Pittsburgh Bradford campus who lives in Elk County. “The propaganda here is pretty strong against vaccines. It didn’t have to be this way.”
Data show 42.1% of those eligible for shots in McKean County were fully vaccinated as of Dec. 6, according to the CDC. That compared to a statewide average of 67.9%.
More than one out of four tests for the coronavirus came back positive in McKean County as of Dec. 2, according to the state Department of Health, much higher than the Pennsylvania overall average of 15.3% and a red flag for widespread presence of the disease in the community. Testing positivity rates were even worse in Warren and Potter counties, which bookend McKean, with rates of 34.6% and 33.8% positivity respectively as of Dec. 2.
Now, the coronavirus is again spreading, filling hospital beds and setting records. The state reported 10,962 new cases on Dec. 2, a peak this year, while the number of people hospitalized with the disease reached 4,000, an 11-month high.
The latest surge is being blamed on the delta variant of COVID, but a new mutation, called omicron and first identified in November in South Africa, may be more contagious still, early research indicates, threatening to further strain health care resources in small town America.
McKean County is watching it all unfold in real time. The timing couldn’t be worse.
Losing hospital beds
In May, Bradford Regional Medical Center — one of two hospitals in McKean County — cut its number of beds to 10 from 107 after years of financial problems. Bradford Regional’s corporate parent, Upper Allegheny Health System in Olean, N.Y., reported losses of $23.5 million in 2020 and moved many of Bradford Regional’s services to affiliate Olean General Hospital, 30 miles away over the New York state line.
Shuttered with the move were Bradford Regional’s intensive care unit beds, which are needed to care for the sickest COVID-19 patients.
Since then, a group of McKean County residents formed the Save Bradford Hospital citizens group to try to get medical services restored as COVID-19 began straining both Bradford Regional and the 186-bed Olean General Hospital. Patient visits and elective surgery were suspended in October at Olean General due to critical staff shortages, prompting an unusual appeal to the community for help by chief nursing officer Gail Bagazzoli.
“Local emergency rooms and hospitals are at capacity with their staffing and struggling to accommodate the overflow of very sick patients,” she wrote Oct. 27, asking for paramedics and registered nurses to fill shifts. “Our nurses are tired and they need help.”
Jill Owens, chief medical officer at the Upper Allegheny Health System, blamed the crisis on the region’s low COVID-19 vaccination rate.
“The vaccination rates in our rural counties are low, and the unvaccinated are likely to get sicker and end up requiring hospitalization and intensive care more often, and this adds to the pressure on the local rural hospitals,” she said in a Nov. 30 statement.
The COVID-19 vaccination rates for rural Warren and Potter counties, located on either side of McKean, were 49.9% and 36.4% respectively on Dec. 7, according to the CDC.
Neither Mary E. LaRowe, interim president and CEO of Upper Allegheny, nor Dr. Owens returned calls for comment.
State Rep. Martin Causer, a Republican from Annin Township, McKean County, who opposed the cutbacks at Bradford Regional, said the latest surge in COVID-19 cases has exposed cracks in the region’s health care system.
“Our health care system is being overwhelmed right now,” he said. “There was an assumption that Olean General could handle the intensive care cases, but the pandemic is showing us that they can’t handle them.”
Mr. Causer, who chairs the Pennsylvania House Majority Policy Committee, will host a hearing on the region’s health care problems in January in Bradford.
The only other hospital in McKean County is UPMC Kane, a 31-bed facility in Kane Borough. For the sickest patients, UPMC Kane has five intensive care unit beds — the only ones left in a county of 40,625 people.
Five people were hospitalized with COVID-19 in McKean in early December, according to the state Department of Health. None were in intensive care, but that hasn’t stopped some long-term care facilities from preparing.
Up for the next battle
The staff at Lutheran Home at Kane, a nonprofit senior living facility that took the brunt of a deadly COVID-19 surge a year ago, was resolved in early December as the number of cases in the county inched up. Most of the staff and residents are now vaccinated; the nursing home’s COVID-19 isolation unit is empty; employees have cross trained to fill empty slots.
But memories of last winter remain fresh.
All but two of 78 residents tested positive in December 2020 — 10 of them died — and eventually one-third of employees were out because of the virus, said CEO Char Floravit, a 51-year-old no-nonsense administrator with can-do confidence. Visitors were banned; from outside the building, a family member pounded a loved one’s window, begging them not to go.
Ms. Floravit turned for help from the Pennsylvania National Guard, which sent a registered nurse and five or six housekeepers who helped with sanitation.
Other nursing homes around the state — buckled by the coronavirus — did the same.
In the months since, the nursing home — where a Christmas tree was decorated in the lobby the first week of December — has worked to fight against a repeat of last year.
Eleven Lutheran Home managers and two hourly employees underwent cross training as nurse aides last April to prepare for staff shortages that were all but certain. Lutheran Home offers fully paid medical, vision and dental benefits to attract and keep employees, which has helped limit the expense of hiring temporary staffers.
And 87% of the staff had been vaccinated against COVID-19 as of Dec. 5 — exceeding the statewide average for nursing homes.
On the horizon are the unknowns that may come with COVID-19’s omicron variant, which may be the most contagious strain yet but hasn’t yet reached rural Pennsylvania. At least no cases have been officially identified.
The new variant is not a big worry at the nursing home.
“Let’s be honest,” said Ms. Floravit, who lives south of Kane in St. Marys, Elk County, population 12,429.
“None of these facilities are set up for a pandemic. COVID is COVID, no matter what strain it is. We’ll deal with it.”
A miracle and a change of heart
After Ms. Reigel’s decision to withhold further care for her husband that October morning, he was given morphine and anti-anxiety medicine through a vein. Ms. Reigel and her family spent the afternoon reminiscing with him at the Erie hospital, where he’d been flown by helicopter from UPMC Kane Hospital.
His oxygen levels had fallen dangerously low, prompting the emergency flight.
The family left Hamot that evening after a supper of chicken noodle soup and grilled cheese sandwiches in the hospital cafeteria. Ms. Reigel drove the 97 miles home to Kane Borough in McKean County to wait for the telephone call from the hospital.
She tossed and turned all night.
In the morning, she was surprised by her husband’s voice on the phone.
“What are you doing,” she asked, stunned.
“I’m sitting here talking with the doctor, having coffee,” he said. “What are you doing?”
Dr. Shakoor called Mr. Reigel’s recovery a miracle, his wife said. No one has been more surprised by his turnaround than Mr. Reigel, a former Marine who served in Vietnam.
“A year ago, we’re in rural Pennsylvania: COVID was everywhere but here,” he said, now getting rehab care in the skilled nursing unit at Lutheran Home at Kane, walking distance from his home. He was continuing to receive oxygen as he tried to regain his strength.
“He just doesn’t want to quit,” his wife said.
Mr. Reigel, too stubborn to die, was also too stubborn to get a COVID-19 shot for a long time.
Marine “hardheadedness” kept him from getting vaccinated, he said. He wasn’t sure the scientists had all the details nailed down either, adding, “They didn’t know enough about it, really. They were just flying by the seat of their pants. They still don’t know what’s going on.”
Social media posts about COVID-19 vaccines causing sterility in women or restarting menopause or implanting microchips were enough to make his wife hesitant about the shots.
What changed after Mr. Reigel’s two-week trial in the ICU is the couple’s resistance to getting the vaccine: both plan to get vaccinated with their next doctor’s appointment.
“I wouldn’t want anyone to have to go through this,” Mr. Reigel said, panting. “It’s going to be a difficult Christmas, but I’m alive.”
Kris B. Mamula: email@example.com or 412-263-1699