Kurt Papenfus, a doctor in the small town of Cheyenne Wells, Colo., started to feel sick around Halloween. He developed a scary cough, intestinal symptoms, and a headache. In the midst of a pandemic, the news that he had COVID-19 wasn’t surprising, but Papenfus’ illness would have repercussions far beyond his own health.
Papenfus is the lone full-time emergency room doctor in the town of 900, not far from the Kansas line.
“I’m chief of staff and medical director of everything at Keefe Memorial Hospital currently in Cheyenne County, Colorado,” he said.
Just 62 people in the county have been diagnosed with COVID-19, according to Colorado’s coronavirus data website.
With him sick, the hospital scrambled to find a replacement. As coronavirus cases in rural Colorado, and the Eastern Plains especially, surge to unprecedented levels, Papenfus’ illness is a test case for how the pandemic is affecting the fragile rural healthcare system.
“He is the main guy. And it is a very large challenge,” said Stella Worley, CEO of the hospital.
If she couldn’t find someone to fill in while he was sick, Worley might have to divert trauma and emergency patients nearly 40 miles north to Burlington.
“Time is life sometimes,” she said. “And that is not something you ever want to do.”
“The ‘rona beast is a very nasty beast”
As deaths from coronavirus surpass 250,000 in the U.S., new data shows the pandemic has been particularly lethal in rural areas — it’s taking lives in those areas at a rate nearly 3.5 times higher than in metropolitan communities.
Papenfus, a lively 63-year-old, was discharged after a 9-day stay in St. Joseph’s Hospital in Denver, and he was eager to sound the alarm about the disease he calls the ‘rona.
“The ‘rona beast is a very nasty beast and it is not fun. It has a very mean temper. It loves a fight and it loves to keep coming after you,” Papenfus said.
He isn’t sure where he picked it up, but thinks it might have been on a trip east in October. He says he was meticulous on the plane, sitting in the front, last on, first off. But on landing at Denver International Airport, Papenfus boarded the crowded train to the terminal and soon alarm bells went off in his head.
“There are people literally like inches from me and we’re all crammed like sardines in this train,” Papenfus said. “And I’m going, ‘Oh my God, I am in a superspreader event right now.'”
The airport’s spokeswoman declined to comment about Papenfus’ experience.
A week later, the symptoms hit. He tested positive and decided to drive himself the three hours to the hospital in Denver. “I’m not going to let anybody get in this car with me and get COVID, because I don’t want to give anybody the ‘rona,” he said. County sheriff’s deputies followed his car to be sure he made it.
Once in the hospital, chest X-rays revealed he’d developed pneumonia.
“Dude, I didn’t get a tap on the shoulder by ‘rona, I got a big viral load,” he texted a reporter, sending images of his chest scans that show large, opaque, white areas of his lung. Just a week earlier, his chest X-ray was normal, he said.
Back in Cheyenne Wells, Dr. Christine Connolly picked up some of Papenfus’ shifts, although she had to drive 10 hours each way from Fort Worth, Texas, to do it. She says the hospital staff is spread thin already.
“It’s not just the doctors, it’s the nurses, you know. It’s hard to get spare nurses,” she said. “There’s not a lot of spares of anything out that far.”
Besides Papenfus, another six employees — out of a staff of 62 at Keefe Memorial Hospital — also recently got a positive test, Papenfus said.
Hospitals on the plains often send their sickest patients to bigger hospitals in Denver and Colorado Springs. But with so many people around the region getting sick, Connolly is getting worried hospitals could be overwhelmed. Health care leaders created a new command system to transfer patients around the state to make more room, but Connolly says there is a limit.
“It’s dangerous when the hospitals in the cities fill up, and when it becomes a problem for us to send out,” she said.
“Bank robbers wear masks out there”
The impact of Papenfus’ absence stretches across the Eastern Plains. He usually worked shifts an hour to the northwest, at Lincoln Community Hospital in Hugo. Its CEO, Kevin Stansbury, says the town mostly dodged the spring surge and his facility could take in recovering COVID-19 patients from Colorado’s cities. Now, Stansbury said the virus is reaching places like Lincoln County, population 4,000. It has had 144 cases according to state data, and neighboring Kit Carson has had 301. Crowley County to the south, which is home to a privately managed state prison, has had 1,239 cases. That makes it far and away the number one most affected county per capita in the state.
“So those numbers are huge,” Stansbury said. He says as of mid-November about a half dozen hospital staffers had tested positive for the virus; they think it’s unrelated to Papenfus’ case.
The hospital is ready to once again take recovering patients. Finances in rural health care are always tight and accepting new patients would help.
“We have the staff to do that, so long as my staff doesn’t get ravaged with the disease,” Stansbury says.
Rural communities are particularly vulnerable. Residents tend to suffer from underlying health conditions that can make COVID-19 more severe including high rates of cigarette smoking, high blood pressure, and obesity. And Brock Slabach, with the National Rural Health Association, says 61% of rural hospitals do not have an intensive care unit.
“This is an unprecedented situation that we find ourselves in right now,” Slabach said. “I don’t think that in our lifetimes we’ve seen anything like what is developing in terms of surge capacity.”
A couple of hours east of Cheyenne Wells, COVID-19 recently hit Gove County, Kan., hard.
The county’s emergency management director, the local hospital CEO and more than 50 medical staff tested positive. In a nursing home there, most of the more than 30 residents caught the virus; six died since late September, according to the Associated Press. A county sheriff ended up in a hospital more than an hour from home, fighting to breathe, due to the lack of space at the local medical center.
Papenfus fretted about his home county and their odds of fighting off the virus.
“The western prairie isn’t mask country,” he said. “People don’t wear masks out there; bank robbers wear masks out there.” He is urging Coloradans to stay vigilant, calling the virus an existential threat. “It’s a huge wake up call.”
Since being released from the hospital, Papenfus’ recovery has been rocky. His wife Joanne drove him back to Cheyenne Wells, wearing an N-95 mask and gloves, while he rode in the back on oxygen, coughing through the three hour drive.
Once back at home, Papenfus hunkered down, with the occasional trip outside to hang out with his pet falcon.
But a week after getting home, he started having nightly fevers. He had a CT scan done at Keefe Memorial, the hospital where he works. It revealed pneumonia in his lungs, so last weekend he was back in Denver, getting readmitted at St. Joseph’s Hospital. This time, Papenfus arrived via ambulance.
Finding a replacement for Papenfus at Keefe has been hard. They’re working with services that provide substitute physicians, but these days, with coronavirus roaring around the country, the competition is fierce.
“They’re really scrambling to get coverage,” Papenfus texted from his hospital bed. “Whole county can’t wait for my return but this illness has really taken me down.”
He said he was now at Day 35 from his first symptoms, laying in his hospital bed in Denver, “wondering when I’ll ever get back.” Papenfus noted COVID-19 has affected his critical thinking and that he’d need to be cleared cognitively to return to work. He said he knows he won’t have the physical stamina to get back to full duty “for a while if ever.”