Medical workers wear protective suits and ready to take care of coronavirus patient in isolation room. (iStock photo)

Joel Wells says the worst moments at rural Wayne County Hospital came last fall, when COVID-19 hospitalizations were spiking statewide.

Wells works as a family physician in the third decade of his career. At that time, he said he had nine COVID-19 patients. That’s a lot for a 25-bed rural critical access hospital in south central Iowa.

“We had to make lots of decisions on the fly. And we had patients that really, when I say were critical, they were. We had quite a few deaths at that time,” he said.

But, Wells said, facing surges of sick patients was far from the only challenge his hospital has faced in the past year.

Some patients have aggressively pushbacked against his public health recommendations, he said. That’s something he said he — and his colleagues — never expected to experience during a pandemic.

“We, as a medical profession, don’t have the trust that I thought we did. It just rocked my world. I just said, ‘Oh, man, people really don’t want to listen to me,” he said.

On top of all of that, Wells said about half of the Wayne County Hospital staff had to be furloughed last summer to deal with COVID-related budget shortfalls.

These challenges aren’t limited to small hospitals like Wayne County.

“There were multiple moments that when we were standing on the edge of the cliff, you never thought the cliff could be steeper,” said Suresh Gunasekaran, CEO of the University of Iowa Hospitals and Clinics, the state’s largest hospital.

There were times during last fall’s surge when his region was reporting no available ICU beds, he said. The entire health care system was completely stressed.

Like Wayne County, Gunasekaran said UIHC experienced economic strain that trickled down to every single hard-working staff member.

“We had folks that took pay cuts, and we had folks that gave back vacation and did these things that you know, very much were stressful, and very much were dollars out of their pockets,” Gunasekaran said.

A year of battling the coronavirus has left many hospitals and their workers across the country emotionally and financially drained.

Aaron Wesolowski is the vice president of the American Hospital Association. His organization estimates hospitals lost $320 billion in 2020.

“A lot of states imposed really strict bans on certain kinds of services. And people avoided certain services that resulted in reduced revenue,” he said.

Hospitals also faced increased expenses for personal protective gear and caring for COVID-19 patients, Wesolowski said.

He said he anticipates hospitals will continue to face pandemic-related challenges for a long time even with the vaccine now available. This year started with a massive surge in COVID-19 cases, he said.

“They put a tremendous strain on, on hospitals in terms of, you know, having ICU that were essentially maxed out. So we think it’ll be quite a while before we return to any sort of baseline,” he said.

But some hospitals seem to have fared better than others.

Joanne Roepke-Bode is the public relations manager for the Kossuth Regional Medical Center in northern Iowa, another rural 25-bed hospital.

She said government support from the CARES Act helped the hospital avoid having to furlough staff.

Their biggest challenge in the last year was pacing and preparing for the virus, she said. Roepke-Bode said they were ready last spring for a surge in cases. But that didn’t happen until months later – in late fall.

“And then when cases came, I think people were already hitting COVID fatigue, you know, and they were just ready to move on. And that’s when we kind of needed to really buckle down and say, ‘oh, gosh, we need to stay home now,'” she said.

OTHER COVID COVERAGE: Pregnant nurse caring for COVID-19 patients

In Wayne County, Wells agreed pacing is a huge issue for many health care workers, who quickly forgot that a pandemic is a marathon — not a sprint — and didn’t stress that important message to the public.

“We had a tendency to paint hope. There was no hope. This was going to be a long siege. And I think a lot of us saw that and we just, we just try not to talk about it,” he said.

He knows the pandemic is far from over, he said, but with vaccines now available, he remains cautiously optimistic that a return to some normalcy is near.

This story was produced by Side Effects Public Media, a public radio collaborative covering healthcare. It is based at WFYI in Indianapolis and has partner stations in six Midwestern states, including Iowa Public Radio. Natalie Krebs works out of Iowa Public Radio.

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