Tagged Montana

COVID Spikes Exacerbate Health Worker Shortages in Rocky Mountains, Great Plains

COVID-19 cases are surging in rural places across the Mountain States and Midwest, and when it hits health care workers, ready reinforcements aren’t easy to find.

In Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.

“Just one more person out and we wouldn’t be able to keep the surgeries going,” said Dr. Shelly Harkins, chief medical officer of St. Peter’s Health in Helena, a city of roughly 32,000 where cases continue to spread. “When the virus is just all around you, it’s almost impossible to not be deemed a contact at some point. One case can take out a whole team of people in a blink of an eye.”

In North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.

“How long can we run at this rate with the workforce that we have?” Blasl said. “You can have all the licensed beds you want, but if you don’t have anybody to staff those beds, it doesn’t do you any good.”

The northern Rocky Mountains, Great Plains and Upper Midwest are seeing the highest surge of COVID-19 cases in the nation, as some residents have ignored recommendations for curtailing the virus, such as wearing masks and avoiding large gatherings. Montana, Idaho, Utah, Wyoming, North Dakota, South Dakota, Nebraska, Iowa and Wisconsin have recently ranked among the top 10 U.S. states in confirmed cases per 100,000 residents over a seven-day period, according to an analysis by The New York Times.

Such coronavirus infections — and the quarantines that occur because of them — are exacerbating the health care worker shortage that existed in these states well before the pandemic. Unlike in the nation’s metropolitan hubs, these outbreaks are scattered across hundreds of miles. And even in these states’ biggest cities, the ranks of medical professionals are in short supply. Specialists and registered nurses are sometimes harder to track down than ventilators, N95 masks or hospital beds. Without enough care providers, patients may not be able to get the medical attention they need.

Hospitals have asked staffers to cover extra shifts and learn new skills. They have brought in temporary workers from other parts of the country and transferred some patients to less-crowded hospitals. But, at St. Peter’s Health, if the hospital’s one kidney doctor gets sick or is told to quarantine, Harkins doesn’t expect to find a backup.

“We make a point to not have excessive staff because we have an obligation to keep the cost of health care down for a community — we just don’t have a lot of slack in our rope,” Harkins said. “What we don’t account for is a mass exodus of staff for 14 days.”

Some hospitals are already at patient capacity or are nearly there. That’s not just because of the growing number of COVID-19 patients. Elective surgeries have resumed, and medical emergencies don’t pause for a pandemic.

Some Montana hospitals formed agreements with local affiliates early in the pandemic to share staff if one came up short. But now that the disease is spreading fast — and widely — the hope is that their needs don’t peak all at once.

Montana state officials keep a list of primarily in-state volunteer workers ready to travel to towns with shortages of contact tracers, nurses and more. But during a press conference on Oct. 15, Democratic Gov. Steve Bullock said the state had exhausted that database, and its nationwide request for National Guard medical staffing hadn’t brought in new workers.

“If you are a registered nurse, licensed practical nurse, paramedic, EMT, CNA or contact tracer, and are able to join our workforce, please do consider joining our team,” Bullock said.

This month, Kalispell Regional Medical Center in northwestern Montana even stopped quarantining COVID-exposed staff who remain asymptomatic, a change allowed by Centers for Disease Control and Prevention guidelines for health facilities facing staffing shortages.

“That’s very telling for what staffing is going through right now,” said Andrea Lueck, a registered nurse at the center. “We’re so tight that employees are called off of quarantine.”

Financial pressure early in the pandemic led the hospital to furlough staff, but it had to bring most of them back to work because it needs those bodies more than ever. The regional hub is based in Flathead County, which has recorded the state’s second-highest number of active COVID-19 cases.

Mellody Sharpton, a hospital spokesperson, said hospital workers who are exposed to someone infected with the virus are tested within three to five days and monitored for symptoms. The hospital is also pulling in new workers, with 25 traveling health professionals on hand and another 25 temporary ones on the way.

But Sharpton said the best way to conserve the hospital’s workforce is to stop the disease surge in the community.

Earlier in the pandemic, Central Montana Medical Center in Lewistown, a town of fewer than 6,000, experienced an exodus of part-time workers or those close to retirement who decided their jobs weren’t worth the risk. The facility recently secured two traveling workers, but both backed out because they couldn’t find housing. And, so far, roughly 40 of the hospital’s 322 employees have missed work for reasons connected to COVID-19.

“We’re at a critical staffing shortage and have been since the beginning of COVID,” said Joanie Slaybaugh, Central Montana Medical Center’s director of human resources. “We’re small enough, everybody feels an obligation to protect themselves and to protect each other. But it doesn’t take much to take out our staff.”

Roosevelt County, where roughly 11,000 live on the northeastern edge of Montana, had one of the nation’s highest rates of new cases as of Oct. 15. But by the end of the month, the county health department will lose half of its registered nurses as one person is about to retire and another was hired through a grant that’s ending. That leaves only one registered nurse aside from its director, Patty Presser. The health department already had to close earlier during the pandemic because of COVID exposure and not enough staffers to cover the gap. Now, if Presser can’t find nurse replacements in time, she hopes volunteers will step in, though she added they typically stay for only a few weeks.

“I need someone to do immunizations for my community, and you don’t become an immunization nurse in 14 days,” Presser said. “We don’t have the workforce here to deal with this virus, not even right now, and then I’m going to have my best two people go.”

Back in Helena, Harkins said St. Peter’s Health had to close a specialty outpatient clinic that treats chronic diseases for two weeks at the end of September because the entire staff had to quarantine.

Now the hospital is considering having doctors take turns spending a week working from home, so that if another wave of quarantines hits in the hospital, at least one untainted person can be brought back to work. But that won’t help for some specialties, like the hospital’s sole kidney doctor.

Every time Harkins’ phone rings, she said, she takes a breath and hopes it’s not another case that will force a whole division to close.

“Because I think immediately of the hundreds of people that need that service and won’t have it for 14 days,” she said.

Mountain States editor Matt Volz contributed to this story.

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Despite Pandemic Threat, Gubernatorial Hopefuls Avoid COVID Nitty-Gritty

Just 15 days ahead of the election, Montana Lt. Gov. Mike Cooney laid out his ideas on how he’d handle the COVID-19 pandemic if elected governor. Details were few, but the Democrat’s plan became one of only a handful being offered by candidates in the 11 U.S. governor’s races about how they’ll approach what’s certain to be the dominant issue of their terms, should they win.

While much of the nation’s focus is on who will be president come January, voters who are deciding the next occupant of their governor’s mansion are also effectively choosing the next leader of their state’s COVID-19 response. The virus has made governors’ power highly visible to voters. As the states’ top executives, they decide whether to issue mask mandates, close businesses and order people to stay home.

All but two races for governor feature incumbents running for reelection: Montana’s Democratic Gov. Steve Bullock can’t run again because of term limits and Utah’s Republican Gov. Gary Herbert decided not to run for another term. In several other competitive races for governor this year, such as those in North Carolina and Missouri, opponents clash on the role of state mandates in slowing the virus. Still, COVID-19 often fades into the backdrop of many long-standing platforms or primarily comes up as candidates talk about the need to revive the economy.

Cooney’s proposal, released Monday, suggested using the National Guard to transport patients in extreme weather and subsidizing heating bills to help those quarantining at home. But other parts vaguely described how he would “develop a robust plan” to come.

His opponent, Republican U.S. Rep. Greg Gianforte, has acknowledged the health crisis but has focused primarily on the economy, saying the state has to “cure the economic pandemic” the virus caused.

Rep. Greg Gianforte, Mike Cooney’s Republican opponent, joins President Donald Trump at a rally at the Bozeman Yellowstone International Airport on Nov. 3, 2018, in Belgrade, Montana.(William Campbell/Corbis via Getty Images)

Bryce Ward, a health economist with the University of Montana, said Cooney’s list was one of the first times he’s seen long-term planning for COVID-19 come up in what appears to be the nation’s tightest governor’s race. But, he added, neither Montana candidate has offered a concrete plan to deal with the dual crises that risk public health when people gather and businesses’ bottom lines when they don’t. Meanwhile, the state’s number of COVID-19 cases climbs and its economy suffers.

“Whoever wins, this is going to be the bulk of their term,” Ward said. “How are the candidates going to keep people afloat as long as they can? What are we doing in terms of planning for what we think our post-COVID world is going to look like?”

An October KFF poll found 29% of registered voters said the economy was the most important issue in choosing a president, while 18% said the coronavirus outbreak was their top issue. Republican voters were more likely to pick the economy, the survey found, and Democrats were more likely to pick the coronavirus. (KHN is an editorially independent program of KFF.)

“There are voters that feel that the government needs to lead, and there are voters that feel that the government is utilizing a pandemic to become too invasive,” said Capri Cafaro, a former Democratic Ohio state senator now teaching in American University’s public administration and policy department. “People are not necessarily making their decisions on ‘Did you do contact tracing? Are you going to slow the spread?’”

Among the incumbent governors seeking reelection this year, most of their campaigns’ focus on COVID-19 has been on how well they’ve responded to the crisis. Several pledge more of what they’ve been doing. “We’ll continue to follow the science and wear masks,” Delaware Democratic Gov. John Carney said in a recent debate.

Meanwhile, their challengers generally seek to cast the incumbents as mismanaging their states’ response and promising to undo what’s been done. Those who have put out actual plans to handle the pandemic are Democratic challengers to Republican governors, and their plans are similar to what Cooney released — some specific ideas and promises to fill in the gaps later.

In Missouri, Democratic challenger Nicole Galloway, who is the state auditor, made health care the center of her campaign and released a plan to respond to the virus with a statewide mask mandate and a limit on when public school classes can meet in person based on the community’s rate of infection.

Republican Gov. Mike Parson is the apparent front-runner in that state’s race. He has pledged to lead “the greatest economic comeback that we’ve ever seen in Missouri history.” The former Polk County sheriff also has focused on supporting law enforcement amid backlash against police brutality and racial injustice.

Curbing the coronavirus has taken a back seat to boosting the economy in Parson’s campaign. And, as governor, Parson has refused to issue a statewide mask mandate, despite a White House recommendation to do so. In late September, the governor and his wife tested positive for COVID-19. Parson has returned to work, which includes traveling across the state.

One of the more heated races is in North Carolina, where Democratic Gov. Roy Cooper is defending his seat against a challenge by his lieutenant governor, Republican Dan Forest. Forest sued Cooper this year to challenge the governor’s authority to impose COVID-related restrictions by executive order.

Forest dropped the lawsuit in August after a judge made a preliminary ruling against his case, then said on Twitter, “I did my part. If y’all want your freedoms back you’ll have to make your voices heard in November.”

Cooper’s campaign called the lawsuit “a desperate tactic to garner attention” for Forest’s political campaign. Since then, the governor has slowly eased COVID restrictions, updating an executive order to allow a limited number of people in bars, sporting events, movie theaters and amusement parks. Cooper is leading the race in recent polls.

Back in Montana, the pandemic surfaced in the gubernatorial campaign after health officials announced on Oct. 16 that a Helena concert, which Gianforte attended, was linked to several COVID-19 cases. More than 100 health professionals blasted him in an open letter for flouting local health restrictions, going maskless and making light of safety precautions at campaign events. Cooney called on him to suspend his campaign events until tested. Gianforte’s campaign has said he’s taking proper precautions and accused Cooney of politicizing a public health issue.

Cooney has said he’ll keep Montana’s COVID-19 response on the track he is helping set as lieutenant governor, with science guiding that work. Gianforte, who built a tech startup in Bozeman, has touted his business experience as proof he can lead Montana’s comeback. Both have said more needs to be learned about this virus and have pitched themselves as the one to steer the state’s economy through the crisis.

Ward, the University of Montana health economist, said the details are missing, such as how the winner will support businesses through the winter without federal aid. Or what the new governor would cut from the state budget if the economic crisis hits its coffers.

The state has a public mask mandate and a plan for reopening the economy with no apparent thresholds or timelines. The option for stricter rules has been left to county governments as the state sees its largest COVID surge yet.

Jeremy Johnson, a political scientist at Carroll College in Helena, said the initial lack of detailed pandemic policy in the state’s race could be attributed to both candidates trying to win over swing voters with safe themes. President Donald Trump won Montana in 2016 by 20 points, but the state has also had a Democratic governor for 16 years. While polls show Gianforte leading Cooney slightly, election handicappers Real Clear Politics and the Cook Political Report still consider the race a toss-up.

Yet as Election Day nears, the question of how to address the pandemic only looms larger. Montana’s case count is rising, adding to its total of more than 23,000 cases in the state of roughly 1 million.

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COVID Stalks Montana Town Already Saddled With Asbestos Disease

LIBBY, Mont. — Frank Fahland has spent most days since the pandemic began at the site of his dream house, working to finish a 15-year labor of love while keeping away from town and the people closest to him.

Like thousands of people from Libby and Lincoln County in the far northwestern corner of Montana, the 61-year-old Fahland has scarred lungs after years of breathing in asbestos fibers from dust and soil contaminated by the town’s now-defunct plant that produced vermiculite, a mineral used in insulation and gardening.

Fahland recently gave a visitor a tour of his partially finished log home overlooking a meadow that stretches to the foothills of the Cabinet Mountains. He struggled to climb a small hill and stopped to reach for his inhaler.

“It feels like someone is standing on your chest, or almost like someone stuffed a pillow down there in your lung,” he said.

Fahland’s condition makes him more vulnerable to complications from COVID-19, so he’s keeping his distance from people in hopes of avoiding infection. He hasn’t visited his son and granddaughter in months and he recently wrote his will.

He’s not alone in taking such precautions. Lincoln County has one of the nation’s highest asbestos mortality rates. At least 400 people have died from asbestos-related diseases, which can include asbestosis, mesothelioma and lung cancer. At least 1 in 10 people in Libby have an asbestos-related illness, said Miles Miller, a physician assistant at the Center for Asbestos Related Disease.

“Our patients having an underlying lung disease that would make recovery from COVID-19 more difficult,” Miller said.

Lincoln County, population 20,000, largely was spared from outbreaks of the novel coronavirus at the beginning, which Miller chalked up to the community’s vigilance in testing, tracking and prevention efforts.

But by the fall, cases began to climb in the county along with the rest of Montana. By early October, the number of confirmed cases in Lincoln County was 170, nearly double the count at the end of August. County health officials said in a Facebook post that cases were all over the county and “it would be irresponsible to classify any towns as safe.”

Frank Fahland is one of hundreds of Libby, Montana, residents living with an asbestos-related disease ― making him more vulnerable to complications from COVID-19. He keeps his distance from people to avoid infection, including his son and granddaughter, whom he hasn’t visited in months. (Nate Hegyi)

The vermiculite mine closed in Libby in 1990. For decades before that, Miller said, the mine constantly spewed asbestos-laden dust throughout Libby.

“During the heyday, I don’t think you could shop for groceries in this town without breathing some of the dust,” he said.

The extent of the public health disaster in Libby became known only after the Seattle Post-Intelligencer published a series of stories by journalist Andrew Schneider in 1999. Lawsuits began pouring in from across the nation, and W.R. Grace filed for bankruptcy protection in 2001, putting a hold on more than 100,000 pending claims against it.

The Environmental Protection Agency added Libby and the surrounding area as a Superfund site in 2002 and declared a public health emergency in 2009. The EPA spent more than $600 million to clean up 2,600 homes and properties and removed more than 1 million cubic yards of contaminated soil, according to the agency.

The company and its executives were acquitted in 2009 of federal charges that the company had conspired to conceal the mine’s health risks. Grace emerged from bankruptcy in 2014 after a legal settlement that set up trust funds to pay for current and future asbestos victims’ medical costs. The company agreed to pay $250 million for the cleanup in 2008.

Asbestos victims also sued the state of Montana, saying that state officials knew the danger but failed to stop it. Settlements in 2011 and 2017 totaled $68 million.

The threat isn’t over. People are still being diagnosed with asbestos-related diseases. Three decades or more can pass between exposure and the development of symptoms, according to the Centers for Disease Control and Prevention.

Also, the former mine site and surrounding forest have not been cleaned, leading the EPA to classify the Superfund site as still not under control for human exposure to asbestos. Those most at risk of exposure are loggers, firefighters and trespassers, the EPA said.

The county public health officer has issued an order requiring people to wear masks in public regardless of how many cases of COVID-19 the county has — a more stringent rule than the statewide requirement to wear a mask in counties where there are four or more active cases.

Julie Kendall and her mother, Ellen Adkins, both have asbestos-related diseases ― and fear contracting the COVID-19 virus. Kendall, a phlebotomist at a local hospital, dislikes Libby’s summer crowds. “These people that come to these events from out of town are going to our gas stations and our grocery stores,” she says. “They could be exposing you right there.” (Nate Hegyi)

Doug Shaw’s lungs are scarred after years of breathing in asbestos fibers from the town’s now-defunct plant that made vermiculite, a mineral used in insulation and gardening. (Nate Hegyi)

Though many in the community have accepted public health guidelines to avoid the coronavirus, a strong libertarian streak runs through this remote county on the U.S.-Canada border, where residents’ distrust of government is heightened by the town’s history with the mine.

Doug Shaw, 69, is another resident with lungs scarred from breathing in asbestos. He blames W.R. Grace and the state government for covering up the contamination for decades and calls Libby’s asbestos deaths murder.

Grace officials did not directly respond to Shaw’s accusation, but instead referred to the company’s financial relief fund for residents with asbestos-related illness.

Shaw said he’s frustrated by the government’s COVID restrictions on events and businesses.

“It’s nuts. Nobody has to live like this. We need to get back to work,” he said.

The area depends on summer tourism to keep its economy healthy. The county has allowed large public events such as a rodeo and an international chainsaw competition to occur, raising concerns that visitors to those events could spread COVID-19 in the community.

“We need people to come here and spend money and jolt the economy,” Fahland said. “Problem is, with that rodeo, there were faces in that crowd that have different license plates that came from different places that may have had issues.”

Julie Kendall, a phlebotomist at a local hospital who was diagnosed with an asbestos-related disease two months ago, echoed that concern.

“These people that come to these events from out of town are going to our gas stations and our grocery stores,” she said. “They could be exposing you right there.”

Kendall sat at a picnic table near a railroad track where she was exposed to asbestos as a child. The area used to be home to a community swimming pool and children would play near piles of mine waste. She said she sees a similarity between asbestos and the novel coronavirus.

“It’s unseen,” she said. “You can be doing the most innocent thing and it could still get you.”

But Kendall also believes those parallels have given folks like her a leading edge on dealing with this pandemic.

“We’re already afraid here,” she said. “So it’s kind of like one more shake of the dice. You can’t live every day in fear. But here we do.”

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