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Missouri Rural Hospital Braces For 'A Worse Surge' In COVID-19 Cases


We're going to begin the program today looking at the latest surge in COVID-19 cases happening now across the country. For three days in a row, there were a record number of new reported coronavirus infections. And now in places like Texas and Florida, leaders are reversing some of the restrictions that had been eased not long ago.

We're going to focus on Missouri, one of the first states to fully reopen on June 16. On Thursday, the state reported its daily record in COVID-19 cases. Much of the increase in cases is happening in rural outlying counties in the central and southwestern parts of the state, and so we wanted to hear how rural hospitals are coping. So we've called Dr. Randy Tobler once again. He is the CEO of the Scotland County Hospital in Memphis, Mo. And we spoke to him at the beginning of the pandemic to find out he and his staff were preparing. And he's with us now once again.

Dr. Tobler, thanks so much for being with us once again.

RANDY TOBLER: My pleasure. Good to be with you.

MARTIN: So when we last spoke, which was in April, you said you and your staff were preparing as if a big storm might be coming. And so with these latest numbers being as high as they are, especially in Missouri, do you feel like that storm has arrived? Like, what are things like now?

TOBLER: I think that actually, we've become even more concerned than the first time. And while we're still in preparedness in the staging phase, we are noticing a lot of complacency. And I don't think it's just anecdotal in our community.

It appears as though as the ebb and flow of this disease has ebbed and flowed after the big lockdown, and then as states, including Missouri, opened up earlier or later, you know, there was - you saw the curve going down. And I think it was almost a binary response that we've noticed among patients and even businesses - sort of a - it's either we're all in lockdown, or we're all open.

And that's what's concerning us - that maybe there's been an overreaction to the success that was seen early on after the lockdown. And so we're braced for potentially a worse surge unless the box in strategy, which the Department of Health and Senior Services in Missouri has embarked on - unless that works.

MARTIN: So you haven't had in your hospital an overwhelming influx of patients, but - well, like the one that's happening in southwestern Missouri. Like, so what would you do if you did?

TOBLER: We're going to be best poised to do what I would call sort of a medical patient exchange program, where if we were to get an influx of sick inpatients that looked like they would need long-term ventilation or some significant ICU care for any length of time, probably we would want to transfer those people to where there's more able and more depth of care.

And, you know, maybe we take those folks who we know - because patients are getting tested when they're admitted to the hospital - are COVID-free, and that way, we can free up some space for the patients that I think are really going to be transferred from the rural centers into those more tertiary centers.

MARTIN: On Tuesday, Governor Mike Parson said he doesn't consider himself responsible for the uptick in coronavirus cases in Missouri. But the state has been fully reopened since June 16. I mean, we're talking about leadership more broadly across the country - like, what example leaders are setting in different places, and those are different examples. So I have to ask you, you know, what do you think about that? Should the state be considering putting restrictions back into place?

TOBLER: Yeah. I think - I'm glad to see that we are taking a more nuanced approach. The things that work in New York City at a given time with a given prevalence and a given, you know, disease severity probably doesn't work in a town of 2,500 people in rural Missouri or rural Texas. And, in fact, Missouri and Texas may be different for a number of reasons.

And I'm glad to see that governors are taking a different approaches. And I think it's a work in progress, and it'll continue to be that way, all the way from trying to assimilate the evolving knowledge coming from the basic research on the virus and the epidemiologic research along then with, you know, what's going on on the ground?

MARTIN: Yeah. I just have to ask you, though - you know, 120,000 people in the United States have died...


MARTIN: ...Because of this. And I don't - you know, and the evidence is very strong that many of those people didn't have to - should not have died. I mean, it's because - for all kinds of reasons. There's all kinds of reasons. And I just have to ask, as a medical professional, I mean, what do you think about that?

TOBLER: I think that part of that is the natural history of a new, emerging disease - you know, an infectious disease - about which assumptions were made, some of which were good, some of which were off-target, combined with political realities and an environment that is certainly toxic by any estimation (laughter). And the reality that, I think, a one-size-fits-all approach, I think, has proven in this case to be perhaps not the most effective, at least in the very beginning.

This virus to me is like a rattlesnake in the distance. You know, you have to - you don't have to be afraid of it. But stay away from it, and have a lot of respect for it. And I think if people start having that kind of an approach - especially young people who are going to be the asymptomatic or mildly symptomatic carriers - we're going to see that death toll rise.

And I agree with you. It's a concern. And the balance between, you know, a sort of - a sustainable economy and limiting the carnage from the virus is a difficult tightrope act. There's no doubt about it.

MARTIN: That's Dr. Randy Tobler, CEO of Scotland County Hospital in Memphis, Mo.

Dr. Tobler, thanks so much for talking to us once again.

TOBLER: Great to be with you. Thanks so much. Transcript provided by NPR, Copyright NPR.

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