Coronavirus tests rural health networks in New Mexico

SANTA FE, N.M. (AP) — New Mexico is bracing for the possible spread of coronavirus to some of America's most remote, impoverished communities, as hospitals across the state prepare to convert operating rooms into acute respiratory care units.

Health officials are outlining medical triage strategies in the state that struggles to keep physicians in rural areas. Officials have declined to disclose the number of hospital beds and ventilator machines that could be made available quickly to treat severe coronavirus cases.

For most people, the virus causes only mild or moderate symptoms, such as fever and cough. For others, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

A collaborative effort in New Mexico is intended to guide medical personnel in far-flung locations on responses to the virus, using a web-conference method that has been deployed in response to complex diseases in other countries, including India and Vietnam.

The initiative through Project ECHO at the University of New Mexico Health Sciences Center aims to prepare physicians, aides, nurse practitioners and others to make decisions about virus testing, quarantines and severe infections that can lead to acute respiratory problems, said Joanne Katzman, senior associate director at Project ECHO.

“This is one of the few epidemics where people are told, ‘don’t come into the doctor's office, don't come into the emergency room,'” she said, describing precautions against transmission of the virus.

Health officials also are poring over emergency triage plans with hospital executives in anticipation of a likely surge in COVID-19 cases. Mostly travel-related coronavirus infections have occurred in New Mexico's urban corridor along the Upper Rio Grande, with one untraceable transmission. Cases in rural areas include an infection in Taos County and a couple in Socorro County.

The preparations are taking place as Gov. Michelle Lujan Grisham discourages social contact with new orders Wednesday that limit restaurant service to take-out food, reduce the flow of people at hotels and close down movie theaters, shopping malls, spas and gyms through April 10. Previous advisories and orders have shut down schools statewide, ski resorts, commuter rail service, museums, cathedrals and many autonomous tribal casinos.

The containment strategies, as with other states, are designed to slow infections to a rate that won't overwhelm the health care system.

New Mexico has reported 28 infections, while the U.S. has reported more than 6,500 cases and at least 116 deaths. Almost half of the deaths are in Washington state, where dozens of residents from a suburban Seattle nursing home have died.

In a northern New Mexico county the size Connecticut, physicians say a shortage of protective equipment such as respirator masks threatens to undermine front-line efforts to contain the virus at clinics that cater to Medicaid patients.

Physician Leslie Hayes of El Centro Family Health clinic in Española said she and colleagues resorted to social media solicitations for donations of masks that filter out virus-sized particles.

Hayes worries the virus could race through a small staff at a rural clinic and force physicians into quarantine.

“For the small communities, we're really worried about what happens if a patient walks in asymptomatic for hypertension, and then two days later they all come down with COVID-19," Hayes said. “Then the whole clinic would have to shut down.”

State health authorities note that many rural clinics are part of provider networks where staff can fill in for each other in a crisis or even call on volunteers. New Mexico´s congressional and Senate delegation has pressed federal authorities to release more protective equipment such as masks and gloves.

State health officials have acknowledged that there are about 340 intensive care beds statewide — with roughly 55 available. Requests for updated statistics went unanswered.

New Mexico Human Service Secretary David Scrase said he met Tuesday with hospital executives from the University of New Mexico, Presbyterian and Lovelace to review state-registered triage plans for converting a variety of surgical facilities with ventilators into intensive care units for coronavirus patients while elective operations are put on hold.

In the most severe cases, the coronavirus damages healthy tissue in the lungs, making it hard to get oxygen to the blood. Ventilators feed oxygen into the lungs of patients with severe respiratory problems through a tube inserted down the throat.

Scrase says hospitals can expand their intensive care capacity overnight to treat acute coronavirus patients.

“It's about the process and the reserve capacity," he said. "The hospitals talked about being able to increase their in-patient volume by 20% to 30% with almost no difficulty at all.”

Wide open spaces and low-density cities could give New Mexico an advantage over some metropolitan areas in preventing the rapid spread of coronavirus.

In Socorro, a southern New Mexico city of 9,000 residents, family physician and Mayor Ravi Bhasker said the area is well equipped to detect coronavirus. But he warned that any virus patients who develop severe respiratory complications would need to travel at least 70 miles (110 kilometers) for ventilator support.

“Rural health care at this point is not overwhelmed. But if we have people who need respirators, we're not going to be able to handle that," he said. “That's going to be kicked up to Albuquerque.”