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DENVER (KDVR) — Rural hospitals can serve as clearing houses for Colorado’s COVID-19 cases, stressing limited staffing and equipment even as residents think themselves out of contagion’s reach.

Dr. Kurt Papenfus is an ER doctor in Cheyenne Wells and Keefe Memorial Hospital Chief of Staff. He was transferred to St. Joseph Hospital in Denver for COVID-19 healthcare from a county he feels needs to take the pandemic more seriously.

“In Cheyenne County where we live, that’s not mask country,” Dr. Papenfus said. “In that part of the state, only bad guys wear masks. And that has to change. It’s not a hoax. It’s super serious. And its hunting you.”

In particular, Dr. Papenfus said rural Coloradans need to take it more seriously because there is simply less room for error.

“Rural hospitals are not up to the task,” he said. “I know rural hospitals. If you have sick COVID patients like me…to take care of me when I got really sick, that would have wiped out the whole damn hospital.”

Health officials agree, though state data does not reflect it.

Mike Burnett of the Northeastern Colorado Health Department said rural hospitals are in a double bind when it comes to treating county coronavirus cases. Their resources are drained but the drain doesn’t show up in the public eye.

“Cases that get transferred don’t show up as hospitalizations,” Burnett said. “The reporting doesn’t necessarily paint the whole picture.”

Rural hospitals end up transferring a large portion of their patients, particularly those with high-care needs like COVID-19 patients. The hours of intake, arranging for transfer and care in the meantime take manpower and resources the public doesn’t see in data.

This plays a role in a cycle, loosening the rural public’s defenses while stressing both its own and urban healthcare systems.

Rural healthcare facilities have limited staff and limited equipment. Available beds, Burnett said, does not mean available staff to care for each bed. Burnett’s district has eight hospitals – few of them have true ICUs, and even the respirators available are designed for ambulance use rather than extended in-hospital use.

When city hospitals get crowded, it limits transfers from these less well-equipped rural areas.

“They’re struggling when they need to transfer patients in finding new facilities to accept them,” Burnett said. “It’s very concerning.”

Death rates in Burnett’s district’s Morgan County, among other, justify his concern.

Common wisdom would say COVID-19 claims more lives in higher-density locales than rural areas, and to an extent this is true. The counties with the highest overall numbers of deaths are the populous Front Range counties.

For all the explosive growth around the Denver metro area in the last 10 years, Colorado is still a majority rural state. Many of those rural counties haven’t experienced high death rates.

Others, however, have death rates that far exceed those in urban areas. 

The three counties with the highest rates of death among COVID-19 cases per 100,000 are Morgan, Chaffee and Prowers counties.

Morgan County’s high rate comes in part from a single outbreak that claimed two dozen nursing home residents. Even absent those numbers, though, the rate is still higher than Denver’s metro counties.

Burnett echoes Dr. Papenfus, insisting that rural areas under serious resource strains should take the pandemic as seriously as though they live in a high-contagion area.

“These hospitalization rates and outbreaks, long term care…it’s an extension of what’s going on in the community,” he said. “These cases all come from somewhere. Everybody’s actions have consequences.”