SCOTT SIMON, HOST:
Many rural communities have resisted masks and calls for social distancing during the coronavirus pandemic, but now rural counties are experiencing record-high infection numbers and deaths. The sickest residents are often transferred to cities for treatment. And as Alex Smith of member station KCUR reports, urban hospitals are buckling under added strain.
ALEX SMITH, BYLINE: Registered nurse Pascaline Muhindura has spent the last eight months treating COVID-19 patients. She works at Research Medical Center in Kansas City, Mo. But when she returns home to her small town outside of the city, she's often stunned by what she sees, like on a recent stop for carryout.
PASCALINE MUHINDURA: No one in the entire restaurant was wearing a mask, and there is no social distancing. It was like - I had to get out 'cause I almost had a panic attack. I was like, what is going on with people? Like, why are we still doing this?
SMITH: Kansas City has a mask mandate, which isn't the case in many smaller communities nearby. They don't require masks. In the last few months, a lot of rural counties in both Kansas and Missouri have seen some of the highest rates of COVID-19 in the country. And in both states, in three out of four counties, there isn't a single intensive care unit. So when people in those places get critically ill, they're sent to city hospitals.
Dr. Marc Larsen leads COVID-19 treatment at Saint Luke's Health System in Kansas City, where a recent count showed a quarter of the hospitalized COVID-19 patients came from outside of the metro.
MARC LARSEN: Not only are we seeing an uptick in the patients in our hospital from the rural community, they're sicker when they - when we get them because they're able to handle, you know, the less-sick patients.
SMITH: Larsen says that two-thirds of patients coming from rural areas need intensive care and stay in the hospital for an average of two weeks.
LARSEN: And we get the sickest of the sick.
SMITH: Dr. Rex Archer is the head of Kansas City's Health Department. He warns that the city's 33 hospitals are put at risk by the influx of rural patients.
REX ARCHER: We've had this huge swing that's occurred because they're not wearing masks. And, yes, that's putting pressure on our hospitals, which is, you know, unfair to our residents that might be denied an ICU bed.
SMITH: Hospital leaders have pleaded with Missouri's governor, Mike Parson, a Republican, and with Kansas' conservative Legislature to implement statewide mask requirements but had no luck. Meanwhile, local cases in Kansas City have started picking up again, too, and an average of 190 people are being admitted to hospitals with COVID-19 each day.
Nurse Pascaline Muhindura says that bed space isn't the only hospital resource that's running out. As patient counts continue to rise, she and fellow hospital workers are struggling with anxiety and depression.
MUHINDURA: The hospitals are not fine because people taking care of these patients are on the brink. We are tired.
SMITH: And trend lines indicate the latest surge is only going to get worse.
For NPR News, I'm Alex Smith in Kansas City.
SIMON: And that story comes to us from NPR's partnership with KCUR and Kaiser Health News.
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