A few days after getting a positive COVID-19 test in late November, Cheri collapsed in her kitchen in rural Wisconsin. The next day she was at a hospital in North Dakota, a nearly 300-mile drive from her family.
“‘How the fuck am I gonna get home?’” Cheri’s daughter, Erica Balcerek, said her mom told her over the phone from the hospital, laughing between labored breaths. “And my mom does not say the f-word,” she added.
Her local hospital, in St. Croix Falls, Wisconsin, was overwhelmed by the coronavirus surges hitting the region in November and did not have the capacity or resources to treat her. So they called around and found the closest hospital that did: Essentia Health, in Fargo, North Dakota. After staying in her local hospital for a few hours, Cheri was put in a futuristic, transparent oxygen hood, driven about 12 miles to the airport, and loaded onto a propeller plane.
Cheri’s situation is not unique. As the coronavirus increasingly hammered rural areas in recent months, the small hospitals that serve those areas have found themselves with too many patients, too few beds, and not enough staff to deal with the situation. So they have started airlifting them to any hospital that can take them, no matter the distance, scattering rural patients all over the country.
Two air medical transport companies that serve the Midwest — Life Link III and Midwestern Medical — told BuzzFeed News that during the pandemic the volume of patients they are airlifting to distant hospitals has increased. Midwestern Medical said it normally transports between two and eight patients a month, but in November, it transported 21. A spokesperson for Essentia Health said in an email that the hospital saw an uptick in patients from “outside our normal service area,” and experts on rural hospitals and public health in the Midwest said many hospitals in the region have been significantly overwhelmed.
Rural hospitals often have a small staff, limited beds, and limited resources. Sixty-one percent of rural hospitals don’t have intensive care units, the National Rural Health Association (NRHA) found. So even before the pandemic, patients in rural areas facing life-threatening illnesses often had to be transported to faraway urban hospitals.
The rural Midwest was hit hard and early by the massive surge in COVID-19 that rolled across the US from September, as colder weather made people spend more time congregating indoors. In Wisconsin and across the northern plains states, hospitals were stretched to capacity, reaching a peak in mid-November. Although new cases and the number of hospitalized patients have declined across the region, what happened in the Midwest last month is a dire warning for other rural parts of the country where the virus is continuing to spread.
“In such a rural area, with so much open air space, where you know everyone and what they’re up to, people here kind of think we’re invincible, which we’re not,” said Jeff, Cheri’s husband. “Of course everyone thinks you are pretty much invincible until something comes along and bites you in the ass.”
Cheri is 66, and Jeff is 67. They’re generally healthy, but their age puts them in one of the groups at risk for more severe cases of the coronavirus. Their town in northwestern Wisconsin is about 2 square miles and has a population of about 1,100 people. Because of this, Jeff asked that only his and his wife’s first names be used and for their hometown’s name to be left out as well.
“We’re a small town, and I don’t want a neighbor to read the article and think…” Jeff trailed off and did not elaborate.
During the first and second waves of the coronavirus spread in the spring and summer, their region was left largely untouched by the virus. That’s part of why his family and the rest of the town thought they were safe, Jeff thinks.
Unlike many in their town, Jeff and his daughter said they had been very cautious throughout the pandemic. They wore masks whenever they went out, even if they sometimes got judgmental or questioning looks from neighbors at the grocery store. Cheri works at a shelter for people escaping domestic violence, and she was careful at work as well, wearing her mask and social-distancing when she could.
But they weren’t always as careful within their family. Their oldest son, Devin, 43, was over every weekend helping out around the house without a mask, and Cheri and other members of the family were often over at her parents’ farm nearby, helping feed the animals and taking care of things around the house. Then Cheri got sick.
The family isn’t completely sure how COVID-19 got into their circle. Devin was the first to test positive, then Cheri, Jeff, and both of Cheri’s parents followed.
“Devin has been one to believe this is all a hoax until now,” Jeff said over the phone, pausing for a sigh. “I love my kids dearly, every one of them. Devin can be the bullheaded one, but he’s also the first one, if I need anything done, he’s the first one that’s here. That’s all I really wanna say on that.”
Devin denied he ever thought COVID-19 was a hoax, but over the phone, he said this situation with his mother has definitely changed his mind on aspects of the way the country is dealing with the coronavirus, like wearing masks. And he said he’s felt guilty about the possibility he could have infected his family all week.
“Yeah, I feel like shit about it,” Devin said, speaking from a hotel room while on the road for work. “To the point where I got a hold of my ex-pastor, even though she is now retired.”
Devin is a calibration technician, meaning, by his own definition, that his job is to “make sure things measure what they’re supposed to measure.” He’s been working through most of the pandemic, traveling to factories and workplaces all over the country, working in enclosed spaces with different people, often not wearing a mask.
“Originally I was like, Let people make their own decisions,” Devin said, explaining that he saw the way the pandemic was ravaging small businesses, like the paintball business he runs in the summer. “Before I was like, if the customer required me to wear a mask, I wore a mask; if they didn’t, I didn’t. But now that I know where things stand, I’m wearing a mask no matter what.”
Devin said that now that he’s had the virus, he’s looking for a way to donate plasma, so he can potentially help save other people who have had severe reactions to the virus, like his mom. But he’s having a hard time finding a place to donate near where he lives.
Jeff only had mild symptoms, and Cheri’s dad had to go to the hospital but didn’t need intensive treatment that would take him outside of the region. But for Cheri it was touch and go.
“On Saturday evening, she fell, trying to get from one room to the next,” Jeff said about his wife, Cheri. “She was lying and moaning and groaning on the floor. I said, ‘Did you hurt yourself?’ But she was having a hard time breathing.”
Jeff called 911, and the EMTs came and took her vitals. They told Jeff her oxygen was down to 60%, he said. They rushed her to the nearest hospital, but quickly realized they couldn’t keep her there. They made an exception to the no-visitors rule most hospitals have adopted during the pandemic, and allowed Jeff to come and sit with his wife before they strapped her to transportable oxygen machines and drove her to the airport.
“After she got settled in Fargo, the nurse that was taking care of her that day called me and said, ‘If you don’t hear from us that’s good, but I also might be contacting you for some face time with her,’” Jeff said, taking in a sharp breath. “That really set me off, you know — that would mean that they were gonna take her into the ICU, put her on a ventilator, and of course, I didn’t even want to think about what that meant.”
There, her husband said, she was given an experimental convalescent plasma therapy treatment — in which blood from people with COVID-19 antibodies is reduced to plasma and given to patients with severe cases in the hopes it will help fight the virus, and the FDA-approved drug remdesivir.
For a while, Cheri wasn’t sure how she would get home. Much of her family had the virus as well, and though they were feeling OK, they were still under quarantine and shouldn’t do a multistate road trip. But she ended up being in the hospital for longer than she imagined — nearly two weeks. By the time the hospital was ready to discharge her, Jeff could make the trip.
On Monday, Jeff got the call that Cheri could come home. He jumped in the car at 5:30 a.m. the next day and drove 13 hours there and back, making pit stops on the way home to make sure Cheri was OK.
The couple is on Medicare, and have supplemental coverage that should mean they won’t be charged more than a few hundred dollars for Cheri’s treatment and her emergency flight to North Dakota, Jeff said, which they can afford. Many aren’t so lucky.
Sometimes a rural ambulance will drive hundreds of miles to drop a patient off at a city hospital that can treat them properly. Without proper insurance, this can cost the patient thousands of dollars and leave their county without any ambulances for hours at a time, said Brock Slabach, NRHA senior vice president of member services. Long delays in getting proper care can worsen a patient’s condition, especially with the unpredictable crashes that often accompany severe COVID cases, Slabach said. If the hospital is too far for a drive, the patient could be looking at even higher bills.
“The financial component of an air transfer is very difficult. You’re looking at sometimes $30,000 or $40,000,” Slabach, who used to set up similar transfers as a rural hospital administrator, said over the phone. “And many times were finding commercial insurances don’t pay for air transport, so that’s left for the patient to meet.”
Once they’ve recovered, insurance often doesn’t pay for the trip back home. Discharge planners — hospital staff who help figure out the best way to transfer a patient out of the hospital — can often help patients navigate this problem, but they have become overwhelmed during the pandemic as well. Not only do they have more patients than they’re used to, but they’re from all over the country and have complex, long, and often unpredictable recovery needs.
Then there’s the burden on the families, emotional and financial.
“Families feel so helpless in this situation to begin with, and then you add that distance,” Alana Knudson, the director of the Walsh Center for Rural Health Analysis, said in an interview. “Being that far away is even harder because there’s no chance to go visit somebody if any last-minute issue arises unless you’re staying in a hotel nearby, which isn’t financially viable for many people.”
The problem rural hospitals are facing now could have been avoided, or at least mitigated, Slabach and Knudson both said. These hospitals don’t have “surge capacity,” Knudson said, meaning the ability to expand capacity, workforce, and equipment for emergencies like the pandemic. They should have funds to bring in more staff to help, space for extra beds, and stockpiles of personal protective equipment and respirators. But when state or local governments are looking to cut budgets, Slabach and Knudson said, funding for stockpiles and extra staff are often the first things to go. Things like that aren’t missed until they’re needed.
While Cheri was in the hospital, Jeff and Devin kept themselves busy, trying not to focus on what the future might hold. Devin said that he’s never seen his dad like this, that he’s been through a lot of ups and downs, but he’s never been this worried.
“My mom is— She’s my lady. She’s my rock,” Balcerek, Jeff and Cheri’s daughter, said over the phone, sitting in her car. “I mean, yeah, I’m happily married and he’s my rock, whatever, but a mom is just different.”
“That’s the thing about this: Your loved one goes to the hospital and you can’t go see them. You’re left here holding a big bag of What If,” Devin said. “And that stress is huge.”
The virus severely affected Cheri’s lungs, Balcerek said, and they don’t know if it will lead to permanent damage. A company set up an oxygen tank in their house connected to Cheri by 40 feet of tube, which she’ll drag along with her as she moves through the house. She’ll have to stay attached to that tank for the next month or so, her daughter wrote in an email Wednesday.
“That was a tough pill to swallow, hearing that,” Balcerek said. “But my mom is a tough lady, she’ll fight through and be home when she can...hopefully sooner than later.”
“We had all these dreams about how things were going to be this coming winter, and then this shit hit,” Jeff said. “Now we just want her home.”
Peter Aldhous contributed to this story.