Kurt Papenfus, a doctor in the small town of Cheyenne Wells, Colo., started to feel sick around Halloween. He developed a scary cough, intestinal symptoms and a headache. In the midst of a pandemic, the news that he had COVID-19 wasn't surprising, but Papenfus' illness would have repercussions far beyond his own health.
Papenfus is the lone full-time emergency room doctor in the town of 900, not far from the Kansas line.
"I'm chief of staff and medical director of everything at Keefe Memorial Hospital currently in Cheyenne County, Colo.," he said.
Just 62 people in the county have been diagnosed with COVID-19, according to Colorado's coronavirus data website.
With Papenfus sick, the hospital scrambled to find a replacement. As coronavirus cases in rural Colorado, and the Eastern Plains especially, surge to unprecedented levels, Papenfus' illness is a test case for how the pandemic is affecting the fragile rural health care system.
"He is the main guy. And it is a very large challenge," said Stella Worley, CEO of the hospital.
If she couldn't find someone to fill in while he was sick, Worley might have to divert trauma and emergency patients nearly 40 miles north to Burlington.
"Time is life sometimes," she said. "And that is not something you ever want to do."
"The 'rona beast is a very nasty beast"
As deaths from the coronavirus have surpassed 250,000 in the U.S., new data show the pandemic has been particularly lethal in rural areas — it's taking lives in those areas at a rate reportedly nearly 3.5 times higher than in metropolitan communities.
Papenfus, a lively 63-year-old, was discharged after a nine-day stay at St. Joseph's Hospital in Denver, and he was eager to sound the alarm about the disease he calls the 'rona.
"The 'rona beast is a very nasty beast, and it is not fun. It has a very mean temper. It loves a fight, and it loves to keep coming after you," Papenfus said.
He isn't sure where he picked it up but thinks it might have been on a trip east in October. He said he was meticulous on the plane, sitting in the front, last on, first off. But on landing at Denver International Airport, Papenfus boarded the crowded train to the terminal, and soon alarm bells went off in his head.
"There are people literally like inches from me, and we're all crammed like sardines in this train," Papenfus said. "And I'm going, 'Oh my God, I am in a superspreader event right now.' "
An airport spokeswoman declined to comment about Papenfus' experience.
A week later, the symptoms hit. He tested positive and decided to drive himself the three hours to the hospital in Denver. "I'm not going to let anybody get in this car with me and get COVID, because I don't want to give anybody the 'rona," he said. County sheriff's deputies followed his car to ensure he made it.
Once in the hospital, chest X-rays revealed he'd developed pneumonia.
"Dude, I didn't get a tap on the shoulder by 'rona, I got a big viral load," he texted a reporter, sending images of his chest scans that show large, opaque, white areas of his lung. Just a week earlier, his chest X-ray was normal, he said.
Back in Cheyenne Wells, Dr. Christine Connolly picked up some of Papenfus' shifts, although she had to drive 10 hours each way from Fort Worth, Texas, to do it. She said the hospital staff is spread thin already.
"It's not just the doctors, it's the nurses, you know. It's hard to get spare nurses," she said. "There's not a lot of spares of anything out that far."
Besides himself, another six employees — out of a staff of 62 at Keefe Memorial — also recently got a positive test, Papenfus said.
Hospitals on the Plains often send their sickest patients to bigger hospitals in Denver and Colorado Springs. But with so many people around the region getting sick, Connolly is getting worried hospitals could be overwhelmed. Health care leaders created a new command system to transfer patients around the state to make more room, but Connolly said there is a limit.
"It's dangerous when the hospitals in the cities fill up, and when it becomes a problem for us to send out," she said.
"Bank robbers wear masks out there"
The impact of Papenfus' absence stretches across the Eastern Plains. He usually worked shifts an hour to the northwest, at Lincoln Community Hospital in Hugo. Its CEO, Kevin Stansbury, said the town mostly dodged the spring surge and his facility could take in recovering COVID-19 patients from Colorado's cities. Now, Stansbury said the virus is reaching places such as Lincoln County, population 5,700. It has had 144 cases, according to state data, and neighboring Kit Carson has had 301. Crowley County to the south, which is home to a privately managed state prison, has had 1,239 cases. It is far and away the No. 1 most affected county per capita in the state.
"So those numbers are huge," Stansbury said. He said as of mid-November about a half-dozen hospital staffers had tested positive for the virus; they think it's unrelated to Papenfus' case.
Lincoln Community Hospital is ready once again to take recovering patients. Finances in rural health care are always tight, and accepting new patients would help.
"We have the staff to do that, so long as my staff doesn't get ravaged with the disease," Stansbury said.
Rural communities are particularly vulnerable. Residents tend to suffer from underlying health conditions that can make COVID-19 more severe, including high rates of cigarette smoking, high blood pressure and obesity. And Brock Slabach of the National Rural Health Association said 61% of rural hospitals do not have an intensive care unit.
"This is an unprecedented situation that we find ourselves in right now," Slabach said. "I don't think that in our lifetimes we've seen anything like what is developing in terms of surge capacity."
A couple of hours east of Cheyenne Wells, COVID-19 recently hit Gove County, Kan., hard.
The county's emergency management director, the local hospital CEO and more than 50 medical staff tested positive. In a nursing home there, most of the more than 30 residents caught the virus; six have died since late September, according to The Associated Press. A county sheriff ended up in a hospital more than an hour from home, fighting to breathe, due to the lack of space at the local medical center.
Papenfus fretted about his home county and its odds of fighting off the virus.
"The western prairie isn't mask country," he said. "People don't wear masks out there; bank robbers wear masks out there." He is urging Coloradans to stay vigilant, calling the virus an existential threat. "It's a huge wake-up call."
Since being released from the hospital, Papenfus has had a rocky recovery. His wife, Joanne, drove him back to Cheyenne Wells, wearing an N95 mask and gloves, while he rode in the back on oxygen, coughing through the three-hour drive.
Once back at home, Papenfus hunkered down, with the occasional trip outside to hang out with his pet falcon.
But a week after going home, he started having nightly fevers. He had a CT scan done at Keefe Memorial, the hospital where he works. It revealed pneumonia in his lungs, so he went back to Denver, getting readmitted at St. Joseph's Hospital. This time, Papenfus arrived via ambulance.
Finding a replacement for Papenfus at Keefe has been hard. The hospital is working with services that provide substitute physicians, but these days, with the coronavirus roaring across the country, the competition is fierce.
"They're really scrambling to get coverage," Papenfus texted from his hospital bed. "Whole county can't wait for my return but this illness has really taken me down."
He said he was now at Day 35 from his first symptoms, lying in his hospital bed in Denver, "wondering when I'll ever get back." Papenfus noted that COVID-19 has affected his critical thinking and that he'd need to be cleared cognitively to return to work. He said he knows he won't have the physical stamina to get back to full duty "for a while, if ever."
MARY LOUISE KELLY, HOST:
A big challenge for hospitals across the country is what to do when their own employees get sick with COVID-19 and they have to find healthy doctors and nurses to cover shifts. For rural hospitals, losing just one doctor can completely upend operations. A little town on the plains in Colorado is dealing with that right now. Colorado Public Radio's John Daley has the story.
JOHN DALEY, BYLINE: Cheyenne Wells is a town with just 900 people. Sixty-three-year-old Kurt Papenfus is the lone full-time ER doc at its 11-bed hospital.
KURT PAPENFUS: I'm chief of staff and medical director of everything at Keefe Memorial Hospital currently in Cheyenne County, Colo.
DALEY: Around Halloween, Papenfus flew back east to visit family. He says he was meticulous on the plane, sitting in front, last on, first off. But on landing in Denver, Papenfus boarded the crowded airport train back to the terminal, and soon alarm bells went off in his head.
PAPENFUS: There were people literally, like, inches from me, and we're all crammed like sardines in this train. And I'm going, oh, my God, I am in a superspreader event right now.
DALEY: A week later, the symptoms hit. He tested positive and decided to drive himself the three hours to the hospital in Denver.
PAPENFUS: I'm not going to let anybody get in this car with me and get COVID because I don't want to give anybody the rona (ph).
DALEY: County sheriff's deputies followed his car to be sure he made it.
PAPENFUS: It doesn't just hit and run. This stuff keeps going and going and going.
DALEY: Besides Papenfus, another six employees out of a staff of 62 at Keefe Memorial Hospital had also recently tested positive. Dr. Christine Connolly picked up some of Papenfus' shifts, but she lives 10 hours away by car in Fort Worth, Texas. She says there's not a lot of surge capacity in places like Cheyenne Wells.
CHRISTINE CONNOLLY: It's not just the doctors; it's the nurses. You know, it's hard to get spare nurses. There's not a lot of spares of anything out that far.
DALEY: There are big hospitals a few hours from the town in the Denver area, but they're scrambling to keep staffed up and often can't send help. Small hospitals like the one here typically send their sickest patients to those big hospitals. But with so many people around the region getting sick, Connolly worries hospitals could be overwhelmed.
CONNOLLY: So it's dangerous when the hospitals in the cities fill up and when it becomes a problem for us to send out.
DALEY: At least two Colorado hospitals have hit capacity. Recently, health care leaders created a new command system to transfer patients around the state to make more room. And some little hospitals, which have tight finances, may benefit. But the CEO of a small one in nearby Hugo, Colo., Kevin Stansbury, says it wouldn't take much for his hospital to get derailed, too.
KEVIN STANSBURY: We have the staff to do that so long as my staff has - doesn't get ravaged with the disease.
DALEY: Brock Slabach with the National Rural Health Association says small hospitals are and have long been vulnerable. Sixty-one percent of rural hospitals do not have an intensive care unit, and a third of Colorado hospitals anticipate staffing shortages in the next week.
BROCK SLABACH: This is an unprecedented situation that we find ourselves in right now. I don't think that, in our lifetimes, we've seen anything like what is developing in terms of surge capacity.
DALEY: Meantime, Dr. Kurt Papenfus recently returned to Cheyenne Wells after nine days fighting COVID-19 in the big-city hospital.
PAPENFUS: The rona beast is a very nasty beast, and it is not fun. It has a very mean temper. It loves a fight, and it loves to keep coming after you.
DALEY: He's looking to get back to work if he has a successful recovery but expects to be out of commission for at least two more months.
For NPR News, I'm John Daley in Denver.
KELLY: And that story comes from NPR's partnership with Colorado Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.