For the last three years, the University of Nevada, Reno School of Medicine has been sending its recent graduates to the Elko Family Medical and Dental Center, a single-story brick building that serves a county whose total population is fewer than 54,000 people.
Those medical residents are helping fill gaps in health care access for Elko, a remote mining and ranching town nearly 300 miles northeast of Reno. In September, the community saw its deadliest month since the pandemic began. The Elko Daily Free Press reported 25 people died that month alone.Listen here.
That’s due to the arrival of the highly transmissible delta variant, part of a nationwide surge that began this summer. As national case numbers were starting to taper off, the impact on rural, conservative communities like Elko was only growing.
“I thought it was bad when I was in the hospital last July and August, but it’s gotten much, much worse since then,” said resident physician Dr. John Davis.
Davis, a member of UNR Med’s rural health program, will finish his training in Elko. He says the tremendous rise in cases pushed him and other doctors to work extra hours at the local hospital.
In response to surging cases, the hospital took to social media to plead with local residents to wear masks and avoid gatherings to “keep our healthcare system from being overrun.”
But in this deeply conservative community, elected officials have used their platforms to spread misinformation about the pandemic – and urge their constituents to reject measures that could slow the surge.
Other states in the Mountain West have seen similarly grim statistics.
Davis says it’s not just the number of patients that makes the delta surge so scary – it’s also the unpredictability of the disease itself.
“It’s like a Russian roulette, it’s like you just never know how the patient is going to do,” he said. “Sometimes they may get better. Sometimes they get worse despite our treatments and they end up on a ventilator.”
Despite the risk, fellow UNR resident Dr. Samantha Rosekrans says patients offer stiff resistance when she encourages them to get vaccinated.
“It’s been disheartening,” she said. “Even before coming out here, though, I’ve kind of gotten to a place where I’m apathetic about it, where I realize that I have little to no agency in changing their minds.”
But even before the delta surge, many people in the area were struggling to get medical care. Much of the county is considered a Health Provider Shortage Area by the federal government. That means it can be tough to see a doctor, even in the best of times.
“It’s 300 miles to Reno, or it's three hours to Salt Lake, or it’s, you know, three hours to Boise,” said Dr. Bryce Putnam.
Putnam is a dentist in his day job but also serves as the Elko County Health Officer – a role that’s had him waking up at 4 a.m. every day for almost two years.
“I’ve gotten a lot grayer, I’ll tell you that much,” he said of his experience during the pandemic.
According to John Packham, associate dean for UNR Med’s Office of Statewide Initiatives, COVID-19 made the chronic shortages of healthcare providers across Nevada worse.
He says during the early days of the pandemic, Nevada relied on traveling nurses to fill gaps in hospitals, clinics and ICUs. Almost two years later, those extra resources are stretched thin – and so are the agencies that supply them.
“You can only rob Peter to pay Paul so many times before it catches up, and it’s catching up with the agencies. They’re having staffing issues themselves,” he said.
Packham explained that’s partially because demand is high in neighboring states like Idaho, Utah and Arizona.
In the long term, he’s also concerned about polling that suggests some doctors might retire early due to COVID-19.
“The data indicate that we have an aging physician workforce up north compared to other parts of the state, particularly compared to Las Vegas,” he said.
Dr. Bayo Curry-Winchell is medical director of St. Mary’s Urgent Care in Reno and specializes in pediatric medicine. She says even suggesting that a child be tested for COVID-19 can trigger mistrust.
“When you enter that room, it’s not about just diagnosing, seeing that child, connecting,” she said.
Instead, she finds herself wondering if the parent will get upset.
Ultimately, Curry-Winchell finds an empathetic approach is the best way to address vaccine hesitancy.
“When I go into these conversations, it’s more of, ‘Please tell me why you're hesitant,’ ” she said. “I think there’s so much information in that question that helps spark the dialogue and maybe decrease misinformation.”
Experts say we’ll have to vaccinate almost 90% of the population to have any chance of stopping the pandemic.
In Elko County, the vaccination rate stands at about 30%.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.