This story was expanded on March 26 to include a look at what the data cited in the Kaiser Family Foundation report could mean for South Carolina's rural communities.
Twelve of the state’s 46 counties have no intensive care unit beds, according to a report released by the Kaiser Family Foundation (KFF) that looks at the ratio of Americans age 60 or older to ICU beds. (See below for a breakdown of South Carolina.)
So what does that mean in a pandemic? Dr. Jan Probst, professor emerita of the Arnold School of Public Health at the University of South Carolina, says that counties immediately adjacent to an area where there is adequate hospital coverage – for example, Fairfield, which abuts Richland County and the City of Columbia’s hospital network – should be able to handle an influx of patients in an emergency.
“I realize the value of centralized healthcare,” she says; the concentration of hospitals and emergency personnel means a density of technologies and knowledge. “However, when you get to the counties that are not immediately adjacent, then you really start to worry.”
Take Abbeville County, which has six ICU beds and a ratio of seniors (the 60-and-above set is among the most at risk of advanced symptoms of Covid-19) to those beds of 1,174 to 1. Abbeville sits on the western end of the state, 55 miles from Greenville, it’s closest hospital metro area. Outside of a pandemic, Abbeville’s six-bed capacity is usually adequate, Probst says. But during a pandemic, having so few beds so far from a city center highlights how quickly a small, rural system could become overwhelmed.
'You had to decide who could live and who could die. We will see that problem again in South Carolina if people do not take shelter-in-place seriously.'
“Even in rural areas, six ICU beds is not a lot,” she says. “We have seen family clusters where everybody in the family gets sick. We have seen where everybody who has ignored a social distancing warning and gone to a tiny church picnic could get sick. These are not inconceivable scenarios and they are really, really scary.”
At the beginning of this week Surgeon General Jerome Adams warned that the days ahead were “going to get bad.” Health officials at the state and federal levels warned that we are now in an acceleration phase, when cases of Covid-19 will multiply.
Probst worries that people won’t take stay-home warnings seriously, and that such carelessness will lead to large numbers of people needing a hospital at once. And if that happens, like it is happening currently in Italy, she says doctors and families will have to make decisions on who most deserves treatment – in other words, who gets to live and who doesn’t.
“My first job in the world was at the VA hospital in Washington, D.C.,” she says. “They had a committee, because they only had so many dialysis machines, they had to decide who gets the machines. So you had to decide who could live and who could die. We will see that problem again in South Carolina if people do not take shelter-in-place seriously.”
Graham Adams, executive director of the South Carolina Office of Rural Health, says the pandemic highlights the kinds of problems rural residents deal with in their healthcare options every day. But he emphasizes that rural communities are not being left to wander the void on their own.
“Our hospitals and healthcare systems throughout the state are working together to make sure that folks are cared for no matter where they are and that people are getting the resources they need,” he says.
Part of that effort has been to free up hospital beds that would have been used for elective surgeries – something Governor Henry McMaster recently asked be put on hold. At his press conference Monday, McMaster said that pushing off elective surgeries has freed up nearly 2,000 beds statewide.
A Look at South Carolina's Numbers
The South Carolina counties without ICU beds are: Allendale, Bamberg, Barnwell, Berkeley, Calhoun, Dorchester, Edgefield, Fairfield, Lee, McCormick, Marlboro, and Saluda –have a combined population of 542,000, with almost 113,000 of those residents being age 60 or older.
The largest county, by population, with no ICU beds is Berkeley. The KFF report cites 204,632 residents; 18 percent are at least 60 years old – the demographic in the most danger from the coronavirus.
McCormick County, by contrast, has fewer than 10,000 residents, but 40 percent are seniors.
Even in counties with multiple ICU beds – such as York and Beaufort counties, which each have 24 – the ratio of seniors to those beds would be overwhelming. In York County, almost 49,000 residents are at least 60 years old. That translates into more than 2,000 seniors per ICU bed. Beaufort County’s nearly 57,000 seniors make for the state’s worst seniors-to-beds ratio: 2,372 to 1.
Neighboring Charleston County has the most ICU beds in the state, with 221. The ratio of seniors to beds there is 371 to 1.
The best seniors-to-beds ratio in South Carolina is in Florence County, which has 98 ICU beds and 30,487 seniors. That’s 311 seniors for every ICU bed.
Scott Morgan is the Upstate Multimedia Reporter for South Carolina Public Radio. Follow Scott on Twitter @ByScottMorgan