Of all the times one would think a hospital would have patients, it would be during a pandemic.

But that’s not the case in Putnam County.

“We’ve actually dropped probably 62 to 65% of business,” Putnam County Memorial Hospital CEO Gayle Pickens said.

The hospital is located in Unionville, which has a population of about 1,800 and is nine miles from the Iowa border.

In harder hit areas of the U.S. like New York City and New Orleans, hospital hallways still bustle with a cacophony of activity as frontline workers treat an overwhelming number of COVID-19 patients.

But almost all hospitals across the country have been forced to cancel elective and non-emergent procedures in an effort to limit accidental exposure to COVID-19. Additionally, many people are putting off regular visits and choosing to stay home.

That means that in Missouri, however, many smaller hospitals are now eerily empty.

Some are short of protective equipment if they encounter COVID-19 patients. According to the Missouri Hospital Association, there are five hospitals facing a critical shortage of N95 masks, four a critical shortage of surgical masks and 17 a critical shortage in hospital gowns. However, overall, the average number of daily new cases has been going down and they are concentrated in the state’s metropolitan areas.

All of this poses a different sort of problem for already cash-strapped rural hospitals – how to keep the doors open.

“It’s tough times for the rural hospitals across the board,” Pickens said.

Pickens said a significant amount of the hospital’s revenue comes from Medicare and Medicaid procedures, many of which aren’t happening as hospitals have had to limit their scope to emergent cases only.

Last week Pickens was forced to lay off 25 workers, amounting to 25% of her staff. Remaining staff members’ hours were decreased to 32 a week.

“It’s a horrible, horrible situation,” Pickens said “In our little community and this little hospital, we have people who have been here a very long time. This is like a family and when one family member is hurting everyone hurts.”

It’s not just Pickens’ hospital that is hurting. She said that she’s talked to numerous hospital CEOs in the surrounding area. Not one in a 60-mile radius of Putnam County Memorial isn’t “in the same boat” she said.

Earlier in the month Dr. Randy Tobler of Scotland County Memorial Hospital in nearby Memphis told National Public Radio that he was prepared for possible COVID-19 cases. He was confident they either had or could source the necessary personal protective equipment. What kept him up at night, he said, was how he was going to make the payroll.

Both cases are part of an ongoing trend in rural hospital closures throughout the country. Locally, Missouri has seen at least six rural hospitals close their doors since 2010.

In January, Pinnacle Regional Hospital in Boonville closed its doors due to an inability to pay for necessary repairs.

As for Pickens, she’s optimistic she’ll be able to hire back her staff when the hospital can resume normal procedures and increase its revenues. But it’s hard to know when that will be.

“How long is it going to last? How long can these rural hospitals hold on?” she said. “That’s a big concern. How long can we hold on financially in order to be viable in a month?”

Even more alarming to Pickens is the effect the hospital's closure would have on the community. The hospital and the local public school are the two biggest employers in Unionville. Not only that, but it would likely cause worse health care outcomes for Unionville’s aging population.

All of this weighs heavy on Pickens, who voluntarily took a pay cut. She said, for now, her objective is clear – her little hospital just has to hold on.

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