Ten hospitals have closed across Tennessee in the last eight years, more than any state other than Texas. Many more are in dire financial straits and at risk of closure.

Both Texas and Tennessee are among the 14 states that have opted out of Medicaid expansion, which many experts point to as a major cause of rural hospital closures. Eighty-two percent of Tennessee’s 95 counties are considered rural.

That’s why so many fear a rural COVID-19 outbreak in Tennessee.

If a hospital such as Sumner Regional is at capacity from an influx of patients, it puts a huge strain on the rest of the community, despite being well-prepared for COVID-19 cases.

“It’s a very, very difficult and sad situation for everyone, and predictions are it’s going to get worse, and that is a scary prospect,” Gallatin Mayor Paige Brown says. “We just keep trying to explain to people the seriousness, the potential burden on health care, which we’ve certainly seen here in Gallatin.

“It looks like projections show that there will be a situation that health care is going to be a real challenge in the coming weeks, and so you’re going to need to find somewhere that can treat you if you need treatment. I know that there are multiple places that you can be tested, if you just need to be tested. But if you get to a place where you actually need some advanced medical care, it could be a challenge to find that.”

Sumner County Mayor Anthony Holt agrees that the biggest concern for the county right now is overwhelming the medical system.

“We have structures; we can house people,” he says. “The problem is are we going to have the available staff to be compassionate, caring, and really provide the kind of medical care that some of these critical patients are going to need? That’s what scares me to death.

“People better start waking up and doing the right thing. I understand you have to go places. You have to buy food. But just to get out, to be out and to socialize, is really, really dangerous right now.”

Ken Weidner, director of Sumner County Emergency Management Agency, helped facilitate the transport of 95 residents and staff from Gallatin Center for Rehabilitation and Healing during that facility’s breakout, along with Greg Miller, chief of Emergency Medical Services, as part of the Sumner County Unified Command Center.

The transport of that many patients required the coordination of outside resources, keeping medical staff safe and arranging for 54 ambulances and two buses. The thought of multiple incidences happening at once seems overwhelming.

Miller says each county has a regional consultant, an employee of the state they can call to advise them about how many ambulances they might need. That consultant would then put out a call to their region. Sumner got ambulances from the Middle Tennessee region, the Upper Cumberland region and the Southeast region.

“If we had a big event and Robertson County had a big event at the same time, that means they’re just going to have to stretch the request out further in the state and go all the way to Memphis on the west end, go all the way to Bristol on the Northeast end,” Miller says.

“And if it gets to where the state can’t handle it, then it goes into FEMA, and FEMA goes outside the state, and the State EMS has contacts with other states. So in our area, they would reach out to the closest, which would be Kentucky. If you’re on the south side, you might reach out to Alabama or Georgia to bring some ambulances in. But it just continues to grow as big as you need it.”

Weidner says in his 36 years working the area he has never seen a need like they just dealt with, and the scariest part is what will happen in the days to come as we finally break the curve and cases start to level off.

“We’re in the unknown. We’re dealing with something that’s unprecedented in the United States of America. Nobody that’s alive today has dealt with this incident,” Weidner says. “That’s the problem. It’s not real for a lot of people, and we get beat up when we say this, but what’s so wrong with saying ‘Shelter in place?’ To me that truly lets people know how serious this is.”