For months, the chief executive officer of Candler County Hospital battled COVID-19 from the confines of his bedroom, with his wife running between her job as a teacher in Metter and his bedside.
On some days, Missy Purvis would arrive from work to find her husband with a raging fever and lying in a pool of sweat, barely cognizant of where he was or what was happening to him.
As his illness progressed, it became increasingly agonizing. He suffered a series of complications, including multifocal pneumonia, which seriously damages lung tissues and has caused many virus-related deaths.
Yet for fear of infecting his team of physicians and nurses as the county was seeing the coronavirus infection rate swell, Michael Purvis avoided the hospital, only occasionally visiting the emergency room when he needed supplemental oxygen. When he needed to see a doctor, he would make an appointment at the local clinic.
Purvis, who is 46, ultimately recovered. But the tenuous situation illustrates just how fragile Georgia’s rural healthcare safety net can be and how easily it can topple in a time of crisis, industry leaders say.
Purvis was hired roughly three months before the pandemic hit as part of a crucial move by the Candler County Hospital Authority to stabilize a hospital that in years past had been on the brink of closure.
That would be a crippling loss for the county, where one-third of residents live below the poverty line and one in five is uninsured, and the county ranks near the bottom in the state on key health outcomes. For many of the county’s roughly 10,000 residents, the hospital is their sole source of healthcare; without it, those with life-threatening emergencies would have to travel as far as 60 miles to the next closest facility.
Without its chief, the hospital easily could have sunk into chaos after years of financial instability, a dire shortage of doctors and high staff turnover, local leaders, including some physicians, told the Atlanta Journal-Constitution.
“When you look at a rural hospital without its CEO, it can be extremely difficult steering during an already very stressful time,” said Brock Slabach, senior vice president for the National Rural Health Association in Kansas. “It can create an imbalance to the entire system.”
The county was pinning hopes on Purvis to keep the hospital strong, based on his years of experience as a facility manager and clinician. He arrived in Metter after a decade as CEO for Cook Medical Center, overseeing construction of a $48 million replacement facility for Tift Regional Health System, which now owns the Adel hospital.
“We have been fortunate for Michael to agree to come to Metter,” Mayor Ed Boyd said. “It would have been a huge loss if something were to happen to him.
“It would have been devastating.”
Coming to grips
A radiologist by training, Purvis spent the early months of his administration preparing for the unprecedented coronavirus public health emergency.
He spent his time establishing and monitoring an incident command center to keep track of PPE stockpiles, staffing, patient admissions and bed capacity. He also was key in public health messaging, issuing notices urging the public to observe precautions. This was at a time when town leaders acknowledge many in the area resisted instructions to wear masks and comply with social distancing rules, seeing no threat from the virus.
During those months, he took great care to avoid exposure to the coronavirus, never removing his mask while at the hospital and out in public and trying to stay home as much as possible.
Yet on July 7, he tested positive for the virus. He said he must have been infected by an asymptomatic painter working at his home after he and his wife married in May.
“I knew I had the risk like anybody,” he said. “But I was being so careful. In the first 24 hours, I was just so shocked that I had it. I had to really come to grips with it and, I thought, ‘I got to get over this so I can get back to work.’”
Purvis had taken the job with a plan to make the hospital not just survive, but thrive.
Years ago, county officials agreed to shore up the hospital’s finances, after missteps with equipment purchases burdened the facility with more than $3 million of debt. To keep it afloat, commissioners acted to dedicate a portion of tax collections under the special purpose local tax option to the hospital. All told, about $280,000 a year is contributed, County Administrator Bryan Aasheim said.
To strengthen the hospital, among Purvis’ earliest efforts was to expand a telemedicine program with Augusta University Health System that brings more doctors into the mix to be available to see more patients. Only recently under Purvis’ direction the hospital purchased 3D mammography so residents don’t have to travel long distances to receive cancer screenings, and medical air gas systems for virus patients who are on oxygen support.
“What can be beneficial to a rural community, what can be afforded, he knew it,’' said Dr. Loy Cowart, an emergency medicine physician at Candler Hospital.
“The big difference is what is needed in a rural town of 3,500 people isn’t maybe what’s needed in metro Atlanta.”
‘Brain shut down’
Purvis worked to stay on top of hospital operations, even as COVID-19 hit him fast.
“After dinner one night, he just, all of a sudden had this, ‘I don’t feel good,’ feeling,’' Missy Purvis said. “About 30 to 45 minutes later, he was burning up with fever.”
He lost his sense of taste and smell. He developed a shortness of breath and chest pain that stayed with him for weeks. “It got to where I was struggling to breathe so much, it became normal.”
Still, over the first 12 days of the virus, each morning he monitored the hospital’s incident command center that tracked supplies and admissions. He also went through work checklists and communicated through frequent emails.
Then on Day 13, the virus took over. That day, he got up, completed his routine checks, then decided to lie down for a nap at about 9 a.m.
When his wife returned from her classroom eight hours later, she found him drenched in sweat and feverish.
“My brain just shut down,’' Michael Purvis said. “I didn’t realize I had spent eight hours down.”
There hadn’t been a lot of research at that point on treatments for COVID-19 patients, so Purvis had been following a daily vitamin regimen of zinc and melatonin recommended by his doctors. He also took hydroxychloroquine, the antimalarial drug Trump had touted but that the FDA already had cautioned was likely ineffective.
His wife attended to him, while taking steps to protect herself. During his illness, she stayed in a separate bedroom on the other side of their house, wearing gloves, masking up and spraying door knobs, each time she would deliver food and medicines.
“It was just the two of us battling it,’' she said.
By the sixth week of his illness, though, he went to emergency room physician Thomas Ferrari, who ordered a chest X-ray. It showed Purvis was suffering from multifocal pneumonia.
“That can be very dangerous and rapidly progress,’' Dr. Ferrari said.
Purvis was prescribed dexamethasone, a steroid shown to be effective with critically ill patients. After several rounds, he said he began to feel like his old self again. In the latter part of September, he was finally able to return to his regular work hours.
“He’s a very strong man, to think that he actually pulled through all that,” Ferrari said.
Late in November, Purvis kicked off his second year as CEO, gearing up for some of the worst days of the pandemic for his 25-bed critical access hospital.
In the weeks following the holidays, his 12-bed “COVID-unit” of acute patients was bursting at the seams; at times, patients had to be carried in by stretcher after passing out in the lobby of the clinic next door. The hospital was so full that ambulances with sick patients had to be rerouted to other facilities.
“We’ve been very busy since Christmas,’' Purvis said.
As he continues to guide the tiny facility through the pandemic, he can speak directly to sufferers because he’s been there.
His case also is helping change opinions in the community. “Everyone realized it can happen to anyone,” Missy Purvis said. “It’s not socioeconomic, it’s not about race. It can affect everybody.”
Yamil Berard is a reporter for The Atlanta Journal-Constitution. She may be reached at firstname.lastname@example.org
To read more of The Atlanta Journal Constitution’s coronavirus coverage, visit AJC.com/news/coronavirus