COVID-19’s relentless ascent statewide is beginning to take its toll on Minnesotans’ access to hospital care — and doctors are sounding the alarm.
One ER doctor at a small hospital in northern Minnesota tells a story of struggling to find a bed for a patient who needed an emergency procedure the hospital wasn’t able to perform.
“She was very sick. She needed an emergent procedure down in the [Twin] Cities or anywhere,” he said.
For smaller hospitals, that’s not an uncommon situation. They have agreements in place that allow them to transfer patients to hospitals that are better equipped to handle more acute care.
“It was an overnight shift I was working. Two in the morning and not a single hospital system had a bed” where the patient could get the care she needed, said the doctor, who didn’t want to publish his name because he wasn’t authorized by his employer to speak with the media. “We called everywhere. I called 10 different hospitals.”
Finally, hours later, he said, they found a bed. But the doctor said he’s worried the patient didn’t make it, though he doesn’t know for sure.
“There was a huge time delay,” he said. “She needed this procedure, and there were no beds.”
That was three weeks ago. Until recently, the doctor said, he hasn’t run into much trouble trying to find a place to transfer patients who urgently need care.
That night in the ER was his first inkling that, after months of hospitals around the state being able to manage their capacity during the coronavirus pandemic, things were about to shift — for the worse.
He’s among six physicians working on the front lines of COVID-19 care across Minnesota who described to MPR News this week a looming tipping point in the state’s ability to manage hospital capacity as COVID-19 cases make their grim climb upward. Some didn’t want to be named publicly because they didn’t have permission from their employers to speak with the media.
They all described a similar scene: Patients waiting hours and hours in the emergency room before being admitted to a hospital bed. Doctors having a harder and harder time finding free space at other hospitals when patients need to be transferred. And patients who are transferred being moved to hospitals hours away from where they live.
Behind the scenes, hospitals are engaged in a complicated game of chess, moving staff, beds and other resources from one to another to accommodate a growing patient volume that they say is the result of multiple factors at once.
Rapidly rising COVID-19 case counts statewide have meant that more people are being admitted to the hospital to be treated for the virus, and those patients are typically staying longer than other patients.
But at the same time, hospitals are trying to make up financial ground through surgeries and other procedures after they halted noncritical care in the spring when the pandemic first came to Minnesota. And many patients who had delayed care in the early days of the pandemic are now catching up on care they urgently need.
As coronavirus cases continue their record-breaking rise, doctors say continuing to move patients and staff around to meet the needs of a growing volume of patients is a strategy that will work only so long before the state will have to quickly stand up new beds and extra space. And even then, they worry there won’t be enough doctors, nurses and other health care professionals to staff those additional beds.
“The big fear is that we’re going to get to the situation that New York and Italy were in in the spring, and it’s a total disaster,” the emergency room doctor said. “We’re worried. We’re all really worried.”
Rising case counts
Since spring, state health officials have repeated their mantra for preventing the spread of the coronavirus: Wear masks, social distance, avoid large gatherings and stay home if you don’t feel well.
But as the warmer months came on and daily COVID-19 case numbers dropped, public health experts say, Minnesotans became complacent. Pandemic fatigue set in — and weddings, funerals and casual gatherings large and small drove COVID-19 transmission throughout the summer — and into parts of the state that had, until then, been largely unscathed.
Today, nearly half of the 164,800 confirmed COVID-19 cases have been traced to exposure in the community. And more than half of those are cases in which patients have no idea how they contracted the virus.
In the last two weeks, daily cases counts have routinely surpassed 2,000 — and, more recently, 3,000 cases. Hospitalizations mirror the rise in cases, though they lag new cases; growth in hospitalizations often comes weeks after case numbers start to rise.
As of Thursday, more than 900 people were being hospitalized for COVID-related issues, with roughly 200 in intensive care units — a high water mark for the state since the pandemic began.
That’s on top of the hundreds of people who are being hospitalized for other reasons, some because they put off care too long in the spring; others catching up on procedures or surgeries that were delayed when hospitals put everything but emergency care on hold. Meanwhile, public health officials warn of the coming flu season, which could land even more people in the hospital.
Those factors colliding simultaneously have officials at the Minnesota Department of Health concerned. In the Twin Cities, 98 percent of ICU beds are in use this week, as are 97 percent of general hospital beds. Statewide, there’s slightly more space — but not much.
“We are very concerned. We continue to see record high case numbers and with that, more hospitalizations are likely to follow,” said Assistant Health Commissioner Marie Dotseth. “We have a real risk of exceeding the capacity our hospitals can handle.”
And while a state dashboard shows there’s still some wiggle room in hospital bed capacity, state and hospital officials say that the prospect of labor shortages is making it increasingly difficult to staff even the beds that are available.
“Staffing is becoming an increasing problem,” Dotseth said. “Staff are sick, staff are caring for others who are sick, and staff are in quarantine because of a community exposure. We urge Minnesotans to take the public health guidelines seriously.”
Canary in the coal mine
At a hospital in the southern part of the Twin Cities metro area, one emergency room doctor said he’s seen a dramatic and urgent shift in capacity within the last week.
Instead of being quickly admitted, patients who need urgent, in-hospital care — often for COVID-19 — are sometimes spending hours in his ER’s triage unit, waiting for a bed on a different floor. On one day this week, he said, 19 of the 40 beds in his emergency room were occupied by patients who were waiting to be admitted to the hospital — a highly unusual situation, the doctor said.
In some ways, he said, the emergency room is like a canary in a coal mine for what to expect in the coming weeks of the pandemic.
“We’re going to start feeling the need to be worried before other parts of the hospital system. We’re the ones that start to get turned down: ‘This hospital doesn’t have an ICU [bed], or this hospital doesn’t have an ICU [bed],’” he said.
“We’re the ones that start to see our patients who, when they get admitted, are supposed to be going upstairs within 30 to 45 minutes. … [But they] are now sitting downstairs in the ER for hours, being monitored by ER nurses who have new patients trying to come in.”
At another large hospital in the northern Twin Cities, a doctor who treats people after they’re admitted to the hospital said that, until recently, her hospital has been able to make space for new patients without too much trouble.
“All of a sudden in the past week, that’s drastically changed,” she said. “It’s a chess game trying to figure out which bed is available at which time. It’s gotten scary really fast.”
She said the volume of COVID-19 patients at her hospital has doubled in the past week, going from a few dozen to more than 70 in just days.
And that’s put a huge strain on resources for patients who are coming to the hospital with other needs.
“People are still getting heart attacks, they still get pneumonia,” she said. “It’s not just COVID, it’s everything. But it’s COVID that’s putting us at this tipping point.”
She said the dance of moving people around and shifting staff to care for patients is only a temporary solution. Minnesota is surrounded by states whose COVID-19 cases are also surging. Traveling nurses and doctors are in high demand in the region as a result, and staffing has become just as important as bed space.
“The much more precious resource is bodies, and we don’t have bodies,” she said. “If we can’t staff beds, and we don’t have resources … we’re going to start rationing care really quickly.”
She said that’s when mortality rates — and not just for COVID-19 patients — will start to rise.
Worst-case scenario too close for comfort
The pinch is being felt in hospitals outside the Twin Cities, too.
At Grand Itasca Clinic and Hospital in Grand Rapids, President and CEO Jean MacDonell said that for months, her staff has been able to either treat COVID-19 patients locally or, more often, transfer them to Duluth, where they can get a higher level of care.
“That was all fine until about three or four weeks ago, when the Duluth facilities started to report they were at capacity,” she said.
While MacDonell said her hospital hasn’t reached a crisis point yet, “the worst-case scenario for us is that the metro hospitals are full, the Duluth hospitals are full, and we’re potentially full and would then have to implement those worst-case scenario surge plans, where we’re using every open space in the building to care for patients.”
At St. Luke’s Hospital in Duluth, internal medicine physician Dr. Rachel Gordon has been treating COVID-19 patients since March. For weeks throughout the summer, case loads were manageable, she said.
But that’s changed.
“Over the last few weeks, it’s just felt like that wave is coming up upon us,” she said.
Gordon said lately her hospital has been running beyond its typical capacity.
More of her patients have COVID-19, ”and your overall number of patients that you’re caring for is just growing and growing and growing,” she said.
Gordon said she was speaking from her own experience, and not on behalf of St. Luke’s. In the last few weeks, she said, it’s become more and more routine for her hospital to pause transfers from smaller hospitals in the region, which are also running at capacity.
“If we continue the way we are, we’re at a tipping point,” she said.
And the trauma for health care workers, she fears, will be substantial.
“[We’re] a group of people who have made a decision to put their lives and career in a place to take care of others. We’re going to stay. We’re going to take care of people,” she said. “But you’re going to see [in] their faces the same [things] you saw the nurses in New York at the beginning of this pandemic.”
While Gordon and the other doctors said that their role is not to prevent those worst-case scenarios but to respond to them, they said the best way to slow the progression of the pandemic to heed advice from public health experts: Wear a mask, social distance and avoid large gatherings.
“I hope that we can come together as a community to realize that we can go back to where we were before the pandemic,” Gordon said. “It doesn’t have to get that bad.”