HIBBING — At Fairview Range Medical Center, Dr. Pete Olson, who specializes in emergency services and critical care, has been working 12-hour shifts in an effort to treat an increasing number of local individuals who tested positive for COVID-19.
Every morning, after night watch in the emergency room, he meets with the hospital’s CEO and management to update them on his patients, the state of the intensive-care unit and sectioned-off rooms for people presenting with coronavirus symptoms and the latest data from the Minnesota Health Department. They discuss internal plans concerning how to best protect their health care workers, some of whom have become infected with the virus, and check-in with regional and statewide medical facilities to ensure all have enough staff amid the annual flu season.
When the sit-downs finish, Olson heads to the Fourth Floor call room and rests. He repeats that schedule for eight days. He then works primarily as an administrator for three weeks, before another eight-day stretch in the emergency room.
“It’s been quite busy,” Olson told the Mesabi Tribune during a recent wide-ranging interview at the hospital.
The physicians and nurses at Fairview Range — the largest medical facility on the Iron Range — have been on the front lines of the regional surge of the coronavirus.
They are pulling long hours as many of the worst outbreaks in Minnesota right now are in rural counties and cities found in the northern parts of the state. Where earlier peaks were centralized in the Twin Cities and suburbs, the current surge is hitting sparsely populated regions where smaller medical centers are recording increases in hospitalizations due to an uptick in community spread of the virus. Last month, health care leaders from Essentia Health and St. Luke’s, with a combined 700 beds in Duluth, told the Star Tribune that their staff were operating near capacity and they were working on surge plans to prepare for a “perfect storm” at the start of the flu season and the ongoing increases in coronavirus cases. Like many other hospitals, the plan called for the need to move patients between facilities across the state.
“We knew that Minnesota would have this surge at some point because we watched other states around the country that seemingly, out of nowhere, would have an increase in cases,” Olson said. “But we don’t know exactly when it’s going to accelerate.”
He continued, “That’s a tremendous increase in a strain on our collective system.”
The coronavirus was slow to come to northeastern Minnesota. As the virus began to rise in the state in mid-May, health officials recorded 13,438 cases, 1,915 hospitalizations and 663 deaths. St. Louis County confirmed 100 cases and 12 deaths, mostly from outbreaks in congregate living facilities. Gov. Tim Walz had issued his stay-at-home order and the city of Hibbing, among others in the region, declared a local emergency and shut down government buildings to the public. The local school district moved to distance learning. Bars and restaurants and other venues have shuddered dine-in services. The Hibbing fire chief was leading the local COVID-19 incident command unit to stock up on masks and other personal protective equipment for police, firefighters and first responders who were strategizing with Fairview Range management how to react to a potential influx of patients. Olson lived at the hospital for two months while preparing various rooms and equipment.
At that time, county health officials were not reporting how many cases were located in each particular city. But businesses such as L&M Fleet Supply in Hibbing and the Ely Dairy Queen posted news of employees testing positive for the virus onto their social media and websites. Many citizens rushed to Target and Walmart to buy food and cleaning supplies in bulk. Others dismissed the concerns and voiced their beliefs that they lived remote enough from metro hotspots. Despite the denial, health officials warned the virus was here to stay and people would become infected if they did not follow state and federal guidelines to wear masks and social distance.
During the early months of the pandemic, Fairview Range was collaborating with Minneapolis-based M Health Fairview to prepare “multiple testing platforms” and protective personal equipment while “cohorting patients” who tested positive for COVID-19 to Essentia Health and St. Luke’s in Duluth, Olson said.
By early October, St. Louis County recorded 2,121 cases and 53 deaths, with an increased number of cases resulting from community transmission. At least 15 assisted living facilities in the county had outbreaks and accounted for 17 percent of exposures. The cases in Hibbing had doubled within a month to more than 200 and the National Guard sent a medical crew to the Guardian Angels Health and Rehabilitation Center, where 65 staff and residents became infected with the virus and at least nine residents died.
As the partnering hospitals were nearing capacity, Fairview Range began cohorting COVID-19 patients in Hibbing. “Our referring hospitals are fuller and so they don’t always have the capacity to accept transfers,” Olson said. Several weeks ago, the local staff, which had been preparing for months, made the switch to cohorting patients. “We’ve been prepared and we’ve been staffed up,” he said.
The local focus on maintaining a healthy team of health care workers comes as COVID-19 patients are rapidly filling up inpatient hospital beds across the state.
The Minnesota Health Department earlier this week reported that infected patients filled a record 908 beds, including 203 requiring intensive care, the Star Tribune reported on Thursday.
Moreover, the number of patients in ICU beds are on the rise. At least 18 percent of the ICU beds are full of COVID-19 patients. The majority of beds are being used for people undergoing treatment for surgeries or other unrelated issues. State health officials reported that ICU beds were 98 percent full in the metro and 92 percent full in other parts of the state. They also noted that hospitals were increasingly transferring patients and reducing the length of stay and discharging them with oxygen and monitoring.
“We’re at a red alert for ICU beds,” Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told the Star Tribune on Wednesday. “It’s bad.”
Minnesota officials said the state had 1,501 immediately available ICU beds. Another 408 could become available within 72 hours. Still, hospitals continue to say the space means nothing if the nursing staff and physicians become infected with the virus.
Meanwhile, the governor has requested medical professionals from the Federal Emergency Management Agency to help staff in hospitals and long-term care facilities.
On Friday, state Health Commissioner Jan Malcolm said ICU capacity in the metro region is “particularly limited,” but the statewide capacity looked better, though it “fluctuates daily and hourly.”
She continued, “Things are absolutely getting tighter in Minnesota. Hospitals are running very full,” and COVID-19 patients have added to many hospitals’ routine patient load, pushing capacity and staffing limits alike. “Health systems are working very closely together — an unprecedented level of collaboration and data sharing.”
Essentia Health declined to detail capacity and staffing numbers, but through a spokesperson, acknowledged increased patient volumes due to COVID-19 and people who have delayed treatment during the pandemic and recently required acute care.
“Essentia Health hospitals have experienced a high volume of inpatients over the past few weeks, resulting in many of our facilities being at or near capacity. Our census fluctuates on an hourly basis,” said spokesperson Louis St. George. “Our teams are constantly monitoring that volume and are managing it as needed. We have internal processes and surge plans in place to respond to these fluctuations in census. Those processes involve managing staff and resources, triaging patients as appropriate and occasionally transporting patients between Essentia Health facilities.”
As of Saturday, the state reported 4,647 news cases and 34 deaths after ending a streak of daily records for four straight days. St. Louis County had 95 new infections. Statewide infections are at 174,954 cumulative with a death toll of 2,625
The total number of coronavirus cases and deaths in smaller cities on the Range remain fewer than in Duluth or Minneapolis due to the low population, but there has become a sudden increase in cases in communities where many local residents venture into the same schools, work spaces, bars, restaurants and grocery stores. “We haven’t had hundreds of people outside waiting to get in,” Olson said during the interview last week. “It’s been this gradual increase in other states and now we’re seeing it.”
Standing amid the rooms in one of the hospital’s coronavirus units, Olson said that patients wind up here if they are “having severe organ dysfunction, as kidneys and livers can be affected by COVID.” He explained, “This is a multi-system virus. We’re learning more that this is a virus that’s known to cause clotting. You can have a complicated case of clotting. Some people present with a stroke. This is a unit that has that level of care.”
Ten months into the pandemic, Olson said he has been seeing young children and older adults who have tested positive for the coronavirus. He has been treating adult patients with remdesivir, an FDA-approved treatment for COVID-19 that was among the several drugs used on President Donald Trump when he was infected last month. A study by the World Health Organization found that the drug offered no benefit to hospitalized patients and some health experts question the greenlighting of the drug while taking the stance that it has mediocre treatment capabilities. For Olson, the ability to treat patients with remdesivir has become “a game changer,” in the way he and other physicians and studies say it can help lower respiratory tract infection and shorten the time of recovery in hospitalized adults. Minnesota health officials report being among the agencies that monitored their stock of the drug for months, as it was one of the few FDA-approved therapeutics as vaccine trials continue.
When asked whether the hospital had the space to handle the increase in hospitalizations, Olson described speaking with partnering medical facilities about open inpatient and ICU beds and how he talks with the Minnesota Health Department since the agency manages capacity for the hospitals statewide. He declined to say how many patients have been treated or are currently receiving medical care at the hospital.
But like health experts elsewhere, Olson said the space only matters if the hospital has enough health care workers to treat patients.
While Fairview Range is fully staffed, for now, there have been nurses who tested positive for the virus and had to quarantine. “We are not at a point where we don’t have enough staff to take care of patients,” Olson said. “We have everything we need right now” from the various partnerships throughout the state. He continued, “But in a rural area like this you don’t have a huge depth of healthcare providers … You don’t want doctors and nurses in this area getting ill, because we don’t have a huge condrate to replace them.”
The hospital has implemented safety measures. “The story here is our thorough screening process” that includes temperature checks and separating nurses from patients if they had been exposed to someone inside or outside of the hospital who tested positive with the virus. The need to protect medical teams from the coronavirus becomes immediate as regional assisted-living facilities and nursing homes have been reporting staff shortages due to an increased number of workers becoming infected with the virus. Physicians from the hospital treat patients at such facilities. Olson and management find it necessary to keep their eyes on the state-reported number of cases in long-term care facilities, as well as the growing rates of community transmission.
“It can be more dangerous at times for a healthcare worker to be out in the community,” Olson said. “That’s why wearing a mask and social distancing and avoiding these larger gatherings are so important. When we trace things out it doesn’t appear that our healthcare workers are getting sick here. Oftentimes it’s in the community.”
Malcolm, the state health commissioner, said in a press briefing Friday that recruiting staff and traveling nurses from other states will be a challenge — if Minnesota needs to — because surrounding states are searching for the same help.
As the metro region pushes capacity, the State Emergency Operations Center told MPR News last week that it is not considering opening Langton Place in Roseville “any time soon” as an alternate-care site. That will happen if all ICU, critical care, patient care, non-patient care bed and overflow areas are in use and hospitals are “unable to redistribute patients across the state.”
Even then, the agency told MPR, staffing shortages could play a factor in opening Langton Place.
Olson was finishing one of his emergency room shifts and headed to update management last week when he stressed the importance for people to come into the hospital if they are feeling symptoms of COVID or influenza. “It is concerning,” he said. “We might have patients coming in with overlapping symptoms: fever, chills, a lot of respiratory symptoms. Influenza can be a deadly disease as well. As the whole state works to ramp up their testing capabilities, we want to figure out whether a patient has COVID or influenza.”
He advised people to come into the hospital if they are feeling any symptoms of either COVID-19 or the flu. “Some people are coming in late with heart attacks and strokes because they’re scared to come in,” he said. “A lot of people are delaying care and we were seeing patients with chronic health conditions, chronic heart and kidney problems that weren’t coming in and because they didn’t get treatment they’re health was worsening. And that’s taken up a tremendous amount of capacity statewide.”
The majority of patients who come into the hospital do not get admitted, but the longer people wait to see a physician, the greater the possibility their condition worsens and requires a hospital stay. “The vast majority do very well,” Olson said. “They can recover at home. They can quarantine. The best way they can do is prevent the virus from spreading to someone else.”