VIRGINIA — Rising coronavirus infection rates across Minnesota and St. Louis County tell the story of a worsening pandemic, one that is being felt full force at hospitals as they push capacity levels to the brink.
The alarming rate that COVID-19 swept across the state last week and into this week prompted a new round of restrictions ordered by Gov. Tim Walz, aimed at easing the pressure on the health care system. Iron Range hospitals have not been immune to the trend with staffing levels becoming more of a daily balancing act and less of the sure thing they were months ago.
At Essentia Health in Virginia, the staff infection rate is similar to the broader community, but those numbers are increasing and doctors are watching as delays in care and workflow logistics become harder to navigate.
“It’s one of those things that, every once in a while, somebody would be out,” said Dr. Kelsey Redland-Kladivo, a family medicine physician in Virginia who has doubled as a hospitalist when needed during the pandemic. “Now, it’s a daily thing.”
Sam Stone, the administrator at Essentia, said they’re “at a critical juncture of our operations where we’re at or near capacity almost on a daily basis,” but the hospital and clinic haven’t had to shut any services down because of staffing levels. Still, the increase of cases in the Northland is drawing on those fears as hospitals call on residents to heed precautions and state guidelines to prevent the spread of COVID-19, which has rapidly advanced largely through unknown community transmission in the county.
“If it gets worse before it gets better, are we going to be able to handle this surge if we don’t get vigilant about it?” Stone asked.
The seriousness of the most recent surge in cases boils down to this: About one-third of St. Louis County residents infected with the virus don’t know where they contracted it. Without a contact point, tracing the virus around the community is harder for state and regional health departments. Itasca County officials recently suspended individual contact tracing because of how quickly infections have expanded and the state this week introduced a smartphone app designed to notify residents if they were in close contact with the virus.
In St. Louis County, the impact of the virus is also reaching critical sectors of society and the economy. Long term care facilities have been hit the hardest across Minnesota, especially in terms of fatalities, and 21 congregate care facilities in St. Louis County are currently on the Minnesota Department of Health list of outbreaks. Eight eldercare facilities are located on the Iron Range, where almost every center has been hit by the virus at one point.
Meanwhile, schools across the region have opted into distance learning for all grade levels while others remain in hybrid models and in-person learning. The two largest school districts on the Range — Hibbing and Rock Ridge — have closed their buildings to classes and officials in Duluth said Tuesday they would extend distance learning through at least Jan. 21.
Miners, business owners, child and elder care workers and employees at various businesses are also becoming infected at increased rates. “We all have social networks that are wider than we realize,” Redland-Kladivo said of community transmission and being aware of how the virus impacts the region. “All of this is so much bigger than we realize until we’re here.”
The Minnesota Department of Health on Tuesday reported 6,423 new COVID-19 cases and 38 deaths from the virus. In St. Louis County, 221 new cases were reported with 14 in Itasca County, where health officials warned of “uncontrolled spread” and reported an increased 129.9 infection rate per 10,000 residents from a week ago.
In the broader northeastern part of the state, intensive care bed capacity is only around 10 percent and increasingly filling with COVID-19 patients. As of the most recent update last week, the Northeast Healthcare Coalition reported 49 percent of its ICU beds were coronavirus cases.
Linnea Mirsch, director of St. Louis County Public Health and Human Services, said in an interview last week that many area hospitals stopped diverting patients because of a lack of bed capacity and staffing levels. That includes patients within Minnesota and with neighboring Wisconsin.
Meanwhile, St. Louis County is in the midst of its largest infection period to date — reporting more than 200 daily cases for multiple days in a row and record numbers of daily hospitalizations. More than 30 percent of the 360 people admitted for care in the county have come this month, Mirsch added.
“It’s a dire situation for our hospitals,” she said. “Our hospitals are full. That’s health care management at a macro level. There isn’t even capacity to move patients around that ICU level.”
In Virginia, Redland-Kladivo said physicians across the Essentia network are seeing more cases of the virus on a daily basis and with that a widespread impact on the Iron Range community. That’s more people out of the workforce, some of them closing their business to fight the virus and after last week more people out of work due to new COVID-19 restrictions.
She said the status of each patient has varied, and that’s part of what terrifies some of the people she sees — some won’t develop any symptoms while others will be very sick and quickly decline, and how to predict that for each patient is something they don’t know.
“Explaining it to someone who has never seen it is hard,” Redland-Kladivo said of the current outbreak. “That’s where we’re at now. We’re at war with something and we’re still trying to learn the enemy.”
Stone urged Iron Range residents to take the virus seriously and that the hospitals need help in slowing down the speed at which it's moving through the region. Like many hospitals, Essentia has surge plans in place and the hospital system recently implemented more visitor restrictions in light of the current situation.
At Fairview Range in Hibbing, the facility has surge plans ready if necessary and early on in the pandemic shifted their more serious patients to hospitals run by Essentia and St. Luke’s in Duluth as part of an agreement among the three systems.
“Currently, we have the staff and supplies to meet the needs of our communities in caring for increasing COVID-19 cases,” a spokesperson for Fairview said in an emailed statement. “However we need our communities to adhere to CDC and state restrictions in order to protect the precious caregivers we need to care for our community.”
Surge plans include shifting staff and resources from one area to another as necessary — Stone calls it “floating” — but that only goes for far, he said and you can’t triage every position. If they reach critical numbers in areas where resources are tight, that service will be impacted or shut down.
Hospitals are trying not to be overrun by COVID-19 cases to avoid that exact scenario. As they built ICU and ventilator capacity this spring, the state halted non-essential procedures. In effect, the healthcare systems suffered loss in revenue, forcing hundreds of layoffs. Those procedures are back on at most places in the region, but St. Luke’s recently postponed some surgeries in an effort to free beds and staff. An Essentia spokesperson said the system has also reduced elective surgeries to conserve resources and is continually monitoring the situation.
On a day-to-day operations standpoint, the concerns of Stone and Redland-Kladivo center on patients who need medical help outside of the coronavirus. Heart attacks, strokes and accidents still happen during a pandemic and things are often at a bottleneck in the care process.
“If it keeps going down the path it's going down without us doing something about it — as a society, as a community — we want to avoid what that could mean for us,” Stone said.