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Coronavirus Surge in Minnesota Depletes ICU Hospital Space

Metro ICU bed space has grown scarce because many nurses and caregivers were unavailable due to their own infections or viral exposures. Episodic shortages have occurred in central Minnesota and other parts of the state.

by Jeremy Olson, Star Tribune (Minneapolis) / November 4, 2020
An election worker wears a vote facemask as residents cast their ballots at a polling place in Minneapolis, Minnesota on November 3, 2020. - The United States started voting Tuesday in an election amounting to a referendum on Donald Trump's uniquely brash and bruising presidency, which Democratic opponent and frontrunner Joe Biden urged Americans to end to restore "our democracy." (Photo by KEREM YUCEL/AFP via Getty Images/TNS) TNS
MINNEAPOLIS — Only nine intensive care beds were available at one point in the Twin Cities Wednesday morning amid a surge in the COVID-19 pandemic that is sending more Minnesotans into hospitals.
Metro ICU bed space grew scarce Tuesday due to the number of nurses and other caregivers who were unavailable because of their own infections or viral exposures that required quarantines. Episodic shortages have occurred in central Minnesota and other parts of the state.
"We're at a red alert for ICU beds," said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. "It's bad."
A record 908 inpatient hospital beds in Minnesota were filled with COVID-19 patients, according to Wednesday's update of the state pandemic response dashboard. That includes 203 patients requiring intensive care due to breathing problems or complications from infections with the coronavirus that causes COVID-19.
While COVID-19 ICU admissions have nearly doubled since early October, patients with the infectious disease make up only 18% of total ICU usage. Among all 1,140 patients in Minnesota ICU beds, the majority are recovering from surgeries or being treated for unrelated issues such as strokes and traumatic injuries.
The dashboard shows that Minnesota has a capacity of roughly 1,500 immediately available ICU beds — with another 400 or so that could be readied within 72 hours — but one Twin Cities hospital physician said that overstates availability because open beds are useless without nursing staff to treat patients.
"Beds have been sitting open in the metro due to no RNs, but the current ICU use is functionally at 100% across the metro," said the doctor, who declined to give his name because his parent company had not authorized him to speak on this topic.
Patients have been waiting in Twin Cities emergency rooms for hours for inpatient beds to open. Requests to transfer patients from COVID-strapped communities such as Hayward and Baldwin in Wisconsin, and Grand Forks in North Dakota, were declined.
The Minnesota Department of Health on Wednesday reported that ICU beds were 98% full in the metro and 92% full elsewhere and that collaboration was increasing across hospitals to transfer patients and even staff where needed.
Gov. Tim Walz requested 10 more medical professionals from the Federal Emergency Management Agency to shore up staffing in hospitals and long-term care facilities.
" Minnesota's case counts are on the rise, which means the need for staffing support will continue to increase," Walz said in a statement.
Walz last spring used an emergency order to defer nonessential surgeries to maintain bed space. A guiding principle of his pandemic response, including a 51-day shutdown this spring, has been to preserve hospital resources so that infected patients have treatment when needed.
The first hospital surge in late May came shortly after the end of that deferral, when an increase in COVID-19 hospitalizations collided with the resumption of surgeries.
Osterholm criticized hospital leaders in Minnesota for being slow to respond to the new COVID-19 wave as they try to recoup financial losses by maintaining usual surgery schedules. He accused the Minnesota Hospital Association of "downplaying this" to maintain that business.
Minnesota on Wednesday reported 31 more COVID-19 deaths and a record 3,844 more confirmed or probable infections, bringing its totals to 2,530 deaths and 160,923 known infections. While almost all of the deaths involved people 80 or older, Wednesday's count included a Hennepin County resident in the 30s age range.
The Dakotas and Wisconsin continue to have the nation's highest new infection rates, but Minnesota's rate has increased to 13th, according to the most recent state report by the White House Coronavirus Task Force.
"There is a limited time window to prevent further increases in cases, hospitalizations, and deaths," it stated.
South Dakota-based Sanford Health last week announced a delay in nonessential surgeries, though not for its Minnesota hospitals. Sanford's Bemidji hospital added seven ICU beds on Monday in response to rising COVID-19 demands, though, bringing its total to 23.
Mayo Clinic last week deferred nonessential procedures at its hospitals around Eau Claire, Wisconsin.
"This is not a drill," said Dr. John Hick, an HCMC physician who is coordinating the collaborative response by Minnesota hospitals. He encouraged public mask-wearing and social distancing to slow viral spread and reduce pressure on hospitals.
"We have space, we just don't have staff," he said. "So pretty soon we'll be doing things like cutting back elective cases to free up staff to work in units they don't usually work on, and perhaps increasing the number of patients that nurses have to care for on a shift — things that aren't in the best interests of the staff or the patients but are the best we can do with the resources that we have."
Moderate- or high-risk exposures to the virus can result in 14-day quarantines, which can sideline nurses and health care providers.
A U.S. Centers for Disease Control and Prevention report last week showed that 1,953 Minnesota hospital workers sustained high-risk exposures through early July and that 1,256 of them were quarantined and monitored by the state Health Department.
Among them, 382 caregivers returned to work before the end of their monitoring periods. That was about 37% of all hospital workers who had been quarantined. The report also showed that 45% of the workers had been asked by their hospitals to return to work early, but some refused.
Only 339 monitored workers ended up reporting COVID-19 symptoms, and 13 worked while symptomatic.
State infectious disease director Kris Ehresmann said early release of health care workers from quarantine should be reserved for "dire situations," and that the workers should be fully masked at all times and assigned to administrative roles.
( Minneapolis Star Tribune staff writer Joe Carlson contributed to this article.)
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