In northern Minnesota, COVID-19 pushes ‘fragile’ hospital capacity to its limit

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Dr. Jonathan Shultz walks through St. Luke’s emergency room with a clipboard in hand and a phone attached to the waistband of his scrubs.

The phone rings often. He quickly picks it up and jots down notes on a transfer form.

During his shift, Dr. Shultz is in charge of transfer requests that come into the Duluth hospital.

On this Monday morning in late January, he feels a sense of relief that he can offer one of the hospital’s beds to the person on the other end of the line. Weeks earlier, when cases of COVID-19 spiked across the state, it was a much different story.

"I just showed up to work one day and everything was completely full," he said. "We couldn’t accept any patients."

The coronavirus pandemic is exposing the delicate nature of hospital capacity around the state. In northern Minnesota, the tradition of relying on larger, regional hospitals to take on critically-ill patients has been compromised as COVID-19 cases push all facilities to their limit.

Health care providers are increasingly concerned that new variants of the virus could result in a spike in hospitalizations.

"The system as a whole is very fragile," Dr. Shultz said. "We could easily be at capacity and overwhelmed again if we get another surge."

Dr. Shultz explained if that happens, smaller facilities will once again have to hold onto patients that normally would never be admitted in the first place.

"The whole system collapses if you can’t get patients to the hospital, and if it can’t move patients between hospitals," he said.

During the December spike, staff from all departments at Community Memorial Hospital in Cloquet — including the clinic across the street — began caring for COVID-19 patients. Beds filled up quickly at the critical care access facilities just west of Duluth.

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"We had to admit them here and care for them best that we could," said Dr. Charles Kendall, incident commander of the hospital’s COVID-19 response team. "We’re enjoying this, this lull right now, or this reprieve from the way we were for a couple of months."

But Dr. Kendall and others are worried about the variants of the virus from the U.K. and Brazil that have shown up in Minnesota over the last month.

Rick Breuer, CEO of Community Memorial Hospital, said that has created a heightened sense of alert.

"We don’t know if the new variants, you know, how problematic they’re really going to be," he said. "Even right now in a lull, if it’s kind of smoldering in our community, it wouldn’t take much for it to just flare up."

In the COVID treatment ward of St. Luke’s ER, Dr. Shultz slides his arms into a yellow medical gown, pulls on latex gloves and fits a special respirator on his face that covers his nose and mouth.

He knocks on the glass of an exam room before entering to speak to Kimberly, a stay-at-home mom from Esko, Minn., who the night before was diagnosed with COVID-19.

"So, you have COVID," he explains as a fellow doctor inserts an IV line into her arm. "We’re going to give you a big dose of antibodies, infused directly into you to basically fight off COVID."

That morning, Kimberly was the floor’s only positive COVID-19 patient. Dr. Shultz and the staff know how quickly that can change.

"We could be in an unmanageable position in fairly short order," he said. "That’s my fear. That’s what I hope doesn’t happen."