How 'Med City' prepares for pandemic

Rochester, Minn., is nicknamed “Med City” for a reason: As the dominant employer here, Mayo Clinic employs more than 34,000 in Rochester, a city of about 115,000 people.

And that’s not including people who work in Mayo’s home health care, nursing homes or Olmsted Medical Center sites.

For a city whose lifeblood is health care, and has more than 3 million visitors annually who arrive from around the world to take advantage of that health care, managing a pandemic presents unique challenges, where providing treatment and keeping the workforce healthy go hand in hand.

The approach marries Mayo’s expertise and planning with a school, city and county response that is taking steps to limit contact between people living in Rochester.

“Our community is no less prone to COVID-19 infection than the rest of the country,” said Dr. Pritish Tosh, an infectious disease specialist and the medical director for Mayo's emergency planning. “Complicating matters is that we have people coming here with other things — complex medical problems — and people in our community with normal medical problems that need attention as well.”

Olmsted County reported its first case of COVID-19 earlier this week. Health officials said the patient is a person in their 50s who recently traveled abroad. It’s one of 14 positive cases identified in Minnesota overall, and so far, none of those cases have been transmitted locally — which means that health officials have been able to tie them directly to sources outside the community.

But public health officials in Rochester say taking measures before local transmission, when the virus is considered to have begun spreading within the community, is critical to keeping the area’s population healthy.

For Mayo, that’s included some high-profile decisions this week. The federal government’s response to testing has been sharply criticized for being too slow, so Mayo Clinic Laboratories released its own test Thursday, which Mayo says can handle 200-300 samples a day currently, with plans to expand that number.

Testing, preparation — and work on a vaccine

So far, Mayo said all 90 tests they have performed have come back negative.

Mayo has also opened a drive-through testing clinic, a model that public health officials say helps keep potentially infected patients away from other providers and patients inside the clinic walls. Similar clinics staged by different providers are available in Duluth and the Twin Cities.

And in an email to patients Friday, Mayo said it’s working to advance a COVID-19 vaccine.

Behind the scenes, Tosh said, the clinic is preparing for the possibility of more COVID-19 cases in the region that he says may stretch the clinic’s resources.

That preparation includes planning for shortages of space, workers and supplies, he said.

“If it’s an issue of space, we’ll find where else we have space that’s a lower-priority item. If it’s staff, how can we move staff from a lower-priority area into this higher-priority need?” he said. “If there’s a supply that’s preventing us from meeting the patient care demand, then where else is that being used, what else can be substituted?”

Tosh said a lot of the work that’s being done right now is focused on planning for these contingencies.

“If your contingencies are unable to meet patient care needs, then you’re in crisis care. You are essentially trying to decide which patients should get which scarce resource,” he said. “If you don’t spend enough time in contingency planning, you’ll find yourself in crisis care very soon.”

Widespread testing in the community is not happening at this point, in part because Tosh said the test works best in people who have symptoms.

“Our testing is based on the presence of symptoms,” he said. “We wouldn’t know what to do with a negative test.”

Tosh said Mayo health care providers are focusing on identifying people with respiratory illness symptoms, figuring out where they’ve been, who they have been in contact with, and what risk factors they may have. They’re encouraging people to contact their provider first to be screened for whether the test is necessary based on their symptoms.

At the city level, Rochester leaders are recommending city staff not attend in-person meetings, and that they work remotely. City-sponsored events have been cancelled.

In Rochester Public Schools, field trips and group activities of more than 250 people are cancelled until further notice, and no volunteers will be allowed in schools until further notice, according to superintendent Michael Munoz.

Coordinating efforts

In addition to working closely with the state Health Department, the city, schools and county have already created a single information center, said Olmsted Public Health Director Graham Briggs. He said it helps ensure consistent communication about the threat of COVID-19 to all parts of the community.

So far, the state is not recommending school closures, and neither is Olmsted County.

Briggs said doing so is disruptive to the local economy and workforce, and it means some kids could be left without other important services, like meals or child care.

But he left open the possibility that the situation might change, particularly if evidence of local transmission surfaces.

“Right now, if we were to really start moving into measures that will impact the daily life of our residents,” Briggs said, “my take on that is: We need to save those bullets for when we really need them.”

He said that’s especially true for Rochester, where so many children of health care providers are enrolled in the schools. If school is closed, and parents need to stay home to care for their children, it could cause a ripple-effect shortage of health workers available to care for sick patients — which creates a potential risk to people who need treatment.

Because of that, closing schools in the region brings along with it an additional set of challenges.

“What does that mean if parents don’t have their kids in school? Can health care facilities stagger shifts that will allow people to continue working?” he said. “If we get to the point that we feel like for the safety of the community, we need to make some of these calls: How do we not put the community at more risk?”

For his part, Tosh said the decision to close schools would be tough one for the community, and for Mayo.

“We are completely understanding that at some point that people may need to stay home to take care of their kids, that they themselves become ill,” Tosh said. “We are anticipating we may not be at full force.”

Tosh said that watching COVID-19 play out in other countries, like Italy and China, is sobering but has also given Mayo time to observe, learn and prepare.

“This is where the idea of contingency based on staff, space and supplies really comes in,” he said.