Minnesota hospitals plan for 'stages' of COVID-19 patients, warn of a possible surge

Staff in different degrees of protective clothing
Medical professionals in protective clothing perform COVID-19 and flu tests at a drive-through testing location in front of CentraCare St. Cloud Hospital in St. Cloud, Minn., on Monday. Hospital leaders in Minnesota say they anticipate a lot of need, but are worried about a surge of COVID-19 patients.
Paul Middlestaedt for MPR News

The state's hospital systems are preparing for what they know will be a difficult test from the novel coronavirus. Hospital leaders say they anticipate a lot of need, but are worried about a surge in COVID-19 patients that could tax the equipment they need to do their jobs safely.

While hospitals have been preparing over the last two months, the key is for people to stay home when they are sick, stay at least 6 feet away from others and, as much as possible, try to cut down daily interactions outside of their homes, said Rahul Koranne, M.D., president and CEO of the Minnesota Hospital Association.

"So, that's the focus of the now because if we don't do those things now we could see a surge and that would be very, very difficult for the health care system to handle,” he said.

"Our main three concerns that we've articulated repeatedly is — No. 1, the spaces, which is ICU beds, isolation room beds; the second is our professional health care staff who we need to take care of sick Minnesotans who will be affected by this disease; and the third one is supplies such as ventilators and ECMOs (extracorporeal membrane oxygenation)."

Gov. Tim Walz said Monday that concern over too many very sick patients hitting hospitals at once is behind his decision to close bars, restaurants and gyms.

Gov. Tim Walz speaks during a news conference about the COVID-19 outbreak.
Gov. Tim Walz speaks during a news conference about the outbreak of the novel coronavirus in St. Paul on Monday. Walz ordered bars and restaurants across Minnesota to temporarily close to customers who dine in.
Glen Stubbe | Star Tribune via AP file

"We are at a critical point here, if we get beyond that curve where community spread accelerates to the point that our hospitals can't keep up, that our respirators are not be able to and some of the things we need to get to folks, it becomes a really critical situation," Walz said.

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There are about 130 hospitals in Minnesota with around 11,100 beds, not counting state-run facilities, Veterans Affairs hospitals and Indian Health Service hospitals. Koranne told the Legislature earlier this month that Twin Cities hospitals have approximately 5,000 acute care beds, 500 ICU beds and approximately 450 ventilators though that can be expanded slightly if needed. The number of available beds has hovered around 5 percent for the last few weeks, prior to reports of the first COVID-19 cases.

Leaders of the the Minnesota Nurses Association said they'd like all hospitals to be giving nurses N95 masks to treat patients, not just surgical masks. The Centers for Disease Control and Prevention has said surgical masks offer enough on the job protection. Mary Turner, an ICU nurse, who heads the union, said the availability of masks varies from system to system.

"Here's the reality — while everyone else is wrapping themselves in bubble wrap, the nurses are actively walking into harm's way,” Turner said. “And the public will be in a sad state of affairs if the nurses start dropping like flies — because seriously, who is going to take care of everyone?"

Alison Peterson, M.D., an executive at United Hospital and operations section chief for Allina Health incident command, said the health care system is trying make sure all medical staff have the protective equipment they need.

In addition, they’re looking at how to keep patients from coming in contact with the virus.

"Most of the outpatient clinics are looking at — what would we consider elective outpatient visits? So potentially, a wellness visit for an elderly person, we could be placing them at higher risk by bringing them into the building than allowing them to stay home," she said.

While working on that, hospitals plan for surges of people sick with COVID-19, figuring out how they'd use space if there were waves of patients.

"So, you are always one stage ahead of where you are, and understanding that things can move quickly. I can tell you folks are already thinking one to two stages out," Peterson said.