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Hospitals are nearing capacity in North and South Dakota, two states where coronavirus has hit disproportionately hard for their small population size and where cases continue to rise daily.

The Dakotas have the most new daily cases per capita of any other state this week — a record they've held or been close to for many weeks. They're also among the worst in the country for two other grim metrics: 

North Dakota has seen hospitalizations spike in recent days, Dr. Doug Griffin, chief medical officer at Sanford Medical Center in Fargo, N.D., 

"We had fully expected it would get worse," Griffin said. "I think what has surprised me is that really just in a matter of days, it's like we opened up a spigot and (there was) a huge number of patients."

Governor mandates masks, capacity limits as virus surges

The largely rural state had seen only mild outbreaks in the spring and summer when other parts of the country were hard hit. As of Thursday the state was seeing an average of 1,334 new cases per day, after seeing no more than 400 a day in the summer. 

"I think a lot of times people in rural areas feel like, 'Hey, we're immune to the things that happen in the big cities,'" Griffin said. "That's clearly not the case with regards to this."

The situation is so dire that North Dakota Gov. Doug Burgum announced this week that health care workers who are positive for COVID-19 but are not showing symptoms can keep working in COVID-19 units. 

Griffin said that move is a recognition of how serious things are in the state but they aren't planning to implement that option at the moment.

"I think if we had no other way that we felt that we could safely staff our patients, I think that would be it," Griffin told NPR's David Greene. "But we have many options and many levers that we are pulling now ... with our current staff."

Late Friday, after months of resisting statewide mandates, 

In South Dakota, it's "a possibility" the state might follow North Dakota's lead in letting COVID-19 positive health care workers work if cases continue to surge, Dr. Shankar Kurra, vice president of medical affairs at Monument Health Rapid City Hospital,

"South Dakota has seen a rise in cases over the last four to five weeks, and we are on that exponential curve," he said. "And what it has done is put a lot of strain on our capacity in the hospital."

He went on to say that the "mathematics of infection are very clear... We are one of the rampant spread states. And when you have that kind of a community-wide spread with positivity rates in the high 20s and 30s, the likelihood of any of your workers falling ill and therefore unable to take care of folks is distinctly possible."

He said they planned for this influx when they saw cases rise on the East Coast in March, preparing an entire hospital floor for COVID-19 treatment. Now, they're having to get creative with staffing.

"If we ever have a surge like, say, North Dakota, we can shut down our ambulatory services and then repurpose those staff and even our more non-critical areas such as ORs that are not trauma and not essential emergency procedures," Kurra told NPR's Ailsa Chang. 

Kurra went on to say that he's very worried about what's coming this winter. "Coming into November, December and January, this is sad to say, but we will see an increase in cases and increase in hospitalizations," he said. "Our biggest worry is to maintain capacity, be able to take care of critically ill folks that need ICU level of care and will quickly run out of that if these numbers continue."

The Dakotas aren't the only ones facing overloaded hospitals. Vineet Arora, a hospitalist at the University of Chicago, told NPR's All Things Considered that hospitals in Illinois are "dangerously close" to exceeding capacity and running out of ventilators and other critical equipment, as well as trained clinicians. They are worried about having to go into "crisis staffing planning" mode — or, "what's happening in North Dakota." 

While North Dakota and South Dakota are two of the most at-risk states in the country, cases and hospitalizations across the entire nation are increasing. To date in the U.S., there have been more than 10 million confirmed cases of the virus and more than 240,000 have died. More than 68,000 are currently hospitalized. 

more than 184,000 new confirmed cases in the U.S.

Health

COVID-19

Christianna Silva

Author

Faced with overloaded hospitals, doctors in South Dakota and North Dakota are struggling to deal with uncontained community spread of COVID-19 and with medical staffing issues in their states.

COVID-19 hospitalizations surge in Dakotas: 'It's like we opened up a spigot'

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