Minnesota hospitals prepare for coming surge in COVID-19 patients

Leaders of Allina Health huddled Friday morning in a computer lab littered with emergency planning maps and whiteboards of COVID-19 data, and one at a time discussed the challenges and solutions if a widespread coronavirus outbreak emerges in Minnesota.

Stocks of masks and protective equipment would dwindle. Scant open beds would be filled. Stressed-out workers would flood employee assistance programs. Sick workers would exhaust PTO. Call centers would be overwhelmed by questions, demands and rumors. For each expected problem, the health system was developing a solution.

"It won't be business as usual," said Helen Strike, a leader of Allina's incident command team.

Across Minnesota, hospital leadership groups like this have been preparing for what could be a generational pandemic and updating cooperative plans that were assembled after the anthrax bioterrorism scare in 2002 and then tested amid disasters such as the Interstate 35W bridge collapse.

Hospital leaders said Minnesota has the unique strength of cooperation that will ensure patients anywhere in the state get care. But they're also facing the reality of limited capacity when it comes to open beds and intensive care units if public mitigation fails to slow the spread of COVID-19, a respiratory illness caused by a novel coronavirus.

Twin Cities hospitals alone have 500 intensive care beds and 450 ventilators for patients struggling to breathe, a symptom in more severe cases of COVID-19. However, only 5.7% of ICU beds across the state were open Friday.

An unchecked surge of COVID-19 patients could fill those beds and force hospitals to make "scarce resource" decisions that could result in one patient receiving more immediate care than another. At HCMC in Minneapolis, leaders have backup plans if ventilators are all in use, such as pulling ventilator equipment off ambulances or repurposing devices that deliver anesthesia, but there are limits.

"We don't want to get there," said Dr. John Hick, an HCMC physician and emergency preparedness expert. "It's really important that we do our best to try and control the spread of this disease."

Now that COVID-19 has been reported in Minnesota — with 21 confirmed cases in nine counties — health leaders said the state has reached a crucial point for public prevention and mitigation measures.

Gov. Tim Walz and state Health Commissioner Jan Malcolm on Friday announced a peacetime state of emergency and strongly recommended that people avoid large gatherings and stay at home if sick.

Malcolm said the Health Department will be eyeing hospital resources throughout the pandemic and, if necessary, tapping into the strategic national stockpile of ventilators and protective equipment — though other states will likely make use of that resource as well.

"For things like masks and those basic supplies, including ventilators, we're looking to that strategic national stockpile to be a source of additional resources," she said. "So as we see potential shortages emerging in Minnesota we can quickly move things around."

Slowing it down

The coronavirus that causes COVID-19 emerged in China in December and spread globally.

While 80% of infections cause only mild symptoms, health officials are concerned because there are no vaccines or specific medications for this virus.

Some cases result in severe respiratory problems. One of Minnesota's cases involves an Anoka County patient in the 30 to 39 age range who was hospitalized last week in critical condition.

The objective isn't just to stop the disease from spreading, but also to slow down the rate of new cases so hospitals and health care providers can keep up, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

A hospital that can handle 100 cases in a month won't be able to provide the same care if those 100 cases show up in a day or a week.

"They're not at all prepared" for that level of surge, he said. "And it's not because they have not done their jobs. Hospital finances today do not permit hospitals to get ready in any meaningful way" with oversupplies of equipment and rooms.

Minnesota is respected for its regional coalitions of hospitals that share information and resources. Leaders of the Metro Health & Medical Preparedness Coalition met Friday to address critical care supplies such as ventilators.

Hick said metro hospitals will work together to make sure patients are diverted to hospitals with open beds to treat them, and to share resources as needed — though there has been some difficulty among hospitals in sharing N95 masks, which provide the most protection.

"We do often wind up sharing supplies," he said. "Hospitals right now, we're having some issue getting the right number of masks and things and that is a little bit difficult. ... But everybody understands we want to do the right thing for the patients. There's no competition once we get down to a disaster-type circumstance."

Collaboration essential

The Minnesota Hospital Association also gathered hospital chief executives Wednesday to encourage them to collaborate and be consistent in communications and policies such as visitor restrictions.

"We just don't know what the surge might look like in Minnesota," said Dr. Rahul Koranne, chief executive for the hospital association. "We know what the China experience is and we are looking at some of the countries in Europe and we are looking at what we can do from a containment strategy."

Not every assessment of Minnesota's readiness has been glowing. Trust for America's Health gave Minnesota a middling ranking last month for its preparedness, partly because only 23% of the state's hospitals received A grades from the Leapfrog rating group.

The state fell short in other areas as well, including a rate of 52% of workers with paid sick leave benefits that was below the national average.

Walz on Friday acknowledged that rate as a shortcoming and that he and state lawmakers should look for ways to guarantee sick leave or protect income when workers follow state public health guidance and stay home while sick to protect others.

"If there is not a protection for that, there darn sure should be if the state is asking you to stay home," he said.

State health officials encouraged hospitals Friday to follow new guidance from the U.S. Centers for Disease Control and Prevention to conserve resources, including allowing caregivers to use standard masks rather than N95s in working with many COVID-19 patients.

Hospitals also don't have to put all COVID-19 patients in special negative airflow rooms, and they can save those rooms for procedures that are likely to cause infected patients to cough or spit contaminants in the air.

Strike said these changes will help hospitals to expand their capacities and treat more patients in an outbreak, though she said Allina is pushing ahead with the conversion of more spaces to negative airflow rooms in case that standard gets changed back.

Those changes upset the Minnesota Nurses Association, the union for the state's hospital nurses, which is concerned that any relaxation in safety standards increases the threat to front-line nurses working with patients.

"If nurses are not protected, there will be no nurses to care for patients," said Mary Turner, union president, and a critical care nurse at North Memorial Health Hospital in Robbinsdale.

Strike said Allina is looking to provide every resource to keep its workers healthy and not overworked: "We all saw those photos of the nurses in China who had ulcers on their face from the N95 masks."

Koranne said the best way to maintain adequate resources at hospitals is for Minnesotans to follow public health tips that prevent infections in the first place — especially staying at home when sick.

"This is not a normal situation," he said. "This is a pandemic, and we all need to act to break the chain of transmission."

Jeremy Olson • 612-673-7744