Health care centers prep for a surge in cases

As Minnesotans continue to hunker down in their homes in response to the stay-at-home orders by Gov. Tim Walz, area hospitals and healthcare leaders are working hard to prepare for what Walz says will be the inevitable surge in COVID-19 cases.

Last week Walz said people around the state have done so well with their social distancing that the surge could come as late as July, rather than later this month if no precautionary measures had been taken. That allows health care and the government more time to prepare.

Community Memorial Hospital CEO Rick Breuer said staff there are doing everything they can to be ready.

The Cloquet hospital has procured additional personal protective equipment (PPE) such as masks, gloves, gowns and eye protection for its staff. They are increasing bed capacity, making plans to add beds in existing rooms, former rooms, and spaces that are equipped for patient care but have never been used for inpatient care. Breuer said they are planning to create more than 40 additional inpatient spaces.

At CMH, getting ready has also meant not laying off any staff - despite the decrease in revenue caused by postponing all non-essential surgeries by order of the governor (although CMH had already taken that step, Breuer said).

"Our employees are the most valuable asset and resource we have, so we are all about keeping them safe. We're also about keeping them protected financially," Breuer said at a press conference March 30. "We think that's very important, because within a very short order of time, it's going to be all hands on deck. We need to do all we can to stand behind those employees because we're going to be asking that of them very soon."

Instead of laying off people, CMH has been cross-training staff from currently underutilized areas such as surgery, into the inpatient and emergency departments. They have established screening and triage processes for patients coming to the facility who are potentially infected.

Some whose typical work has significantly lessened are being stationed at entries, screening patients or employees and taking temperatures, Breuer said.

The small rural hospital is getting some financial help, the CEO pointed out. CMH recently qualified for a $75,000 COVID-19 response grant from the state. The money is part of $50 million provided by Minnesota lawmakers to provide immediate emergency cash flow relief to health care organizations (including assisted living providers, clinics, health centers and hospitals), covering their highest-priority needs in the first few weeks of the COVID–19 outbreak.

"We will be using the $75,000 to purchase beds and related supplies and equipment to be able to support over 40 additional inpatient spaces as part of our surge planning," Breuer said.

Additionally, Breuer said, CMH qualified for some aid through the recently passed federal CARES Act that, among other things, provides financial assistance to small businesses that keep their workforce employed.

Not all area hospitals have retained their staffing levels.

Earlier this month, Essentia Health officials reduced non-medical staffing employees by 500, as a result of decreased revenue across its facilities in Minnesota, Wisconsin and North Dakota. According to a press release, the health care company plans to redeploy the workforce "to best position Essentia Health to care for patients, while responding to the significant financial impacts caused by a reduction in services due to the pandemic." Additionally, St. Luke's Hospital in Duluth also announced March 25 that it was laying off seven employees considered non-essential, and temporarily cutting hours for workers in some areas.

Breuer said CMH is prepared to treat COVID-19 patients.

However, with only four respirators, the hospital will not be able to treat more than that number of the most sick patients.

That's OK. CMH and other regional health care facilities are planning for the surge together.

"We have been in discussions with St. Luke's about regionally coordinating care," Breuer said. "Patients requiring the presence of a pulmonologist and their care teams would be sent to St. Luke's, but we fully expect to treat a number of COVID-19 patients at all acuity ranges below that."

Breuer said they've been doing a lot of scenario planning, in Carlton County and across the region.

"We are preparing for the worst, and hoping for the best and expecting something in between," Breuer said. "And so because of that, we are doing scenario-planning that in all my years I never thought that we would be envisioning."

Backup help

In the meantime, others are making plans for a surge of COVID-19 infections by searching for a Community Alternate Care Site location in Northeast Minnesota.

Carlton County and the six other counties and three tribal nations of the Arrowhead Region of northeastern Minnesota work collaboratively as part of the Northeast Healthcare Preparedness Coalition. The coalition was formed after 9/11 and has been a central coordinating point for the health care response to every major disaster in the region since then.

The state has not yet selected a Community Alternate Care Site (C-ACS) site for this part of the state.

The Coalition's Jo Thompson explained that the priority is for hospitals to keep as many patients as possible, but a C-ACS will provide backup.

"It's an insurance policy of sorts," she said, explaining that once a site has been selected, the Community Alternate Care Site would be a resource that the hospitals in the seven-county region will have access to.

"It is intended to provide further overflow for hospitals and other health care facilities resulting from the COVID-19 pandemic after hospital capacity is exceeded," Thompson said, explaining that a C-ACS is meant to supplement established healthcare systems by serving specific patient populations in need of low-level medical care or monitoring. "These patients will need to receive a medical screening at an existing medical facility and be referred by medical professionals to free up critical care space," Thompson said.

The Carlton County Sheriff's Office systems administrator and acting emergency manager, Steve VanKekerix, serves on the Coalition along with Fond du Lac Police Chief Fred Petite.

VanKekerix said the state was looking at several sites in Duluth. He didn't think any sites in Carlton County were currently under consideration for a C-ACS.