On The Mark: Hospital navigates Covid storm

Among area enterprises propelled into the Covid hotseat, Community Memorial Hospital must be our local ground zero. Demand for its care and services skyrocketed from the start, peaking in winter 2020. To explore how its management team and staff are navigating ongoing Covid cases, I sat down, adequately distanced, to talk with CEO Rick Breuer.

Breuer emphasized that Covid outbreaks are not behind us. New variants are emerging. “We can tailor something that will defeat it,” Breuer notes, “but we’ll always be a step behind. A flu vaccine can be made well in advance, but it’s not always correct.” He notes that though the Pfizer vaccine was the first out the door, the Moderna vaccine has also been very successful. Mayo Clinic researchers found that those receiving the Moderna vaccine have higher levels of antibodies, although it is not yet fully understood how that translates into long- term protection from Covid. The Johnson & Johnson vaccine is also effective, but it has been studied less due to its being used by a much smaller percentage of individuals.

How did CMH respond to an influx of patients with Covid? When Covid first emerged in Washington state, Breuer convened with his counterparts in the Minnesota Hospital Association and the Wilderness Health Hospital Group to explore how to support each other and limit vulnerability. “One of our local physicians suggested it was time to formalize a work group to make efficient and informed decisions around preparation. Within 48 hours, we had a task force meeting and morphed into a team,” Breuer recalled.

Breuer applauds the Carlton County Public Health and Human Services, “a shining star in our state.” CMH staff met with them early on, to share what each of us were working on. “We all were having similar problems. We appreciated the camaraderie. Now we have contacts across the region: in jails, nursing homes and nearby hospitals. It’s a great support group, needed because conditions are changing all the time.”

How did CMH’s staff respond to early Covid challenges? “Our doctors and nurses want to help people and save lives. None of us had ever seen anything like this — so many people in the hospital sick and many dying. We were strict — no families permitted. It was very traumatic for many of us.”

CMH treated many Covid patients here. “We normally staff 25 beds, and our usual census is about 10 occupied. But last winter, we were completely full, half of them Covid patients.” CMH and many other hospitals applied for and received extra bed licenses, preparing for a surge in patients. With some challenging cases, they transferred patients requiring services that CMH doesn’t offer to Duluth, St. Cloud or the Twin Cities.

CMH is experiencing an uptick again, though unlikely to match last year’s levels of Covid patients. This second round has triggered staff distress. “They felt, ‘here we go again.’” Breuer said. “I worry for our health care workers here and all around the world. However, we retained more staff than some other sites and did not have to limit our capacity.”

Breuer and his team actively promoted community mitigation strategies in hopes of stemming Covid cases in its service area. Some were controversial, such as if and when to shut down bars and restaurants and whether masks should be required. Breuer wrote in favor of masking ordinances that the city of Cloquet adopted. He also championed high-quality masks: “the better the mask, the better the protection for everyone,” he said, citing the precedent of no- smoking ordinances designed to protect smokers as well as others.

CMH adopted multiple precautions, trying to follow the science and the rules “We revamped our entrances, masking, and visitor policies,” Breuer explained. “We tried to follow the science and the rules. It wasn’t always easy. For instance, we took temperatures, but if people come in from the cold and the thermometer says 95, is this their actual temperature or not?” He marvels that some folks are afraid of clinics but not grocery stores. “The safest buildings are clinics and the hospitals. We keep our spaces sanitized and safe.”

Breuer is optimistic about people broadly practicing caution. “It’s not a big inconvenience. There will be a time when everyone will adapt to Covid being around. We’ll get to a point where enough of us are protected, either from vaccines or by contracting and surviving Covid.” Recently, researchers found that up to 83-percent of Americans had developed antibodies, either through being vaccinated or natural immunity acquired from having contracted Covid.

As for challenges going forward, CMH will face new Covid challenges and search for additions to their workforce at the same time. Across the state, hospitals and health clinics are looking for managers at all levels. “For many of us community hospitals,” says Breuer, “we’ve endured battered balance sheets and income statements. It takes time to right the financial side. We have ambitious things to do, including needing a new nursing home. We have a resilience committee — they are doing some fun things. We’re helping our long- term people feel whole again, but it will take time and larger initiatives.”

Breuer says he and his team are bullish on local health care.

“We serve 35,000 people in surrounding zip codes. We’re very collaborative and integrated with the community, including businesses, schools, public health agencies. As long as we keep demonstrating value, we’ll be around. The biggest danger is in the design of insurance products that go to certain providers. If they partner, you’ll see narrowing network products. It may really restrict patient choice — being told where you have to go for your care. It could be a significant threat. It’s up to us to win it.”

I left the hospital feeling awed by what they’ve taken on and accomplished. More on how health care could be changing for the worse, in a future column.

Columnist Ann Markusen is an economist and professor emerita at University of Minnesota. A Pine Knot board member, she lives in Red Clover Township north of Cromwell with her husband, Rod Walli. Reach her by emailing [email protected]