The COVID-19 illness has changed the way medical services are provided in Detroit Lakes.

The Sanford Health clinic now offers drive-up coronavirus testing, extra time between medical appointments and frequent cleaning and sanitizing of offices and waiting areas.

“The challenge is managing all the information from all the sources, and then implementing changes,” Director of Clinic Operations Breanna Adams said.

Within 24 hours, for example, the clinic had implemented curbside testing for COVID-19.

Essentia St. Mary’s hospital has created additional negative-pressure beds using some beds in the intensive care unit and some beds in the regular hospital, said Essentia Health Chief Medical Officer Rich Vetter.

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Severely ill COVID-19 patients need help breathing, and that’s done by inserting a tube through the mouth and then into the airway so that a patient can be placed on a ventilator. The procedure requires airborne isolation and a negative-pressure room, an isolation technique used to prevent cross-contamination.

There haven’t been any confirmed cases of COVID-19 yet in Becker County, but the hospital is preparing for a worst-case scenario.

Remote doctor visits are now a thing in DL

To reduce in-person doctor visits, both Sanford and Essentia now provide a televideo connection between medical staff and patients, who connect at home through their electronic medical portals. Both hospitals already had the electronic medical records portals in use, and it was just a matter of implementing the televideo feature.

“Everybody was thinking that’s where the practice was going, but the payment model didn’t support us going there as quick as we’d like,” Vetter said. “The federal government always paid less in the past for that (an online appointment) but they waived that for the coronavirus,” he said.

If a patient needs to be seen face to face, that can be set up during the virtual visit, Vetter said. Lab work and testing can also be ordered during the virtual visit, he said.

Sanford, meanwhile, rolled out its virtual appointments Monday, March 30. For it to work, patients need to have the MyChart portal and an Apple device iOS 6 or newer. Phone calls and e-visits also are options, using email or messaging.

Family Nurse Practitioner Ronica Wahl, left, and Sanford Director of Clinic Operations Breanna Adams demonstrate social distancing in an empty (but open) Sanford waiting room in Detroit Lakes. (Nathan Bowe/Tribune)
Family Nurse Practitioner Ronica Wahl, left, and Sanford Director of Clinic Operations Breanna Adams demonstrate social distancing in an empty (but open) Sanford waiting room in Detroit Lakes. (Nathan Bowe/Tribune)

Still open for business

Technically, of course, Sanford Health is still open for business. “Call ahead, but we are open -- we still want to take care of people,” said Family Nurse Practitioner Ronica Wahl.

Beginning today, April 1, patients visiting any Essentia Health clinic are asked to attend their appointments alone, with a few exceptions such as for parents or caretakers.

The local clinics and hospital are probably more disinfected than they’ve ever been, and people with chest pains, worrisome bumps or other non-COVID-19 health concerns should not be afraid to go in for treatment, Vetter said.

At Sanford, providers are seeing a 50% lower patient load, which gives time for extra cleaning between visits and space for people to spread out in the waiting rooms.

Layoffs at Essentia

With elective surgeries put on hold and closed clinics or near-empty waiting rooms, the coronavirus has actually been bad for business. Patient visits at Essentia are down 40-50%, Vetter said, even with its new ability to convert clinic appointments to virtual video visits.

Monday, Essentia Health announced layoffs for 500 nonmedical staff across its system. Essentia employs about 14,500 people in Minnesota, Wisconsin and North Dakota, and has experienced “a severe disruption in services,” due to the COVID-19 pandemic, according to an Essentia news release.

Even as it prepares for a surge in COVID-19, the Essentia system is bracing for a 20-40% revenue drop because of declines in the overall number of patients, according to the release.

Sanford does its own COVID-19 testing

The nation has been plagued with a lack of testing capacity for COVID-19, which has required health systems to get creative.

Sanford now does its own drive-in testing in Detroit Lakes. Patients call ahead, and their vehicle is met by a gowned and masked nurse, who takes nasal swabs which are sent off to Sanford in Sioux Falls, S.D., for processing, which takes 24-48 hours, Adams said.

“I’m very proud of Sanford,” she said. “This is a very intense thing to get through the FDA this quickly.”

Earlier COVID-19 testing by Sanford was processed by a private firm, Quest, which became overwhelmed and bogged down, causing weeks-long delays in test results. Anyone still waiting can get rechecked at the drive-up site in Detroit Lakes, she said.

The Detroit Lakes clinic can handle a maximum of 168 tests per day, but “we’re trying to be judicious in our testing, we don’t want to run out,” Wahl said. “Like the Department of Health, we do prioritize -- high-risk patients get priority,” she said. That group includes people such as health care workers, nursing home residents, emergency responders, jail inmates and workers, and homeless shelter residents, among others.

Cleaning and sanitizing is a constant practice in this time of coronavirus: Judy Wanderi, an environmental services technician at Sanford Clinic in Detroit Lakes, was cleaning a chair in the lower waiting area recently. (Nathan Bowe/Tribune)
Cleaning and sanitizing is a constant practice in this time of coronavirus: Judy Wanderi, an environmental services technician at Sanford Clinic in Detroit Lakes, was cleaning a chair in the lower waiting area recently. (Nathan Bowe/Tribune)

Ultraviolet light rooms at Essentia

Both Sanford and Essentia say they have enough masks, respirators and and protective equipment on hand to handle the crisis, but Essentia isn’t taking any chances. Special rooms have been set up at hospitals in Fargo, Duluth and Brainerd, equipped with ultraviolet lights to sanitize surgical masks so they can safely be reused several times.

The process was pioneered by the University of Nebraska for the Ebola virus a few years ago, Vetter said. Essentia St. Mary’s Hospital may also be equipped with such a UV room, he said. “They could reuse them (masks) maybe three or four times if they are in good shape,” he said.

Flu and RSV still out there

One good thing about all the social distancing now in place is that “we’re seeing way fewer kids with RSV (respiratory syncytial virus, a common and very contagious childhood virus) and even ear infections,” Wahl said.

And Vetter said he wouldn’t be surprised to see the number of influenza cases down as well because of the extra hand-washing, hand-sanitizing, number of people staying home, and general COVID-19 prevention practices now in place.

Still, he said, “when people get respiratory symptoms, the vast majority are going to have some other illness (than COVID-19).”

Of those being tested for respiratory illnesses, 8-10% turn out to have the flu and the same percentage turn out to have RSV, he said. “They (those illnesses) are still out in the community,” he said. “We usually give them an influenza test and a RSV test, and if they test positive for the flu we may not even do a COVID test,” he said.

Proud of the community

Like everyone else, medical professionals sometimes get concerned about COVID-19, Vetter said. “There’s a little bit of anxiety,” he said. “We’re trying to remind people that we deal with infectious diseases all the time -- don’t over-react and don’t under-react -- just do what we know how to do.”

Vetter said he is impressed with how seriously most people in the area are taking the COVID-19 prevention measures.

“I’ve been really impressed with our community’s response to what their local, state and federal (health) offices have been telling them,” he said. “I’ve been very happy and pleased with how businesses have cooperated and how people have heeded it, even when it hurt their bottom lines. It’s part of that 'Minnesota nice' -- people are really concerned for their fellow man, their family, their neighbors and their community.”