COVID-19 cases have been surging in North Dakota, and Cass County (where Fargo is the county seat) is one of the hot spots. With 145 staffed beds, Essentia Health hospital in Fargo is at about 95% of capacity, up from its normal level of about 70% of capacity, said Dr. Richard Vetter, the chief medical officer for the Essentia West area, which includes Detroit Lakes and Fargo.
Health professionals keep a wary eye on hospital capacity because bad things can happen when all the beds are full: The death rate spiked when hospitals were overwhelmed with COVID-19 cases in New York City earlier this year.
But Essentia has had three COVID-19 planning levels in place since this spring -- conventional level, contingency level and crisis level -- and it remains at the basic, conventional level, Vetter said.
The Fargo hospital has accepted some patients from western North Dakota, mostly non-COVID-19 cases, he said. And it has transferred a half-dozen recovering non-COVID-19 patients to Essentia hospitals in Fosston and Ada. “It’s always done in consultation with the family,” he said in an online video interview.
“We haven’t had to ship anybody to Minneapolis or Mayo (Clinic in Rochester), he said. “It is an option if necessary.”
CentraCare hospital in St. Cloud is also available to take COVID-19 patients if necessary, he added. “There are conversations among hospitals,” to prepare for contingencies, he said. It’s unlikely that COVID-19 patients would move from a larger hospital in Fargo to a smaller Essentia hospital in Detroit Lakes, he said. Patients usually move in the other direction.
Even with hospital beds available, COVID-19 deaths have been spiking in North Dakota, from 41 in August to 120 in September, with 90 deaths so far in October, according to the North Dakota Department of Health.
COVID-19 cases have also been rising alarmingly in the area: There were 81 active cases in Becker County and 76 active cases in Otter Tail County on Tuesday. And there are nearly 1,000 active in Cass County, with new daily cases in the triple digits. There were 160 new cases there just on Tuesday.
Testing has come a long way since springtime
Part of that is due to an aggressive testing regime in North Dakota, Vetter said. “North Dakota has been first or second per capita in the nation for testing the last few months,” he said.
“Testing in general is more available than it was when the pandemic first started,” he added. “Back then, testing guidelines changed every week. Now the governors of North Dakota and Minnesota say ‘test people if they need to be tested.’”
Essentia has the capacity to ramp up testing if necessary. The Mayo Clinic still processes COVID-19 tests for Essentia, with a turnaround of about 48 hours -- “much better than it was at first,” Vetter said. “We increased our courier trips (with COVID-19 samples for testing) to Mayo to multiple times a day.”
No more shortage of masks, gowns for hospital staff
And there is no shortage of masks, gowns and other personal protective equipment for medical staff. Essentia now has a system to track that protective equipment closely to make sure it’s available where needed, Vetter said.
“What we’ve learned is that PPE, if used appropriately, is very effective. We haven’t really had any outbreaks in our hospital. The few staff that have it contracted it out of work, when they were with family or friends.”
Staff safety requires some education. “When someone codes, everyone used to rush in,” Vetter said. “Now they take a minute to gown up first.”
That’s because those lifesaving procedures can involve things like chest compressions, inserting tubes and using ventilators, which are known to send a lot of virus into the room. Even using nebulizers and administering high-flow oxygen may be risky to medical staff if they aren’t properly masked and gowned.
Antivirals, steroids and antibodies now available
While there is no cure for COVID-19, the antiviral drug Remdesivir is now easily available from the manufacturer, Vetter said. The steroid dexamethasone is also available, and while most people outside the Oval Office don’t have access to the synthetic antibody drug Regeneron, Essentia Health has been using real antibodies in the form of convalescent plasma for several months now, Vetter said.
“We’ve found it actually works best if you give it early (in the illness),” he said. “That’s what you saw with President Trump -- he got it early.”
Schools, colleges open and cases spike
COVID-19 cases are on the rise in Becker, Otter Tail, Clay, Hubbard and other area counties, too. Vetter attributes the increase in cases to the time of year.
“Viruses in general always pick up when people are crowded together,” Vetter said. With schools and colleges opening, more people are exposed in classrooms, dorms and through fall sports. “It’s people being closer together, that’s part of it,” he said.
Of course, “there’s always more we can do,” to encourage public safety, he said. "We've been advocating for universal masking. A mandate is tough to enforce, but we encourage people to wear masks."
Quick-acting saliva tests could be godsend for nursing homes, hospitals
Saliva testing for COVID-19 could open the door for family and friends to safely visit hospitals and nursing homes, Vetter said.
“It will have a big impact,” he said. The immediacy of the test is almost like a home pregnancy test, he said. “That point-of-care testing will allow us to really test that segment of the population,” to make sure visitors are covid-free before interacting with sick or elderly people. “It will make a big difference,” he said.
Minnesota is expanding its saliva testing program, including a semi-permanent saliva testing site that will open in Moorhead Oct. 17. It will offer free saliva tests to any Minnesotan who believes they need to be tested, as part of the state’s strategy to provide easy access to quick, reliable testing.
Want to help? Get a flu shot
It may seem counterintuitive, but one of the best things people can do to help the battle against COVID-19 is to get a flu shot, Vetter said. “Flu shots have been modified this year,” Vetter said, to better match the dominant strains in the southern hemisphere this summer, since they move north in the cold weather months.
The flu vaccine helps prevent serious cases of influenza that send people to the hospital or even kill them, Vetter said. “It’s important to mitigate flu patients, especially high-risk patients, to keep beds available for covid cases,” he said. “So get your flu shot.”