ROCHESTER, Minn. — Sandwiched between anodyne announcements on saliva testing pop-ups and best tips for the deer hunting opener during COVID-19, Minnesota health officials on Wednesday, Nov. 4, acknowledged a troubling convergence of pressures on the health care system, one in which new case counts have begun to break records daily while the state's ICU inventory edges closer to full capacity.

Currently there are 887 Minnesotans hospitalized with COVID-19 — a new record — with 219 of those in an ICU setting — another record. The Twin Cities metro, home to the roughly 1,800 new cases on Wednesday, is at 98% ICU capacity, according to state director of infectious disease Kris Ehresmann. The metro area's non-ICU hospital beds are at 97% capacity.

Statewide, 92% of all ICU beds are now taken, Ehresmann added, with 88% of outstate non-ICU beds occupied.

Full ICU capacity, a hypothetical breaking point in which patients cannot access life-saving care as hospitals become forced to allocate advanced care to those most likely to survive, was the doomsday scenario depicted when jump-starting the state's emergency preparedness plans at the start of the outbreak.

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Those plans included a halt on all elective medical and dental procedures, unpopular moves intended to free beds and preserve personal protective equipment. Elective procedures have since been reinstated but could always be rescinded again to free up capacity, and indeed were voluntarily halted late last week for 10 Mayo Clinic Health System facilities in northwestern Wisconsin.

Until this week, full ICU capacity has never approached likelihood in Minnesota, however, the state has long been spared the soaring case counts that triggered patients housed in hallways in New York and Washington state, and later Florida and Arizona. The Midwest is now leading the country in the spread of the illness, pushing the unthinkable closer.

'We're seeing record numbers of new cases. We set a new record every few days, and it's because we're falling behind the rapid spread of this virus," said Commissioner of Health Jan Malcolm during an afternoon press call that reported almost 4,000 cases and over 30 deaths for the day. Comparing the state's current outbreak to a wildfire that seeks out fresh fuel, Malcolm intimated that the hospital system should begin to feel the squeeze of this recent record-shattering week in coming days.

"We know hospitalizations lag behind case growth, and mortality lags behind hospitalizations," said Malcom. "So as these numbers continue to go up, we are concerned about capacity in a lot of different contexts ... these numbers straining many of our critical systems."

Health officials said the state's Center Critical Care Coordination Center is now employing real-time data on staffing as it assists hospitals in "load leveling" — the term for moving patients around the state as beds fill up in an affected region.

That news was accompanied by a report that Gov. Tim Walz on Wednesday appealed to FEMA for two more five-person emergency staffing teams, and 30 days' continuation of current staffing on loan from the agency, "due to the spike in positive cases across the state," according to the statement.

“Securing this additional staffing support, in addition to extending the current staffing support on the ground in Minnesota, would significantly assist our state during this tenuous time," Walz wrote in the letter to FEMA administrator Peter T. Gaynor.

"At these numbers we know that capacity limits are a real thing," Malcolm said. "But so far the systems in place have been working in a commendable way."

With the pandemic continuing to shift toward a predominantly rural profile, and with few ICU beds to serve large geographical regions in Greater Minnesota, the pandemic threatens to expose the costs of broad settlement patterns that define rural and exurban life today.

The state has now conducted 7,000 tests at its recently launched, predominantly rural saliva sites, with locations showing a 12% positivity rate. Malcolm identified western and central Minnesota as areas of highest concern for new spread at the present time, and said the state had on Wednesday reached a first as all 87 of its counties had reported a new case on the same day.

Of the day's 31 deaths, 23 — nearly three-fourths — were in Greater Minnesota. Among the deceased on Wednesday was a person with underlying conditions from Hennepin County in their 30s. The statewide death count has now surpassed 2,500.

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  • Minnesota Department of Health COVID-19 hotline: 651-201-3920.
  • COVID-19 discrimination hotline: 833-454-0148
  • Minnesota Department of Health COVID-19 website: Coronavirus Disease (COVID-19) website.