GRAFTON, N.D. – Last spring, Unity Medical Center in Grafton prepared for a worst-case COVID-19 scenario: a shortage of patient beds, tight medical supplies and overwhelmed staff.

Now, it's the reality of the small Walsh County hospital.

“It’s happening as bad as we feared it would,” said Dr. Matthew Viscito, Unity Medical Center chief medical officer. “The contingency plans we talked about six months ago, we’re implementing now.”

In Viscito’s role as chief medical officer, text messages on his phone “ping” each time there is a positive test in Walsh County. A few weeks ago, there were several days that numbers of positive tests were in the 50 and 60s. One day, it reached 70.

“It was like music playing for a while,” he said.

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Last week, the daily positive test numbers in Walsh County fell as low as the high 20s. However, on Wednesday, Nov. 18, Walsh County still had the state’s second-highest per-10,000 cumulative positives, with 309, according to the North Dakota Health Department.

For most of November, there has been a patient in a bed in Unity Medical Center’s 11 hospital rooms. On some days, patients have laid in a bed in the chapel or on a gurney, surrounded by privacy curtains, in the hallway. This past week, a couch blocked the entrance of the hospital radiology department, where the room was being remodeled to house a patient.

Because a sharp rise in COVID-19 patients across North Dakota has taxed the state’s hospital capacities, Unity Medical Center is unable to transfer seriously ill patients to other facilities as it typically would, Viscito said.

“Everybody’s beds are full. We are keeping patients who are sicker with COVID and other conditions we wouldn’t normally keep,” he said.

“Even last flu season, we weren’t this full," said Jenny Holand, Unity Medical Center chief nursing officer. “It’s not just COVID patients. It’s other patients who are acutely ill.”

Unity Medical Center has formulated a plan to house patients outside of the hospital if it runs out of beds – it is licensed for 14 – before next month when a new hospital addition, which has 11 beds, will be finished, Viscito said.

“We’ll be reaching out to any place in the community that has beds,” he said.

At the same time that there’s been an influx of patients, several of Holand’s staff of about 30 health care workers have had to quarantine because they were in contact with someone who tested positive for COVID-19.

“We lack enough nurses to fill our shifts,” Holand said. Some health care staff members are working at least one or two extra shifts a week to compensate for the reduction in workers.

“At that rate, staff are going to burn out,” she said.

Holand has looked far and wide for travel nurses to fill the open shifts, but since many hospitals are doing the same, she hasn’t found any. Medical center staff members are pulling extra duty to help out.

“Everybody is stepping outside their normal roles,” Viscito said.

“Physical therapists are doing direct patient care. Business staff are doing clerical work,” Holand said.

Besides nurses, the stress is affecting others, too. Housekeeping staff and laboratory technicians are similarly feeling the strain, she said.

“We’ve done 60- to 80-plus COVID swabs in a day,” Viscito said, noting that three of the medical center’s nurse positions have been dedicated to testing for COVID-19 and calling people to give them their results.

“We are all significantly mentally and physically spread thin with this,” Viscito said.

Holand is concerned that the shortage of staff members and high number of patients threaten to overwhelm Unity Medical Center’s ability to provide the necessary care to patients.

“Something as simple as appendicitis or heart attack, we hope their care won’t be interrupted,” she said.

Besides shortages of beds and staff, some supplies – including cleaning products, gowns, gloves and certain medications – are tight.

Viscito, for example, had to decide on Sunday, Nov. 15, whether to start a COVID-19 patient on a regimen of Remdesivir, an antiviral drug. The medical center had only one dose available, and he wasn’t sure if a scheduled shipment Monday would arrive. Viscito made the call to give the patient, who had a serious case of COVID-19, the antiviral.

“Fortunately it came on Monday, and we didn't have anyone else who needed to start on it over the weekend,” Viscito said.

Neither Viscito nor Holand see a light at the end of the tunnel for the hospital’s plight.

“I don’t know what the end looks like,” Viscito saiid. “We’re still a year from now before the country is vaccinated.”

Even when a vaccination is available, not everyone will choose to get it, he said.

“There will be people who would take it from Putin himself, but there will be people who wouldn’t get it even if it had been out and proven for five years,” Viscito said.

However, people can reduce the spread of COVID-19 by wearing masks, social distancing and avoiding large gatherings, he and Holand said.

“A lot of the public are not taking this seriously,” Holand said. Unless people have had COVID-19 or know someone who has, many of them don’t understand how serious it is, she said.

“It’s theoretical, probably,” Viscito said.

But for Unity Medical Center staff, it’s personal.

“I am not afraid of what’s going to happen to me, but to the community,” Viscito said. “People are dying from this.”