As COVID-19 numbers in North Dakota and Minnesota rise, regional hospitals are beginning to feel the effects. While vaccines and monoclonal antibody treatments keep many of those afflicted with COVID-19 from requiring hospitalization, rising rates of the virus in surrounding communities – paired with staffing, bed and supply shortages – may prove a challenge to smaller hospitals moving into the fall.

“Fortunately, or unfortunately, as the case may be, 2020 was a year that provided us with a huge learning experience in handling COVID patients. So we at least have that under our belts to face what is coming our way,” said Brian Carlson, executive director of Sanford Thief River Falls.

Carlson said staff members at Sanford Thief River Falls have become more comfortable treating COVID-19 patients as they have developed a greater understanding of the virus. They have the personal protective equipment needed to protect themselves from the virus, and 14 rooms in the hospital were converted into negative pressure rooms, which help contain airborne diseases like COVID-19. The hospital is well equipped to handle COVID-19 patients – as long as there are hospital workers to care for them, he said.

“For us, the biggest issue in caring for the influx of patients comes down not to physical space, but human resources. Do we have enough nurses available to care for the numbers coming into our facility?” said Carlson. “Fortunately, up to this point, we have had those resources, but they get tight at times.”

Across the region, rural hospitals are struggling with staffing. Northwood Deaconess Health Center CEO Pete Antonson believes staffing will be the single biggest challenge hospitals in the region will face as COVID-19 numbers rise.

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“Whether it’s us, or Altru or Sanford, or any of my colleagues in smaller places, we’re all screaming for staff,” said Antonson. “We’re aggressively recruiting. Everybody is.”

Solutions to the staffing problems range from recruiting and incentivizing staff to work extra shifts, to cross-training staff so they have the skills needed to work in multiple roles within the hospital.

“I think we have a little advantage in the rural setting because we had to have people cross-trained to do more than one thing, and to help us get through, that’s what we’re doing. Most of our staff wear two to three hats in a day,” said Jac McTaggart, senior director of Sanford Hillsboro Medical Center and Sanford Mayville Medical Center.

Despite the challenges with staffing and uncertainty about when the pandemic will end, hospital staffs across the region have stepped up to the challenges that the pandemic has created, area health administrators say.

"There is definitely fatigue in our staff but our staff have been very resilient and have done a very nice job in dealing with the pandemic," said Keith Okeson, president/CEO of LifeCare Medical Center in Roseau, Minn.

In small, rural hospitals, the ability to serve patients is contingent on bed availability in larger hospitals in the region. Many of the hospitals in the region are designated as "critical access hospitals" by the Center for Medicare & Medicaid Services. These hospitals have 25 or fewer beds and most patients are treated within 96 hours or less, or are transferred to a larger hospital that can provide a higher level of care.

“We’ve accepted some patients from tertiary care facilities that normally we would not and we’ve ended up keeping some patients that we generally would transfer to tertiary care facilities. We’ve been keeping them here because of beds not being available in Fargo, Grand Forks, Bismarck or Minot,” said Aaron Johnson, vice president of patient care services at CHI St. Alexius Health Devils Lake Hospital. He says the patients the hospital is seeing are still within their level of care, and no COVID-19 patients are on ventilators.

Unity Medical Center, in Grafton, N.D., is finding a balance between testing as many people as possible and saving resources for a potential test shortage. Currently, the hospital is testing an average of 20 people a day, and as many as 40 people on busy days. Rapid tests are reserved for the most symptomatic patients so hospital staff can quickly decide whether to use monoclonal antibody treatment. The hospital has discontinued travel testing in an effort to conserve resources.

“We have to ration our resources because we don’t want to get overwhelmed again and have immense shortages,” said Unity Medical Center CEO Alan O’Neil.

Ensuring COVID vaccines are available to anyone who wants one is a universal strategy to maintain manageable levels of COVID in the region’s rural communities. Many in the region have days dedicated to administering vaccinations and are offering to vaccinate patients when they come into the hospital or clinic for non-COVID related appointments.

An approaching flu season provides another opportunity for hospitals to reach patients with COVID-19 vaccines. Flu shots and COVID-19 vaccines are compatible with each other, and some hospitals, like Unity Medical Center, are giving patients the option for a two-for-one deal. This year at Unity’s flu shot clinic, patients will have the opportunity to receive flu shots and their first or second dose of a COVID-19 vaccine at the same time.

In North Dakota, 56% of people over the age of 18 have received at least one dose of a vaccine, according to the North Dakota Department of Health. In Minnesota, 75.7% have received at least one dose, according to the Minnesota Department of Health.

“The clinical evidence supports that vaccinations are effective in keeping people out of the hospital,” said Carlson, the director of the Thief River Falls hospital. “It’s not a hundred percent guarantee; we have seen some individuals who have been vaccinated that end up hospitalized, but it is a very small percentage compared to people that are unvaccinated.”

Along with a focus on vaccines, hospitals in the region are stressing the importance of going back to COVID basics – washing hands, wearing a mask, social distancing and getting tested.