FARGO — Hospitals are scrambling to make preparations for a coronavirus that so far has only lightly touched North Dakota but threatens to overwhelm hospitals in coastal areas at the epicenter of the widening pandemic.

Hospitals and state health officials are adding beds for coronavirus patients — including potential contingency plans to reopen closed hospitals or wings — and preparing to distribute crucial medical supplies soon from the state emergency stockpile.

Already, hospitals around the state have severely curtailed elective surgeries to make beds available for patients with COVID-19, the respiratory illness caused by the contagious virus, Tim Blasl, president of the North Dakota Hospital Association, said Tuesday, March 24.

“For the most part in North Dakota that’s happened already,” the postponement of non-urgent surgeries. “If it’s emergent, they’re still doing the surgery. There’s a lot of discussion going on right now between the physician and patient.”

Leaders representing hospitals, physicians and public health agencies are meeting regularly to plan for an expected surge in patients when the epidemic worsens in North Dakota. As of Tuesday, seven patients were receiving hospital care in North Dakota and 36 have tested positive among 1,602 who have been tested. No deaths have been reported.

State health officials will distribute 40% of the state’s emergency stockpile of medical supplies — including personal protective equipment such as masks, gloves and face protectors — to hospitals around the state, based on their licensed bed capacity, hospital representatives said.

“They do have a very significant stockpile of supplies,” said Bryan Nermoe, president of Sanford Health in Fargo. “Currently at Sanford we do have an adequate supply right now, but adequate is a very flexible word.”

The rest of the state’s supply stockpile, such as personal protective equipment for health care workers, will be held in reserve for possible later use, Blasl said.

With only seven hospitalized patients to date, hospitals aren’t under pressure yet from the coronavirus, Blasl said.

In Fargo, Sanford Health already has set aside beds to handle coronavirus patients. “We have two special care units up and running, adults and pediatric,” Nermoe said.

At its downtown medical center, Sanford has 18 adult beds with another 34 that will be ready by Wednesday, he said.

At least six pediatric beds are ready at the Sanford Medical Center near Veterans Boulevard, with the ability to expand capacity, said Dr. Doug Griffin, Sanford’s chief medical officer in Fargo.

“It’s kind of as much as we need,” Griffin said. “We’ve got it designed in increments.”

Shift to telehealth

Sanford is evaluating clinic visits and nonessential surgeries and procedures on a case-by-case basis, Nermoe said. Surgical volumes are down 30%, he said, and clinic visits have dropped by 40%.

Essentia Health, which has suspended elective surgeries and routine clinic appointments, is asking patients whenever possible to see their providers through e-visits. Over the last four days, Essentia providers have handled 1,700 telehealth visits, said Dr. Richard Vetter, Essentia’s chief medical officer in Fargo.

That compares to an average of 20 to 30 per day before, he said.

At Sanford, e-visits and video conferences with providers also are up sharply. Sanford providers in Fargo already had seen 60 more patients utilize telemedicine in one day compared to last week.

Sanford received 300 requests for video visits as of Monday, compared to fewer than 100 requests a week ago.

Essentia has 14 intensive care unit beds available in Fargo, with more “dedicated space we could easily commit if the need arises,” Vetter said.

“Right now we believe we’re in a good spot,” he said, but added that Essentia is monitoring supplies and bed needs daily in anticipation of spreading coronavirus infections that will send some to hospitals.

“We’ve had more of an opportunity to plan and benefit from that experience that has happened in other places,” Vetter said.

'Worst-case scenario'

As for questions about how and when coronavirus cases will spike in the area, “That’s a question a lot of people are asking,” Vetter said.

Sanford has analysts working on predicting what a surge in patients might look like when the spread of coronavirus infections intensifies in the area, Nermoe said. Last week, Sanford said a “worst-case scenario” for a 60-day period could mean 3,600 infections among a regional referral population of 500,000.

Typically, based on experience in China, health officials have estimated that 80% of those with the virus will recuperate at home, 15% will need some hospital care and 5% will need acute or intensive care.

ProPublica, an independent, nonprofit journalism organization, has reported that pressure on hospitals will vary widely across the country. ProPublica created maps based on data from the Harvard Global Health Institute.

In the Fargo-Moorhead hospital referral region, a population of 560,000, with a moderate coronavirus infection scenario — which the Harvard study defines as 40% of the population getting infected in 12 months — hospitals would have to add acute-care beds to handle sick patients, ProPublica predicted.

Because on average 61% of hospital beds are occupied as a matter of routine, the surge in patients sick from the coronavirus would strain hospital capacity, the study said.

“The influx of patients would require 1,210 beds over 12 months, which is 165% of available beds in that period,” ProPublica’s report said.

The Harvard researchers’ scenarios assume that each coronavirus patient will require 12 days of hospital care on average, based on data from China.

Projections like those by ProPublica and Harvard underscore the importance of people practicing social distancing — staying home as much as possible, avoiding crowds, maintaining a physical distance of six feet or more — and diligence in maintaining hygiene, health experts said.

Social distancing can slow the spread of the coronavirus, helping to keep hospitals from being overwhelmed, federal, state and local health officials have said repeatedly.

“All this mitigation is designed to slow this disease so it doesn’t come in like a tsunami,” said Dr. Kurt Kooyer, a physician at UrgentMED in Fargo. “This battle is going to be fought in the hospitals.”

Kooyer said he’s trying to do his part as a physician by preparing his clinic and educating his patients.

“We don’t want to be alarmist,” he said. “We know it’s going to get busy. A lot of us are going to get sick. We don’t have to be afraid of getting sick. We need to be afraid of everybody getting sick at the same time.”

Link to ProPublica/Harvard study, where searches can be made by hospital referral service area.

Link to Urban Institute map of hospital bed capacities for each county.

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