GRAND FORKS — Brad Gibbens was on a call with about a dozen rural nurses this week — part of his role as deputy director of UND’s Center for Rural Health — grappling with what comes next as coronavirus sweeps through the country.

It was one of scores, if not hundreds or thousands, of such calls that are taking place across the U.S. as the health care industry adopts a war footing against COVID-19 and wages its opening battles against the epidemic.

During the conference call, Gibbens said, one of the nurses put the moment perfectly: "It feels like somebody left a baby on the doorstep, and I can't find the mother."

Gibbens recalls it as a moment that gave him confidence. Health care workers know they’ve been struck by rising cases, and that there might be a potential explosion of them. Although they might not be sure exactly how they’ll get through it yet, they are convinced they’ll get the job done.

“It was very rural North Dakota — absolutely nobody was panicked,” Gibbens said of the call. “Things were calmer this week than last week, because last week they got hit, and they didn't know what was coming. But now they're starting to fall into routines."

North Dakota officials, watching the worst of the virus unfold elsewhere, struck a calmer tone last week than much of the reporting out of the nation’s urban centers. In other cities, which are perhaps several weeks or more advanced along their infection curves, a shortage of medical resources is becoming dire. At New York City’s Elmhurst Hospital Center, for example, a refrigerated truck reportedly stood ready last week to receive bodies; Atlanta’s mayor said last week that intensive care beds are full and that “at some point soon our hospitals may get near capacity.”

But North Dakota’s shift to battling coronavirus still comes amid a sudden scramble for resources — an urgent concern around the nation as the health care industry scrambles for ventilators and beds and personal protective equipment for doctors and nurses. As cases creep upwards, with at least 58 positive tests as of Thursday, there’s a growing belief that the state will need more resources and equipment.

According to data from the U.S. Census Bureau and the state Department of Health, there are fewer than 300 ventilators in North Dakota. In Grand Forks County, there are only 51, or one machine for every 176 people age 65 or older. Cass County has 120 ventilators, with roughly similar availability, but those are among the best rates. In Stutsman County, for example, there’s one ventilator machine for every 1,331 people age 65 and older. A full 32 North Dakota counties do not have a ventilator available, according to state data.

There are — or very recently were — the same magnitude of intensive-care unit beds around the state: fewer than 250, according to 2018 and 2019 data compiled by Kaiser Health News. That study did not include veterans’ hospitals run by the defense department.

“We are, as hospitals, working together, along with the Department of Health and the governor, to prepare for a surge, to prepare for this disease,” said Tim Blasl, president of the North Dakota Hospital Association. “So again, the public should know that we are working around the clock to do our part. And obviously patients are the main focus of any discussion. A lot of stuff is being done, too, whether it's supplies … to be ready for any surge."

It’s that “surge” that’s on the mind of many health professionals. But predicting it is tricky and speculative by nature. Exactly what will happen is still a mystery, but with much of the North Dakota economy shuttered and working from home, it’s expected that the virus’ spread will be slower. Blasl also points out that North Dakota’s relative isolation has given leaders time to prepare.

"Maybe just some of those dense, populated areas don't have time to prepare like we do,” Blasl said. “That works to our benefit at this point, where we can have some planning. If you're looking at Seattle and New York, they're probably not experiencing as much preparation time as we will (have)."

Bryan Nermoe, president of Sanford Medical Center in Fargo, said 60 ventilators have been ordered for the broader Sanford health system, with delivery expected in four or five weeks. He added, too, that Sanford has also deployed a 54-bed unit to combat the epidemic and be ready for any kind of influx of patients.

"’Surge’ is a very interesting word,” Nermoe said. “It's a novel virus, meaning it's something we haven't seen before. We're seeing different definitions of the word ‘surge’ in different countries and in different states. It's hard to say what that will look like. From what we know right now … we would be in a situation where we would be able to respond to a surge as we know it today."

Altru Health System, headquartered in Grand Forks, also has been pivoting to meet new needs. System spokeswoman Annie Bonzer said in an email that officials there are “reviewing appointments and procedures on a case-by-case basis.”

“This includes expanding our telemedicine services, establishing a clinic for those with respiratory symptoms and serving the general patient population in our other clinic locations,” she said. “Our regional clinics are modeling this approach as it works for their facilities.”

Reaching for a historical analogue for the crisis is difficult — not just because of the scale, but also because it hasn’t totally unfolded yet.

"I have visited with people that are older than I am that have been in the health care field longer than I am,” Blasla said. “They try and compare it to things like … 9/11, like (Hurricane) Katrina. It's hard to compare to 9/11, but I think it's grabbed the national attention like those things have."

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