/Minnesota hospitals managing amid record COVID-19 numbers – Minneapolis Star Tribune

Minnesota hospitals managing amid record COVID-19 numbers – Minneapolis Star Tribune

More than 700 Minnesota hospital beds are filled with COVID-19 patients, a consequence of a worsening pandemic that has caused 145,465 infections and 2,437 deaths.

The totals include 18 deaths reported Friday by the Minnesota Department of Health and a single-day record of 3,165 infections with the corona­virus that causes COVID-19. The 738 COVID-19 patients in Minnesota inpatient beds is also a single-day high and includes 176 people in intensive care.

Patients are trending younger than those hospitalized this spring, but those who are admitted share the same need for oxygen support due to breathing problems, said Dr. Chris Kapsner, who directs emergency care at Abbott Northwestern Hospital in Minneapolis.

“It’s a younger population, but still people that have lung disease and other issues and are still feeling the negative impact of COVID,” he said.

Hospitalizations are a key bellwether for the pandemic because they don’t sway with changes in diagnostic tests.

Changes in admissions to HealthPartners’ hospitals underscore the statewide spread of the virus, as the Bloomington-based health system admitted 95% of its COVID-19 patients in the spring to Regions and Methodist in the Twin Cities. That has dropped to 80% as more patients are showing up at hospitals in Stillwater, Hutchinson and Olivia.

Minnesota hospitals still have capacity. Only 15% of ICU patients right now have COVID-19, meaning hospitals are providing surgeries and the majority of critical care to patients with strokes, heart attacks and other conditions. The state’s pandemic dashboard lists 943 ICU beds as filled with non-COVID patients, and another 400 are immediately available.

Hospital leaders have a “heightened sense of alert,” said Dr. Rahul Koranne of the Minnesota Hospital Association, and will react to any worsening of the pandemic by deferring nonessential surgeries or other steps.

“If there continues to be increased community spread and that results in a much higher number of Minnesotans needing both ICU care or non-ICU care, we have, operationally, dials that we will continue to fine-tune within the hospitals,” he said.

The infections reported Friday came from every one of Minnesota’s 87 counties. They included 3,083 confirmed through molecular diagnostic testing and 82 classified as probable due to their confirmation with antigen testing that is faster but less accurate.

Antigen testing is gaining broader use in Minnesota, particularly in the monitoring of long-term care facilities to detect developing outbreaks.

State infectious disease director Kris Ehresmann said infections have started to increase again in long-term care — with 186 reported on Tuesday alone. Prevention measures had stemmed a high rate of long-term care outbreaks and deaths this spring, to the point that Minnesota had one of the lowest rates of infections in those facilities in the nation this summer.

“We have an incredibly high rate of COVID transmission in our communities, and that places tremendous pressure on the safeguards we put in place to prevent COVID outbreaks in long-term care,” she said.

Age and underlying health conditions raise COVID-19 risks for long-term care residents, who have suffered roughly 70% of the state’s deaths. That includes 12 deaths reported Friday.

Minnesota’s current new infection rate is slightly worse than the national average but well behind the nation’s worst COVID-19 rates in North and South Dakota and the fourth-worst rate in Wisconsin.

Mayo Clinic hospitals in Eau Claire and northwest Wisconsin are so busy with 70 COVID-19 patients that they deferred elective procedures on Friday and expect that policy to stay in place for about a month.

“We have never seen anything like this,” said Dr. Richard Helmers, Mayo health system’s vice president for the region.

More than 200 workers from that area are unavailable due to COVID-19 cases or viral exposures, prompting the health system to divert nurses from Rochester this week and critical care staff from Arizona next week.

One positive is that hospital outcomes are improving. The average length of hospital stay for COVID-19 patients is now three to four days, down from four to five days earlier in the pandemic, Ehresmann said.

New therapeutics such as the antiviral remdesivir and the steroid dexamethasone have helped to improve outcomes. A state review of COVID-19 hospitalizations in May showed a 15% death rate, but updated totals as of mid-October showed that the rate had dropped to 10%.

The supply of ventilators was a concern during the first pandemic wave in the spring because of the number of COVID-19 patients unable to breathe without support. Earlier use of less-invasive oxygen management has reduced reliance on ventilators in hospitals, though.

The state pandemic dashboard lists 462 ventilators in use by patients with COVID-19 and other unrelated medical issues. Another 1,191 ventilators remain immediately available.

Kapsner said the need for oxygen support remains the key decider for whether to admit patients with COVID-19. He sent an asthmatic woman in her 20s home because she was breathing on her own despite COVID-19, but he gave her a monitor to track her blood oxygen levels.

If pressure on hospitals worsens this winter, he said they could have to make tougher triage decisions, such as sending home younger patients with breathing problems to preserve beds for older patients at greater risks of severe illness.

Bed numbers are only part of the concern, he noted, along with illnesses that are sidelining nurses and other health care workers.

“The other concern going into winter is flu, COVID and then all the other normal emergencies that we’ve had,” he said. “And now our staff is getting sick. We have beds, but at this point we’re struggling to get nurses and staff to keep the beds open.”

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