FARGO — North Dakota hospitals are racing to take steps to prepare for the spreading coronavirus that include initiating drive-thru testing, planning for a surge in sick patients, taking stock of protective equipment and medical supplies, and taking inventory of available beds.

In Fargo-Moorhead, both Essentia Health and Sanford Health are setting up segregated sites where people can go in for testing for the coronavirus. Both health systems ask their patients to call first to determine whether it would be appropriate for them to be tested.

Meanwhile, Essentia announced that starting Wednesday, March 18, through April 1, it is suspending all routine appointments and elective procedures at all of its hospitals and clinics. A decision about routine appointments and elective procedures after April 1 will be made later.

"The decision was made to protect patients and staff during the COVID-19 pandemic," said Dr. Peter Henry, Essentia Health’s systemwide chief medical officer. The decision also allows Essentia to deploy staff and resources to prepare for expected infection outbreaks in communities it serves.

“We recognize that postponing routine appointments and elective procedures is disruptive to our patients and staff, but we always put safety first,” he said. “We want to be ready to provide the care that our communities need in this unprecedented time.”

Sanford Health has set up a drive-thru testing location in the ambulance bay of its medical center on South University Drive, with results from a private testing lab available in three to five days, said Dr. Doug Griffin, Sanford’s medical director in Fargo.

Test samples have been sent to the North Dakota Department of Health laboratory. Twice-daily courier service is available between Fargo and Bismarck to shuttle samples.

So far, the supply of test kits appears ample, said Griffin and Dr. Richard Vetter, Essentia's chief medical officer in Fargo.

Essentia is working to set up a freestanding site where patients who have COVID-19 symptoms can go to be tested, he said.

“The idea is to keep patients who don’t have to come in away from our facilities and other patients,” Vetter said.

No 'random testing'

Hospitals, which have already imposed restrictions on visitors, also are devising protocols to separate people who might be infected with the contagious virus from other patients.

Symptoms for COVID-19 are similar to those of other respiratory illnesses, such as the cold and flu, including fever, cough and shortness of breath. Patients with those symptoms are first screened for the flu and a panel of other respiratory illnesses. If those are negative, they will be tested for the coronavirus, Vetter said.

“We’re not just doing random testing,” he said. Health providers have been told that more rapid tests, with results in hours instead of one or two days, are on the way.

Sanford has plans to handle a surge of patients, with most of its surge beds to be located within the hospital of its downtown medical center, Griffin said. Essentia hospitals are coordinating bed availability with one another, Vetter said.

North Dakota Gov. Doug Burgum and Mylynn Tufte, state health officer, conducted a telephone meeting with hospitals, physicians and public health officials around the state the night of Sunday, March 15, to discuss preparations.

Also, hospital associations in North Dakota and Minnesota are coordinating with hospitals throughout the two states, tallying the availability of beds, protective equipment for health workers and medical supplies.

“We’re communicating with our hospitals all the time,” said Tim Blasl, president of the North Dakota Hospital Association. “The hospitals in North Dakota are being very proactive in planning for this.”

Maintaining a necessary workforce is a challenge, now that schools have been closed and day care is a need for working parents, that Sanford and Essentia are scrambling to address.

Although Sanford and Essentia are well stocked with supplies now, administrators worry about disruptions and shortages in medical supplies and protective equipment as the epidemic continues for what experts have warned will be months.

“Our suppliers are assuring us that they’re staying on top of it,” Griffin said. “We are anticipating more cases in our footprint. We are at this point waiting for the other shoe to drop.”

If people are vigilant about maintaining hand hygiene, staying home if they are sick, and avoiding crowds, the number of those who are infected can be greatly reduced, Griffin said.

Best case, worst case

Drawing from models from outbreaks in China and elsewhere, Sanford has “best case” and “worst case” projections for its service area ranging from cases in the double digits to thousands of cases, Griffin said.

Even if confronted with the worst case, Sanford is confident that it will be able to handle the load, considering that 80% or more of cases should be mild enough for people to recuperate at home, he said.

Hospitals, clinics and health systems are engaged in serial meetings as they try to prepare for what appears to be the worst pandemic since the worldwide 1918-19 Spanish influenza outbreak.

“It’s a fluid situation,” Vetter said. “Day in, day out we’re meeting across the system.”

Hospitals routinely plan for medical emergencies, and have coped with disasters including floods, Blasl said.

North Dakota and Minnesota health officials have stockpiles of equipment and supplies, including respirators, masks and swabs, available for public health emergencies.

Officials at all levels are scrambling to take emergency precautions to limit the spread of the virus in an effort to prevent hospitals from getting overwhelmed, as happened in Italy.

Widespread preparations, including cancelling schools and large public gatherings, are being made. In spite of such efforts, the U.S. surgeon general warned on Monday, March 16, “When you look at the projections, there’s every chance that we could be Italy,” but said social distancing precautions could limit the spread.

Could the United States find itself with a rapidly spreading outbreak that deluges hospitals, leaving some patients without adequate treatment?

“It’s a concern,” Vetter said. “It’s something we’ll have to monitor day in and day out.”

Is Italy dealing with a worst-case scenario? “I don’t think even Italy has reached the worst-case scenario,” Griffin said. “We’ll continue to monitor. This is an evolving situation.”

Dr. Stephen McDough, a Bismarck physician who was director of preventive health for the North Dakota Department of Health from 1985 to 2000, said valuable preparation time was squandered because the Centers for Disease Control and Prevention decided to devise its own test kit, which had problems that caused delays, while a workable test was available from the World Health Organization.

“We’re like two months behind where we should have been,” he said. “There’s a chance it could go that way,” he said of the situation now confronting Italy. The U.S. has an opportunity to limit the spread and prevent a worst-case scenario if people take heed of urgings to adopt “social distancing” and avoid crowds by “hunkering down.”

“But we got behind on this, and now we’re doing catchup and that’s unfortunate,” McDonough said.

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