Requests come in from places like western North Dakota, Nebraska, Oklahoma and even Texas. They ask if they can send their patients here, since their hospitals are full of COVID-19 cases.

"It happens more frequently right now than when it normally does," explained Janice Hamscher, Chief Nursing Officer with Altru Health System in Grand Forks.

Hamscher said this is normal practice, but it is now elevated by the nationwide surge. They and the other health networks in the region are full too, with the state at 100 active COVID-19 hospitalizations.

"Certainly we would gladly care for patients in those states if we had the capacity to do so, but we try to take the patients that are within our own region first," Hamscher said.

There are roughly the same number of COVID-19 patients now as this time last year, but Dr. Rich Vetter with Essentia Health said this is stacking on top of other types of non-COVID-19 patients who may have delayed care during the pandemic.

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"What we're seeing different this year is that we're full already," Dr. Vetter said.

So where do these patients go? Dr. Vetter said they are moving through a central coordination system — checking with healthcare networks throughout the nation — and seeing which ones have space.

The other challenge they are contending with is having enough nurses. Staffing is fine for now, but they're preparing for this surge to get worse.

"People are tired. People are tired on many levels," Hamscher said. "The pressure of providing care, workforce shortages that are just across the board adding to that..."

"We're just so pleased and grateful for their dedicated service, because they're the ones that do the day-to-day work with those patients, and they're doing a great job," Dr. Vetter added.

They're also mentally preparing for a spike similar to that seen in the fall of 2020. Dr. Vetter said at least 90% of Essentia Health's hospitalized COVID-19 patients are not vaccinated. The majority of Altru's patients are also without the shot.