BEMIDJI, Minn. -- There’s a ward at the Sanford Bemidji Medical Center where Dr. Ramy Abdelfattah likes to walk when he first gets to work in the morning.

It’s on the building’s fourth floor. It’s quiet and well lit. There are beds and ventilators and oxygen tanks — and not a soul there to use them. As he walks this empty floor, he hopes it stays that way.

Abdelfattah is a hospitalist at Sanford. He’s a member of a small team that designed the medical center’s COVID-19 response plan. So far, the hospital hasn’t had to implement most of the team’s planning. But as they watch positive cases in Beltrami County slowly tick upward, they wait — and they worry.

The planning to get to this point, Abdelfattah said, was wildly stressful.

“I can tell you,” he said, “I bring this home with me. When I have free time, I’m just planning. I’m just imagining the worst.”

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Dr. Rami Abdelfattah is a hospitalist at Sanford Bemidji (Minn.) Medical Center. He’s on a small team that designed the medical center’s COVID-19 response plan. The task, he says, was wildly stressful. John Enger | MPR News
Dr. Rami Abdelfattah is a hospitalist at Sanford Bemidji (Minn.) Medical Center. He’s on a small team that designed the medical center’s COVID-19 response plan. The task, he says, was wildly stressful. John Enger | MPR News

For months, he’d head home at night, partaking in the ritual familiar to health care workers in the COVID-19 era: Shed his clothes in the garage, shower — then continue his evening. He’d put his kids to bed, and check the newest research papers. It was his job to keep his team up to date, but things have been changing so fast. At one point, ventilators were vital — and then, maybe, not-so-vital. Medications that showed promise one day might be dismissed the next.

“What was true this Friday,” he said, “the next Friday, it was the opposite.”

Abdelfattah grew up in Egypt, and did his medical residency in New York. He’s still friends with a lot of doctors there, and they told him horror stories from the city’s coronavirus surge. They were overwhelmed. They didn’t know how to treat the virus. They were just trying things. Abdelfattah didn’t like that idea.

“We like evidence-based medicine,” he said. “Clinical trials. In this type of chaos, you can’t have that.”

By late May, Sanford got its first serious, hospitalized COVID-19 patient, an elderly woman. Abdelfattah helped care for her. He wore layers of protective gear that took 45 minutes to put on, and another 45 minutes to take off again. Even after months of study, he said, her case was a shock.

“I read that those patients deteriorate rapidly,” he said. “I don’t think my brain digested ‘rapidly’ the way I saw it. It was different. It was overnight.”

Abdelfattah and his team followed the most up-to-date treatment recommendations of the moment. They tried an experimental drug, narrowly avoided having to put the patient on a ventilator — and she recovered. It was proof of concept for Abdelfattah. He knew then that he would have tools that worked on the virus.

Since then, there’s been a lull. Abdelfattah says the initial, panicky stress has passed, but it’s been replaced by a more enduring kind of stress.

It’s one thing to get ready. It’s another to work brutally hard, for months, to maintain readiness, when there aren’t many cases.

Abdelfattah is staying the course — but outside his hospital, many, it seems, are not. And it’s starting to catch up in the community. Public health officials worry they might soon see an uptick in COVID-19 cases from the Fourth of July weekend.

“We’ve had a significant number of cases bubble up,” said Beltrami County Public Health Director Cynthia Borgen. “We have been able to connect a dozen of them to one group of friends.”

A dozen cases might not sound like a lot when compared to much larger numbers in other parts of the state, but that represents a quarter of the county’s total cases, in just one weekend.

The group of infected friends Borgen tracked down were young, healthy — and mostly asymptomatic. But they visited a handful of local businesses over the holiday weekend. One of the friends was planning a trip to her grandparents’ house, and told Borgen she was terrified of infecting them.

The situation is made worse by a marked lack of precautions in the region — the recommended face masks aren’t ubiquitous in Beltrami County. People, Borgen said, are tired of the precautions.

That doesn’t come as a shock to Abdelfattah. Months of social distancing and hurried, masked grocery store runs can take a psychological toll, he said.

And, he said, people have different ways of dealing with the pandemic.

One way is to ignore what’s happening — to go back to living, as if nothing has changed.

But a better way, said the doctor who’s spent the past four months readying, is to prepare — to wear the mask and wash the hands and stand 6 feet apart.

It can be hard, he said, but doing it means he can breathe deep each morning on his walk through that empty COVID-19 ward.