BISMARCK — With COVID-19 cases climbing exponentially in North Dakota, the state's health care system is feeling the pressure. Major hospitals are overextended, understaffed and running out of room — and officials predict the worst of the crunch is yet to come.
As of Tuesday, Aug. 31, the capital city's two hospitals were caring for 50 mostly unvaccinated COVID-19 patients and had no open intensive care beds between them, said Sanford Bismarck CEO and President Dr. Michael LeBeau.
LeBeau told Forum News Service his hospital is "completely out of space" to care for patients and beleaguered by low staffing levels.
Retha Mattern saw the heavy burden on Bismarck hospitals firsthand. The 36-year-old said she waited in the emergency room at CHI St. Alexius hospital with an acute case of appendicitis for six hours on Tuesday before an inpatient bed opened up in the maternity ward. Even though she received attentive care from staff, Mattern said the hospital was "very busy" and she felt lucky to be admitted as quickly as she was.
Mattern said she overheard several patients in the hospital with COVID-19 symptoms or a positive diagnosis, including a patient in the bay next to hers.
"It was unnerving to be around that many covid cases at once," she wrote in an email. "Every covid patient I heard said they were not vaccinated. One of the individuals refused to let them test him for covid while he was there. It just seemed like so much of the strain on the ER was preventable."
Surgeons couldn't fit Mattern into the schedule Tuesday, but she said they planned to operate on her Wednesday morning barring any emergent situations overnight. Though her ailment hasn't been intensely painful, Mattern said she thinks it's likely the constant pressure on hospital staff has delayed the surgery.
"I’m pretty sure, although I’ve never experienced appendicitis before, that it’s not normal to keep someone with acute appendicitis waiting for 24 hours for a fairly routine procedure," Mattern said.
To manage space, staff and resources, LeBeau said North Dakota hospitals have begun triaging patients — treating them in an order based on the severity of their condition. That can mean long wait times for some patients, whether they have COVID-19 or something else.
Hospitals are bracing to be stretched even thinner as the highly contagious delta variant of COVID-19 infects more unvaccinated residents. LeBeau and North Dakota Hospital Association President Tim Blasl estimated the peak in cases won't come until the end of September. Blasl also notes that unlike last fall's surge, many North Dakotans are seeking care for non-coronavirus health issues, including conditions exacerbated by a lack of medical attention earlier in the pandemic.
Other states riding the worst of their COVID-19 waves offer a glimpse of North Dakota's future.
“We accepted a patient from out of state yesterday and we were told we were the 16th hospital they called," LeBeau said. "That should get everybody’s attention."
In preparation for the grim days ahead, LeBeau said his hospital is trying to add capacity in the ICU and COVID-19 unit, but finding health care workers to look after patients is another problem. Traveling nurses, many of them fighting pandemic peaks in other states, are in extremely short supply, and Sanford Bismarck has found trouble attracting them despite having a willingness to "pay whatever we have to," LeBeau said.
The hospital also took the lamentable step of reestablishing a COVID-19 ethics board to decide who receives care if there aren't enough beds, staff or ventilators to go around.
“It’s important for people to understand that across the state (hospitals) are putting in our processes to get through a difficult time when we’re out of resources," LeBeau said. “I worry that we’re going to have to make difficult decisions about who gets care, who gets the next bed, who gets the next ventilator and how many patients can people on the frontlines take care of before the safety concerns get too high.”
LeBeau said he's confident North Dakota health care providers will band together to maximize capacity and resources, but there's real risk it won't be enough to meet demand.
“We have the potential to overrun health care. If you look at where we’re at from a capacity standpoint today and knowing that we’re going to spend the next month with cases going up, access to health care is going to become difficult,” he said.
As the hospital system stares down the barrel of massive challenges, LeBeau and Blasl say the onus falls on North Dakotans to take proven virus mitigation actions like getting vaccinated, wearing masks and maintaining distance from one another.
"I think the message is that if we’re not able to meet the demand (for health care) and people are not doing what’s right in terms of getting vaccinated, practicing social distancing and wearing a mask when they can’t social distance … one of their loved ones down the road may not get care," Blasl said. "We don’t want that to happen. Everyone in the state has to do their part to control this virus.”