FARGO — The North Dakota Department of Health is positioning extra ambulances on standby as a “safety net” to be available to transfer patients as hospital capacity is strained during the latest surge of the COVID-19 pandemic.

Four or five ambulances are stationed in Bismarck-Mandan to transfer patients, a precaution to beef up the standard fleet of ambulances, Tim Wiedrich, the health department’s chief of emergency preparedness and response, said Monday, Sept. 27. Health officials hope to have as many as seven additional ambulances available soon.

The standby ambulances were mobilized under North Dakota’s COVID-19 response plan in a move that comes as hospitals are dealing with a shortage of medicine that has been highly effective in keeping coronavirus patients out of the hospital.

Ambulances are in increased demand as hospitals that don’t have available staffed beds are forced to transfer patients to another hospital.

“It’s not just affecting people with COVID,” Wiedrich said. “It’s affecting anybody who needs hospitalization.”

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The availability of staffed beds was so tight that a patient from Montana who would have been hospitalized in North Dakota had to be flown to a hospital in Seattle because no hospital in North Dakota or nearby states could admit the case, Wiedrich said.

Monoclonal antibody treatments that are credited with helping to keep those vulnerable to severe cases of COVID-19 out of the hospital are being rationed as supplies run out.

The outpatient treatments, given via intravenous infusion, have proven effective in helping to keep hundreds of patients out of Fargo hospitals during the pandemic, health providers said Monday.

But supplies have fallen short, forcing the federal government to ration the antibodies, meaning hospitals can’t treat everyone who is infected by the coronavirus and at risk of hospitalization.

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“The supply is not meeting demand and the demand is increasing,” Wiedrich said. “That is obviously a concerning situation.”

Starting last week, state health officials began allocating the scarce antibody treatments. North Dakota received supplies to treat 380 patients last week, and the allocation from the federal government was increased this week to 474 without explanation, he said.

Allocations of the antibody treatments will fluctuate based on supply and demand, Weidrich said.

“It’s been the only option we’ve had to offer these patients to keep them out of the hospital,” said Katherine Dean, executive director of Essentia Health’s Institute for Rural Health.

At-risk patients treated with the antibodies were more than 80% less likely to end up in the emergency room or be admitted, she said.

Essentia’s Fargo hospital has administered 490 infusions of the antibodies, almost half since Aug. 1, Dean said. Essentia needs antibodies to treat 50 patients per week in Fargo, and last week received 36.

“That is what we’re combatting,” she said. “It’s not enough to meet the demand in our community from patients that need it.”

The shortage of the antibodies adds yet another reason for people to get vaccinated, by far the best protection against the spreading coronavirus, now driven by the highly contagious delta variant.

Anecdotally, Essentia is hearing from patients who received antibody treatments that they wished they’d gotten vaccinated. Now, not everyone who wants the antibodies will be able to get them, she said.

Dr. Avish Nagpal, Sanford Health’s chief infectious disease specialist in Fargo, said the scarce antibodies are being reserved for those who need them the most.

Sanford’s supply of the antibodies is only 75% to 80% of what’s needed, and Nagpal expects the supply to continue to dwindle. The antibodies have been an effective treatment to help control the number of COVID-19 patients requiring hospital care, he said.

“We’ll have to pick and choose people who are at the highest risk of complications to put them at the top of the list,” Nagpal said. Over the past six or seven weeks, he estimated the antibodies helped keep about 85 Sanford patients out of the hospital.

“It’s not a magical drug,” but helps reduce symptoms and reduce recovery time, he said.

In September, Sanford in Fargo has treated a record 416 patients with the antibodies. Treatments began rising sharply in August after dwindling to less than 10 per month for June and July, according to Sanford figures.

Last year, during the fall pandemic peak, hospital beds were in more plentiful supply because many patients were delaying care to avoid hospitals treating COVID-19 patients. But patients no longer are postponing care, and hospitals are under greater pressure than last year, according to health officials and providers.