Although the majority of Minnesota’s confirmed COVID-19 cases are located in urban areas, the number of confirmed cases in rural communities — areas with limited staff and bed capacity — increases each day.

Northeastern Minnesota counties have ramped up preparation efforts, like adding more hospital beds and coordinating planning with health care facilities. Although experts believe hospitals are currently prepared to manage incoming patients, they’re concerned that a surge of patients could overwhelm hospitals and fill beds, highlighting the need to 'flatten the curve.'

As of Thursday morning, the state has 346 confirmed COVID-19 cases — a number that is expected to continue climbing, according to the Minnesota Department of Health.

Jo Thompson, regional health care preparedness coordinator for the northeast region, said the area had more time than most to prepare for the virus.

“We've had a little bit of time to see kind of how this has played out in those (harder-hit) areas, which has helped us from a health care perspective look at how it could end up impacting us,” Thompson said. “And then you add in (a) pretty aggressive decision to basically kind of shut down society.”

With 4.51 beds per 1,000 residents, St. Louis County has the highest bed ratio in Northeastern Minnesota, according to 2017 data from the Minnesota Department of Health and the U.S. Census Bureau.

Even with only five confirmed cases in St. Louis County and zero in the other Northeastern Minnesota counties as of Thursday morning, all area hospitals are quickly working to expand capacity, Thompson said.

Essentia Health is one local entity assessing and working to expand patient capacity. Efforts like Gov. Walz’s order to end elective surgeries has helped the hospital deploy resources where they’re needed most, according to a statement from the hospital.

It’s also collaborating with regional partners to address virus demands as it evolves, while another committee of hospital experts has created plans to handle a possible COVID-19 surge.

“At this point, we feel well-positioned to care for a significant number of patients beyond our normal capacity. As a result of this collaboration, we have improved our ability to serve the needs of our communities. And we’ll continue to refine these plans moving forward,” the statement reads.

The county’s health care entities are preparing to double or triple their hospital’s capacity if needed, Dr. Andrew Thompson, an infectious-disease expert at St. Luke's, said at a Wednesday news conference.

“We’re all focused as a community on working together,” Thompson said.

A need for ICU beds

Gov. Walz announced the "stay at home" order Wednesday to buy more time to build ICU beds and stock medical supplies.

Lake, Cook and Koochiching counties don't have any ICU beds, while St. Louis, Carlton, Itasca and Aitkin counties do, according to a study from Kaiser Health News.

A lack of ICU beds typically isn't a concern for rural hospitals, as they transport patients to Duluth hospitals should they require such a bed, said Greg Ruberg, president and CEO of Two Harbors' Lake View Hospital and St. Luke's vice president.

This will still be the case if patients with COVID-19 come into either the Two Harbors or Grand Marais hospitals. They can't easily add ICU care, as it requires special additional training.

"Being a real small hospital, there's only so much we can do without ICU or ventilator beds," Ruberg said.

However, the hospitals may become overwhelmed if numerous patients need ICU care, as the hospitals may not have enough transport ventilators that sustain a patient on their journey to a Duluth hospital.

"It all comes back to flattening the curve and really slowing this down until the state can respond and get more tertiary centers set up with ventilators," he said.

Limited resources in rural counties

Although experts believe rural counties are prepared to handle more patients, they're limited by lower numbers of staff and beds.

Cook, Carlton, Lake, Aitkin and Koochiching counties all have 50 beds or less. Cook has 2.96 beds per 1,000 people, while the other counties all have less than 1.6 beds per 1,000 people, according to 2017 DOH data.

The hospitals in Two Harbors and Grand Marais are preparing surge plans, which includes adding more beds if they're needed, Ruberg said. However, hospitals are limited by the number of available staff.

"If the larger centers in Duluth are full, we're going to have to care for more patients," he said. "That's going to put significant strain on the hospital, the equipment that we have, the staff (and) the (personal protective equipment)."

Ruberg's primary concern is people traveling to the area, as visitors may further spread the virus within the small communities.

"We saw a surge of people coming into our communities over the weekend from other areas. ... It puts them at risk," he said. "It could put a strain on our hospitals if they bring COVID-19 up to Lake County or Cook County."

Cook County has taken additional steps to stop the spread, as it has one of the largest populations of older people in the state — a group at the highest risk of COVID-19, a news release from the county read.

It issued a travel advisory Wednesday asking visitors who may have second houses or seasonal residences in the county to stay home.

Ruberg believes strong partnerships with other hospitals and dedicated staff will help them weather the virus.

"I think we're well prepared and we're resilient. But we ... can't be overwhelmed or have that surge happen all at one time. We just don't have the resources to care for that."

As a public service, we've opened this article to everyone regardless of subscription status.