Jill Schramm/MDN Dr. Casmiar Nwaigwe speaks at a news conference in Minot City Hall Tuesday.

Local hospital workers are becoming overwhelmed as COVID-19 cases in the Minot region, including those in long-term care facilities, have risen significantly in recent weeks.

The rolling average number of cases per 10,000 population places First District’s seven counties at the critical risk level, said Lisa Clute, executive director at the health unit, at a news conference Tuesday in Minot.

Admissions are on hold and indoor visitation continues to be suspended at Trinity Homes, where 90 staff and 72 residents have tested positive for the virus in recent screenings. As of Nov. 1, Edgewood Vista had 23 positive staff and 37 positive residents in its assisted living facility. Five other long-term care facilities in Minot also had smaller numbers of cases in either staff or residents and staff.

Trinity Hospital is preparing to impose tightened visitor restrictions.

“Trinity hospital is at or near hospital capacity. We have been for weeks,” said Randy Schwan, Trinity vice president. “We know of other hospitals who are at peak capacity, both in their ICU units as well as their emergency rooms, where they no longer can take in patients in the ER. We’re not at that level yet.”

Dr. Jeffrey Sather, chief of medical staff at Trinity, said North Dakota is in crisis.

“Last night, at our hospital, we had no more room to admit patients. We had patients stacking up in our ER. The normal process is we call around to the larger hospitals that have the same capabilities and ask them to accept our patients. We found no other hospital to take care of our patients. That means those patients stack up and remain in our ER, and then they have to wait until a bed opens up either in our hospital or another hospital,” he said.

“It’s not the physical bricks and mortar beds that is causing us to be in crisis. It’s the ability to have staffed beds,” he said, noting the difficulty in recruiting because of the national demand for medical personnel.

“The only change that can happen is to start stretching the staff that we have,” he said. “We don’t ever want to get to the point that we’d have to start changing standards of care.”

More than 40 people were hospitalized in Trinity Hospital with COVID-19 on Tuesday morning. The large majority of those were admitted because of COVID symptoms and are not in the COVID unit because of a positive test obtained after admission for another reason. At least a half dozen are in the ICU, Schwan reported.

Those COVID patients account for roughly 30% of patient census, although Sather noted they make up about half of patients in the medical/surgical ward on some days. Hospitalized numbers don’t include numerous patients evaluated for COVID symptoms and discharged, and that number is rising, he said.

The number of emergency room patients has remained at pre-COVID levels despite up to a quarter of ER patients coming with COVID symptoms. It indicates people who normally would seek treatment for other concerns are not doing so, Sather said.

Trinity has about 140 employees on quarantine, putting pressure on remaining staff.

“We’re pursuing lots of avenues to augment and relieve our staff, who have been responding like the heroes, really, our first seven months,” said Randy Schwan, Trinity vice president.

Sather said his colleagues fear for their COVID-19 patients and the mental health of their co-workers and themselves during this time.

“What I’ve heard multiple people say, unsolicited, when I get them in a private conversation is, ‘I have to watch someone suffocate to death every day, and sometimes several times a day.’ The toll of this disease is not known by the public,” he said.

Sather said COVID is on track to become the third leading cause of death this year, behind heart disease and cancer. Ward County has had 54 people die of the virus.

Every case of the virus puts pressure on the community and influences the spread, said Dr. Casmiar Nwaigwe, an infectious disease specialist at Trinity Health and health officer for First District.

“We are all in it together,” he said. “As long as it is in the community, everybody is vulnerable.”

He also addressed common questions coming from the public, including information regarding antibodies and a vaccine. He discounted suggestions that people who recover from the disease can be considered immune to reinfection.

“We now know that antibodies do not offer the full protection that we had expected,” he said. “We don’t know what level of antibodies are protective. Not everybody has high levels of antibodies – when you check them in their blood – and we don’t know how long these antibodies last. Some studies suggest that the antibodies disappear anywhere from two to four months.”

What waning immunity means for future vaccination is unknown, Nwaigwe said. It is possible if an effective vaccine is found that multiple shots will be necessary, he said.

Nwaigwe also expressed caution about the vaccines in trial and voiced concern about a large number of people refusing to take approved vaccines.

“We are not sure that there’s going to be an effective vaccine,” he said. “This is a brand new technology. It’s going to require a lot of tweaking, a lot of trial and error to get it right.”

Questions also have been raised in the community about the potential for more widespread use of the drug regimen given President Trump, who recovered from his illness quickly.

Nwaigwe said the president was frequently tested, allowing the disease to be caught and treated at an earlier stage than most people can expect. Also, Regeneron, an antibody therapy used by the president, isn’t at a production level to be widely used.

Because of the limits of treatment, questions about immunity, the chance of a severe infection or long-lasting effects, Nwaigwe said, “The best treatment for this disease is not to get it.”

Health officials continue to recommend hand washing, social distancing, avoiding large groups, wearing masks when around non-household members and staying home when sick as the primary methods of preventing virus spread.

Sather said proper nutrition, exercise, managing stress, getting enough sleep and avoiding substance abuse also are important. Certain over-the- counter products such as vitamin D and zinc might help, although people who wish to use them should follow the dosage labels, he said.

Calls to Trinity’s COVID call center for information or scheduling tests increased 450 on Monday from the 75 to 100 that has been typical before the recent spike in cases.

“Our call volumes are way above what we can effectively deal with. We’re trying to find more resources for that. You might experience longer delays when you try to call that number as a result,” Schwan said.

Trinity has been testing more than 150 people a day at its drive-through clinic for symptomatic individuals.

“We’re trying to find ways to increase it again because we are at capacity,” Schwan said.

First District also reports being at capacity in testing 120 to 130 asymptomatic individuals daily. Testing is offered at Minot State University twice a week and Dakota College at Bottineau once a week. College testings are open to the public, although a testing event at MSU Tuesday was unable to accommodate everyone.

The health unit also is backed up in attempting to respond to a heavy call load. Before calling First District, Clute encourages people to visit the North Dakota Department of Health website for information. People also can go do fdhu.org for links to information on the health department pages.

Active COVID-19 cases

in First District:

Bottineau County — 77

Burke County — 25

McHenry County — 61

McLean County — 99

Renville County — 15

Sheridan County — 16

Ward County — 1,222