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"Our Numbers Are Matching Where We Were Last November. We're There" Grand Itasca Clinic and Hospital Doctors Soular and Lick

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Cassi Chrzanowski
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Dr. Simon Lick and Dr. Dan Soular

As the nation and the world continue to grapple with COVID-19 and the fast spreading Delta variant local communities of Northern Minnesota are also feeling the strain of high numbers of the virus, patient care, staffing issues, vaccine hesitancy, confusion and hospital capacity.

This morning John Bauer talked with Dr. Dan Soular and Dr. Simon Lick from Grand Itasca Clinic and Hospital. Soular is a family medicine physician and Vice President of Medical Affairs, Lick is a hospitalist.

Bauer: Where are we as a community right now?

Soular: Our numbers right now are matching where we were last November during our largest search. Unfortunately we're there. A common question I get in a clinic often is about the Delta variant. The latest statistic I saw from the state is 99% of all positive COVID cases are from the Delta variant. So essentially that is the COVID strain. That's circulating widely through our community. It is very transmissible, which is a little bit different than what we saw last year. It's also why we're seeing so many more cases this time around.

Bauer: Can you give us an average age of the people that are getting it the variant?

Soular: So it's interesting with the vaccine status being higher in our elderly population, the age of infection is really lower than what we saw last year. I can tell you in our hospital where we have a lot of 30, 40, 50 year olds in the hospital that are requiring oxygen, hospitalization, ventilator support, and that's not something we saw last year. Luckily our senior population who are vaccinated at a higher rate are able to stay out of the hospital.

Bauer: Okay. Let's talk reality is what, what is the hospital's capacity right now, Simon?

Lick: Sure. Capacities over the summer have really sort of crescendoed so capacity, both statewide and throughout the nation have been increasingly limited. Metro areas have really suffered a significant hospital bed shortagesbut in rural communities it's really been the same. Those limitations are both on medical floors and with intensive care unit access. We're also seeing a very prolonged stays in emergency rooms for patients that require acute hospitalization and to the east in Hibbing and Virginia - we've been getting calls frequently from Southern parts of the state - Monticello, Marshall, for hospital needs for patients in ER. So it's been hard to juggle that. We're just going to have to continue to find that balance

Bauer: Who's getting in and who's not getting in the hospital?

Soular: Maybe a different way I would approach that is the way we're delivering care right now is different than we've ever done before. And it's certainly uncomfortable for us. We are sending patients home from the emergency room that we normally would admit: simply because we don't have beds. We are keeping people in ICU on ventilators that we just haven't had to do before. I can tell you, I got off a call this morning with Northeastern facilities that have been ventilated patients in cities smaller than us - and they are just not capable of doing that.

When we do take care of those patients, we can, but it taxes our resources to be able to take care of other folks, whether it's a hip fracture or a simple pneumonia or a heart attack or a stroke. It's just this trickle down effect. For example, we have six patients in the hospital today with COVID and that's roughly a third of our beds. We don't ever expect to get to zero COVID patients this time of year, but certainly when a third of our facility is full of COVID, that is essentially preventable right now - it really taxes our system to take care of patients the way that our patients deserve.

Bauer: How are you equipped with the ventilators? You got enough,

Soular: It's interesting. We have enough ventilators but we just don't have physical beds. Every bed we own has a butt in it this morning. We're not at a place where we're having patients in hallways, like you see on some national newscasts. We don't want to get there. We have surge plans to do that if we need to, but again, we're delivering care in ways that make us very uncomfortable.

Bauer: So in the news yesterday, we saw that Cuyuna Range Medical Center announced visitor restrictions because of the positivity rate. Are you guys going to be doing that?

Soular: We get a lot of our visitor restriction recommendations from the University of Minnesota. We certainly have tightened up our visitor restrictions once again. Essentially if you are in the hospital with COVID, you'd have no visitors, which is terrible. You're visiting with your loved one at the hospital through an iPad, which is not what anybody wants to do in that dire time of need. Beyond that, we are allowing one visitor per patient in our non COVID patients. So it is restrictive and we continue to watch that daily for the protection of our staff.

Bauer: Simon. Let's talk about your staff. They went through this just terrifically, difficult time for a long period of time. Then we had a little bit of break and now it's back again. How's your staff holding up?

Lick: Well I would say that the general sentiment is - because of the volumes and because of the workload and because of the history that's led up to this and the prolonged nature of the pandemic - it is feeling very unsustainable. And we've had a lot of difficulty with staffing in hospitals, both here and nationwide. And a lot of it comes down to the nurses who have just continued to show up and continue to work hard and continue to work nights, weekends, and holidays in order to deliver the best care they can in there. But there is just only so much that people are capable of and going forward the need to support each other and the need to keep showing up continues. But needing a light at the end of the tunnel is becoming increasingly more urgent.

Bauer: In the NBA t people that haven't been vaccinated can't play, they can't get paid. I'm sure that you experienced that. Tell us a little bit about staff vaccination and what maybe you do or how you deal with that.

Soular: So it's pretty widely known that most healthcare organizations throughout the country will be mandating vaccines. And vaccine mandates are not new to us. We need to have hepatitis, tetanus and there's a long list of things we need to be vaccinated against. What's new for us locally at Grand Itasca and Fairview Range is the flu vaccine and COVID vaccine mandate. Luckily right now we are over 80% of our employees have been vaccinated against COVID. I know a lot of us leaders at the hospital have been meeting with smaller groups to try to meet our colleagues that are not vaccinated - to try to meet them where they're at - Try to just have those conversations - open conversations - as far as quesitons like what's their hesitancy, what are their concerns to see if we can help provide some science behind that.

There's a lot of science that's known, but there's a lot of unknowns as well. We definitely recognize that. But you know, in the end, the way I perceive this is when patients come to our facility, they're assuming that we're not going to harm them, that we're going to protect them from whether it's COVID flu, hepatitis tetanus, whatever it may be. And this is just one tool that we have to help make sure that when patients come into our facility, they are, they are coming to a place that there'll be protected and won't be harmed by us staff.

As Simon mentioned, our staffing is very short and we need to keep our staff here. You know, every RN in the hospital can take care of four patients. So even one RN that goes home, sick really cuts into our ability to provide for our community. So we're trying to do everything we can to keep our staff as healthy as we can, so we can keep caring for our community.

Bauer: So you're taking care of patients like crazy. What about your capacity for testing?

Soular: We've actually ramped up our testing capacity to where we were last year. W are testing now seven days a week - which we were doing last year as well. But again, every staff that we use to test patients is one less staff we can use to provide care whether it's in the clinic, ER, or the hospital.

Bauer: And how about home testing? There's so many opportunities out there. Are they all good?

Soular: Home testing is definitely an opportunity. I think the important thing is to take those results seriously. This morning, unfortunately I heard, some kids in the community tested positive from a home test and they continued to go to school - Which is just frustrating. So the home tests are available. We certainly encourage folks when they are ill, stay home, get tested. If you're positive, stay home for your quarantine period. Even one person that is out in the community, spreading this can really contribute loudly to our, to our patients.

Bauer: So some people feel like they're strong enough to avoid getting the vaccine or getting the virus. But those of us fully vaccinated can get the delta variant too... What's your advice to the community right now?

Lick: Couple of things on that, John. Number one the evidence that there is safe, effective and available vaccine is overwhelming. And, you know, unfortunately the, the 31 people yesterday who died in the state of Minnesota were not able to withstand an infection. And the great majority of our hospitalized COVID population are unvaccinated. The evidence that it's safe and effective is overwhelming. And that really is, is the way forward.

Bauer: Should we be masking up?

Soular: Anytime you're going to spend a considerate amount of time close to somebody like Simon and I are this morning - we're within a few feet of each other - we're spending more than a handful of minutes together. We're both vaccinated, but we're still masking up. Masks will help protect you from spreading to other people. So it's really about kind of that grace and love of the community to try to try to protect all those around us.

Bauer: Thanks for taking the time from your busy schedule to meet with us and keep up the good work. You guys it's really appreciated.

Soular and Lick: Appreciate the opportunity to get the message out. Thanks.