Covid-19 and Hospital Capacity in Northern MN - Dr. Colleen Swank from Sanford Health in Bemidji

Oct 14, 2020

In every part of Minnesota case numbers for COVID-19 are rising. And as the infections rise, so do the hospitalizations. We had been wondering how the hospitals that serve our communities are doing. So we reached out to the Sanford Bemidji Medical Center and were able to check in with Dr. Colleen Swank.

Dr. Swank is a pediatrician and Sanford Health Vice President of Clinics for northern Minnesota. Maggie Montgomery and Dan Houg spoke with Dr. Swank on the Wednesday 10/14/20 KAXE/KBXE Morning Show. The audio of this interview is below; the interview has also been transcribed.

Maggie Montgomery

Are a lot of people coming in for testing at Sanford Medical Center in Bemidji?

Dr. Swank

We have tested a lot of people up to this point. I think we've had more than 13,000 that we've tested since the beginning.

Maggie

That sounds like quite a few. Under what circumstances should a person come in to get a test?

Dr. Swank

We recommend people test if they're having symptoms of COVID. Hopefully people know what those are by heart by now, but fever, cough, shortness of breath, congestion, runny nose, gastrointestinal symptoms, fatigue, chills. Just about anything is a COVID symptom, it feels like, but the most common ones are still the fever, cough...you know, the cough/cold symptoms; sore throat.

Maggie

Does a person need a doctor's order to be tested?

Dr. Swank

They do for us at Sanford, but all you have to do is call in and explain that you are having symptoms. And then they typically will direct you to our drive through site. But to get tested, you do need to have an order just so that we know who it is that we're testing and so that we can make sure the results get back to you.

Maggie

When are tests available?

Dr. Swank

Tests are available Monday through Friday, eight to five, and then eight to noon on Saturdays.

Maggie

You know, we have been conducting interviews with candidates around our area, as you might imagine, because we have an election in a couple of weeks, and we're hearing from a lot of politicians that the governor has overblown COVID-19, and that especially small towns and rural places shouldn't have to live under a mask mandate because it isn't really a problem. What do you think from what you're seeing in this area?

Dr. Swank

So I would say that that this virus is not political at all. This virus is…you know, we need to treat it with science. And so I think that because we don't have a lot of other options, masking and trying to keep physical distance are the best tools that we have in our toolbox. They're not perfect, but we definitely see decreased transmission when people are following those rules. And in northern Minnesota, in the rural areas, we were not seeing cases at the beginning, but we certainly are seeing them now. And that's the thing. The virus doesn't know whether you live in a city or whether you live rurally. Eventually, if given enough time, the virus will find us. And that's true with any virus. It was the same with chickenpox or, you know, every year with influenza virus.

Dan Houg

I know Sanford has made some preparations for dealing with COVID cases. Can you detail what those are, in terms of hospital capacity?

Dr. Swank

Yeah. So we have been planning for this since the beginning and brought our whole team together. We have added a unit called the Special Care Unit where when we reach a certain number of COVID positive patients that we have to care for in the hospital, then we can move those patients to that area. We've also beefed up our capacity in our ICU as well.

Maggie

How many people can you accommodate?

Dr. Swank

We can accommodate right around 35 to 40 patients depending on what their needs are.

Maggie

Because everybody has to be different - you're talking about the difference between somebody in the ICU and somebody who doesn't need that intensive care, right?

Dr. Swank

Correct. And you'll remember that at the beginning, when we first were hearing about this, there were quite a few people with COVID that were on the ventilators. The standard of care has changed. And so patients are not needing to be ventilated on the ventilators. So right now we only have two patients that are on a ventilator.

Maggie

I've heard too that if you have rooms, it is good - I don't know if it's required - but to have airflow go a certain way. Do you have to equip rooms differently for COVID patients than other ones?

Dr. Swank

Yes, absolutely. All of our rooms that a COVID positive patient would be in are negative pressure rooms. And what that is, it only allows air flow into the room, not out, and then it exhausts out outside. That way the room next door wouldn't be exchanging air with a room that somebody with an infectious disease is in.

Maggie

We just had a story from National Public Radio about Utah and the number of cases going up there straining the capacity of hospitals. How are we doing in this area? What do you know about capacity? Are we stressed?

Dr. Swank

I sit on a meeting a couple of times a week with hospital administrators from across the state. And we talk about the different health systems. We talk about where we're at with our total number of beds and total number of ICU beds, both COVID patients and non COVID patients. And so the state is really doing a nice job; all the systems are doing a really nice job of working together with one another. So if one hospital is short, the next hospital is helping them. Definitely though, it's been busier across the state not just with COVID patients, but non COVID patients as well. The hospitals have been very busy.

Maggie

Do you have enough protective equipment for everyone?

Dr. Swank

Yes, absolutely. First of all, I want to say here in Bemidji, we have not gone beyond our capacity. We've not had difficulties with that. And then as far as protective gear, we have had enough since the beginning. There was a lot of really good planning. I think the other thing to remember though, is that we want to be judicious and we're still taking care because we don't know when there could be a shortage. But we definitely have enough to keep our staff safe and to keep patients and visitors safe.

Dan Houg

As you look at the map nationally, of recent COVID cases within the last seven days, North Dakota, South Dakota...and then I think it's Montana and then Wisconsin are the highest in the nation. So we're kind of surrounded in Minnesota. Does that impact Sanford in Bemidji? Are we receiving cases from those high States?

Dr. Swank

I don't think that we've had any specific transfers from other states. We certainly work closely with Sanford Fargo and so if we needed to transfer somebody there and they were running out of capacity and they had somebody from the area that they could transfer back, we certainly would take those patients back. But we haven't seen them need us in that way at this point in time.

Maggie

Is this stressful, taking care…I mean, everything I've seen is that it is stressful for doctors, nurses - even all of the support staff in a hospital or clinic - to take care of COVID patients. How are you guys holding up?

Dr. Swank

You know, I think that it's stressful whether you're working in healthcare or whether you're not. I think it's a stressful time for every person. And so I think the biggest thing is to give each other grace. You don't know what the person that has cut you off accidentally in your car is going through. So give them a little grace. Same with the person in line in front of you in the drive-through that's taking too long and the cashier that's helping you out. You know, we could just give each other some grace. It's a very stressful time for everyone. I think the way to cope with it is, you know, making sure that you're getting enough sleep, making sure that you're still exercising, making sure that you're still coming in for your regular appointments if you have a health problem that needs to be taken care of. You know, all of those things is what we need to do. But I am really proud of the physician staff and other caregivers here at the hospital. They've really stepped up to make sure that we are able to take care of patients safely.

Maggie

You know, when we think about COVID-19, it can be kind of scary, especially if you're older or you have other conditions. Are you still doing regular routine care at the hospital and clinic?

Dr. Swank

Yes, absolutely. And we encourage people. At the beginning I think people were nervous to come in and they delayed care, and then some conditions worsened during that time. And I just hate the idea of that. And so, you know, making sure that you're getting your routine mammograms and colonoscopies and making sure that you're taking care of your diabetes or your high blood pressure - all of those things are very important.

Maggie

What are you seeing with kids as a pediatrician? It seems like kids are sort of a mystery with COVID-19. Are you seeing any children with the virus?

Dr. Swank

Yeah, we definitely have had positive children, or children that are positive for COVID. Some of them will have symptoms similar to adults, but their symptoms tend to be milder. We think that there are probably more that are asymptomatic. Certainly not here in Bemidji, but across the country there have been pediatric patients that have needed to be hospitalized. But again it's at a much lower rate than those older than 65.

Maggie

One of the things we have done fairly regularly is to speak with Cynthia Borgen in Beltrami County Public Health. And we've seen the reports from the Minnesota Department of Health with COVID-19. At the start of the pandemic things were kind of slow in this part of the world, but that seems to be changing. What are you seeing as trends as a doctor and an administrator?

Dr. Swank

So we are noticing that our number of positive cases are going up. You know, for example, I think last week for the whole week Saturday through Friday we had 124 positive cases. But yesterday we had 45 positive cases just yesterday. And so we are seeing some increases. Definitely.

Maggie

Is there anything you would like to add? You know, a lot of us are tired of the pandemic, but we just, we have a long winter ahead. You have anything you'd like to add to that?

Dr. Swank

Yeah. I mean, number one, again, take care of yourself. Make sure that you're getting the care that you normally would need. Make sure that you're getting your influenza vaccine. We don't know what the influenza season is going to be like this year and we don't know what it looks like when somebody has influenza and COVID at the same time. And the symptoms overlap and so it can be confusing. So trying to prevent getting influenza in the first place is probably the best thing. If you have symptoms, call and ask questions. You can call in and we can help answer those questions and decide whether you need to be tested or what else you need to do. Also, if you're exposed to somebody who is positive then that would be another reason to get tested. An exposure really means being next to somebody for 15 minutes or longer without any protection on. So no mask on would be an exposure.

Maggie

That's really good advice. We really appreciate you taking the time to talk with us today.

Dr. Swank

Thank you so much. And again, the biggest message that I can give is, give each other grace. I know that this has been politicized a bit and it's difficult because there's so many different opinions. Things have changed over time and it's hard to know what's true and what's not. But I think if we just look at it - each other's point of view - and be kind to one another, we'll get through this.