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Minnesota hospitals are finding it increasingly difficult to admit new patients and discharge existing ones amid a record 2021 surge of COVID-19 and other cases.

In addition to cases usually seen in the fall, such as asthma, hospitals are grappling with a high number of trauma patients, an unexpected wave of respiratory syncytial virus (RSV) infections typically seen in the winter as well as nearly 900 COVID-19 patients.

"COVID is not the primary cause of the current situation," said Dr. Marc Gorelick, the chief executive at Children's Minnesota. "It is the thing that could put us over the top."

The pressure on hospitals that began in the metro area in July has spread to facilities large and small statewide.

"We are now actually seeing hospitalizations in greater Minnesota population bases exceed those in the metro area," Minnesota Health Commissioner Jan Malcolm said.

In the metro area, only 1% of non-ICU beds were available, according to a state website, while southeastern Minnesota had only 5% availability.

Some hospitals, Malcolm noted, had no open beds at all.

"These are numbers that we didn't see even in the worst of the last fall surge," she said.

Minnesota's hospitals reported 881 COVID-19 patients as of Wednesday, including 234 in intensive care. Patients infected with the coronavirus accounted for 11% of the nearly 7,800 patients hospitalized statewide, but were 22% of all intensive care patients.

Some hospitals have fully equipped hospital rooms sitting empty but they don't have the staff, including nurses, nursing aides and other health care workers needed to care for patients.

"There are fewer health care workers on the job today than there were last year," Malcolm said.

The length and intensity of the pandemic have caused some to leave the industry altogether or at least take a break.

"Our health care workforce … has been running this race for more than 18 months," said Rachelle Schultz, chief executive at Winona Health. "This can be both fulfilling but it is also exhausting."

With a tight labor market and a high demand for health care professionals nationwide, it is difficult for health organizations to recruit new workers.

"Staffing is very tight," Schultz said. "We can use more people, and they are not out there for us to get."

The worker shortage is also affecting the ability of hospitals to discharge patients to other settings, such as nursing homes or transitional care units, to receive ongoing monitoring or rehabilitation.

"Sometimes we have patients staying in the hospital for three weeks that could be discharged because there is no room," said Dr. Kevin Croston, the chief executive at North Memorial Health.

"Every element of our health care system is incredibly stressed," he said. "It has been a pretty challenging year, in fact it is the most challenging year I have experienced in my 30 years in health care."

The beds at North Memorial's two hospitals are nearly full and most patients are sicker than normal.

"The acuity and severity of the illness that we are seeing has amped up significantly from this time last year," Croston said.

Several studies have shown that primary care visits, including those for chronic conditions such as asthma, diabetes and hypertension, declined during the first stages of the COVID-19 pandemic.

"Some of the current [patient] volumes are from chronic conditions not being well managed during the pandemic because people were not seeking care for a lot of reasons," Malcolm said.

For that reason, hospitals are trying to avoid canceling all procedures that could be delayed even as pressure on capacity remains.

Instead, some are asking patients to reschedule during the crunch times.

"We are able to flex up and down and do the cases when we do them," said Croston. "If we can do it in a week most people have been really good about that."

In April 2020, Gov. Tim Walz issued an executive order that banned elective surgeries for several weeks.

"It was a rather blunt tool," Gorelick said.

Now that hospitals have adequate supplies of personal protective equipment as well as a better understanding of the virus and how to treat it, a moratorium is not necessary, hospital officials said.

"The moratorium that we did in April 2020 sort of shut the hospital down. What ended up happening as a consequence of that is some of what we are seeing," Croston said. "That just delayed the inevitable."

Glenn Howatt • 612-673-7192

Twitter: @GlennHowatt