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Many Hospitals In Largely Rural State Of North Dakota Are At Capacity

DAVID GREENE, HOST:

All right. So the situation is really bad in this pandemic in many parts of the country. And as we've been doing on this program, let's zoom in on one particular state this morning, North Dakota, where positive cases are 60% higher than they were four weeks ago.

KIRBY KRUGER: We've had a couple of record-breaking days in the last week or so, and the curve is still going in the wrong direction. And I think that, yeah, we're going to continue to see cases increase.

GREENE: That's Kirby Kruger, the director of the North Dakota Department of Health's disease control division.

KRUGER: We started to see an increase, gradual increase, over the summer. And then when we got into fall, we have more activities happening, more transmissible moments. And colleges have started, you know, K-12 school starting. So I think that there was a combination of things happening that led up to this.

GREENE: Many hospitals in this largely rural state right now are at capacity. And Dr. Doug Griffin is the chief medical officer at Sanford Medical Center in Fargo, the largest hospital in the state.

DOUG GRIFFIN: I think a lot of times people in rural areas feel like, hey, we're immune to the things that happen in the big cities. That's clearly not the case with regards to this.

GREENE: And, you know, when a pandemic gets worse in a largely rural state, the challenges can be different. I mean, if you start getting sicker really quickly, it's not like you can just run to the hospital. The hospital might be hours away.

GRIFFIN: Sometimes, they become critically ill from looking very well in just a matter of, you know, a few short hours. And so that's the very difficult thing. You know, we'll be talking to somebody - oh, they look good now. You know, maybe if you can hold them and let us know if and when they get worse, you know, sometimes there's just not that time. Sometimes that does delay them getting to the highest level of care that they need.

GREENE: During the surge in North Dakota, hospital staff have been getting sick as well. But with so many patients in need, the governor made this stunning decision. He announced that nurses and other health care workers who test positive for COVID-19 can keep working as long as they aren't showing symptoms. And Dr. Griffin says that worries him.

GRIFFIN: You know, we appreciate the governor just really trying to be innovative, you know, for the staffing challenges that most of the hospitals around - or virtually all - have around the state. We currently are not planning to implement that. Yeah, we do have the concerns. You know, how does that work? What are the logistics of that? But at this point in time, we personally are not planning to have any asymptomatic, COVID-positive nurses on the job.

GREENE: Do you support the idea as a last resort?

GRIFFIN: As a bit of a last resort is how I'd characterize that. And then at that point in time, we'd really - there's many things to think about. You know, it's not just the care of their patients, but how would they interact with all the other staff that they're around? But we - we're not to that point.

GREENE: What would be the threshold? I mean, when would you have to consider that?

GRIFFIN: You know, I think if we had no other way that we felt that we could safely staff our patients, I think that would be it. But we have many options and many levers that we are pulling now to get the support for caring for our patients with our current staff.

GREENE: The fact that the governor has had to make that move, though, and at least give hospitals the option, I mean, what does that tell us about this spike and how serious it is?

GRIFFIN: Yeah, I think it tells us that it's very serious. As you know, the governor has been - not wanted to implement a mask mandate but has very actively promoted personal responsibility on this. But to me, it tells - him to make this sort of move, I think there's a recognition that, hey, this is really putting a huge strain on hospitals across the state. And it is one attempt to help at the staffing across the (unintelligible). But I think it shows that, hey, this has gotten the attention of the - well, of the government at the highest level.

GREENE: Did you see this coming? I mean, when - you know, when months ago when things were bad in the cities and, you know, more rural parts of the United States were largely spared, at least in the beginning, did you see this, see it getting here for you?

GRIFFIN: You know, we thought it would come based on a few things. One, you know, the experts basically said no area would be spared and just the behavior in the state. I think there was some lull. We had a little bit of a surge in the spring. We managed that pretty comfortably. And I think the summer came, and I think people got a bit confident that, no, maybe the worst has passed. But we were always fearful of what the end of the summer, what the fall would bring and do that. Now, did I think it would look exactly like this? I don't think so. But we had fully expected it would get worse. I think what has surprised me is that really just in a matter of days, it's likely opened up a spigot and a huge number of patients influx to us.

GREENE: It just happened so quickly.

GRIFFIN: Yes, yeah.

GREENE: Dr. Griffin, is there a story or a patient or a few patients who - I don't know - they just stay in your mind as you've been watching this play out?

GRIFFIN: Yeah. I've been up on the unit and talked to our providers, you know, a number of times. And some of the stories are not good. I, you know, talked to a provider and he had said, you know, I had been in, I had visited with this patient that had been there for a week or more and were improved to the point we had him all set to go home, ride arranged. And just within a matter of hours, he deteriorated and passed away. And it's that sort of thing about the disease that really has knocked the wind out of our providers. That's hard to see, no matter who you are. So those have been the toughest stories. On the upside, we play the song "Here Comes The Sun" any time we have a patient leave the unit or get discharged. And that brings a bit of a smile to people's faces, and the patients like hearing that. So, you know, there are ups and downs, and we certainly hope for more ups than there are downs as we care for these patients.

GREENE: Well, Dr. Griffin, thank you for taking time out of a busy schedule and hope that the spike in North Dakota doesn't last too long. And we'll be thinking about you and your staff.

GRIFFIN: We appreciate that. And we do as well. Thank you very much.

(SOUNDBITE OF SONG, "HERE COMES THE SUN")

BEATLES: (Singing) Here comes the sun, do do do do (ph). Here comes the sun... Transcript provided by NPR, Copyright NPR.