While writing this article, we are still awaiting our first COVID-19 case at Tri-County Health Care. However, it may not appear that way if you have recently visited our medical campus. While the rest of the community waits to see for how this pandemic will unfold, those of us on the front lines have been in preparation mode for months. We have been working day in and day out to plan how we will protect our patients, staff and communities, and how to best care for the anticipated volume of critically ill patients.

This illness has presented huge challenges for us clinical staff as we first encounter patients. When a patient presents to the Emergency Room with chest pain, it is intuitive that they need to be evaluated for a possible heart attack. The issue with COVID-19 is that they can present with classic symptoms such as fever and cough, but also may be asymptomatic and present for something completely unrelated. In the process of work up for that concern we find imaging or lab values suggestive of COVID-19. In these circumstances, staff and potentially other patients have been exposed because we didn’t know the patient had the virus.

This is happening across the world, causing large numbers of health care workers to end up sick and out of work for weeks. This, in turn, leads to critical shortages of health care workers to care for those in need. Because of the high percentage of people with minimal or no symptoms, we have to treat every patient as if they are COVID-19 positive. Due to every patient being “presumed positive,” this leads to shortages of personal protective equipment (PPE).

At Tri-County, thanks to the incredible preparation by many people, we are not in the extreme circumstances that is seen on the news. We have been conserving our PPE since the beginning. We are short on supply just like every other facility, but so far remain protected. Due to every patient being presumed positive, we need to mask every patient and staff member that comes to the hospital. This will certainly shorten our supply in the days and weeks ahead. We have been fortunate and grateful to have donations from the community and businesses. Every little bit helps and we will need them more than ever as this continues to evolve.

It is difficult to see the reports out of Italy and New York and relate it to rural Minnesota. COVID-19 will certainly not be on the scale of New York in our towns, but it takes very few critically ill patients to overwhelm health care facilities in rural locations. Ventilator numbers, ICU bed availability, critical medications and Emergency Medical Services crews are limited in our service areas. This is why it has been so important for people in our towns to stay home and stay physically separated. Fortunately, the community has been doing a good job of this.

We have slowed down the rates in our area, which will help to spread out the critically ill cases. Our community has been taking this seriously and doing what they can to help by staying home. We plead with the community to keep up their good work and stay home!

The next few weeks will show drastic changes in numbers of cases. Part of this is due to spread of the virus and another part is from availability of testing. Until recently, we have had very strict testing parameters set by the state due to lack of tests to administer. Availability of testing is rapidly changing, but with that comes a large rise in numbers of cases. We have only recently been able to expand our testing capability. We have previously only been able to test patients who required hospitalization, health care workers, and those living in congregate living facilities such as nursing homes.

COVID-19 is in our community; we just couldn’t test those that were not very ill. We have been fortunate that no one has been ill enough with COVID-19 to require hospitalization. As we’re now able to test more patients we will certainly see our numbers rise.

These are unprecedented times for all of us. We all have uncertainty and anxiety surrounding this pandemic. Those of us on the front lines definitely feel it too. Most of us have never been apprehensive to go to work before, but with COVID-19, that has changed. We all hug our families a little tighter before heading to work. We avoid our loved ones after our shift until we have decontaminated. And we hope and pray we didn’t bring it home. Despite occasional reservations, we remain committed to our community and patients and are here to help when you need us and we will continue to do it well.