ST. PAUL -- As the novel coronavirus pandemic spreads, the health industry is confronted with a key challenge: front-line workers say there’s likely not enough patient beds.

Concerns about a lack of capacity, frequently repeated this week by members of the Minnesota Nurses Association, are echoed in a new national report from the Urban Institute and the Robert Wood Johnson Foundation, the nation’s largest health philanthropy.

According to the report, nearly two-thirds of the country’s estimated 728,000 hospital beds are likely already full. The availability of unoccupied beds per 1,000 people varies heavily among states, counties, and urban and rural areas. But the overall prognosis isn’t good.

How many beds?

According to the Urban Institute report, the U.S. in 2018 had an estimated 2.2 hospital beds for every 1,000 residents. Most days, 36 percent of those beds were empty and available, which translates to .8, or less than a single unoccupied bed for every 1,000 people.

Newsletter signup for email alerts

In the Twin Cities area, Ramsey and Hennepin counties beat the national average, but only slightly, in terms of bed volume, and the number of unoccupied beds was below average — at .74 and .66 beds per 1,000 residents, respectively. In short: hospital rooms are already relatively full.

Overall, for every 1,000 residents, Ramsey County had 2.3 beds. Hennepin County had 2.49 beds. Dakota County, where local political leaders have long complained of uneven access to medical services, had about a fifth of those totals, with .49 beds.

Many rural counties in the report reported having zero beds, but some lightly populated Minnesota communities near the Canadian border had several times the national average. In the northwest corner of the state, south of Manitoba, Kittson County reported nearly 18 beds for every 1,000 residents, with 2.59 beds unoccupied on any given day.

Coronavirus is believed to cause serious symptoms in 20 percent of those it infects, with a mortality rate — or death rate — anywhere from around 1 to 3 percent. Given that many infected people will show no symptoms at all, some experts say the mortality rate may be slightly less than 1 percent.

That may not sound like an overwhelming percentage to skeptics, but if even a fourth of Minnesota’s 5.7 million residents were to become infected, that could still translate to tens of thousands of hospitalizations.

Taking steps?

“We have not expanded staff, we have not expanded facilities,” said Cliff Willmeng, an emergency room nurse at United Hospital in downtown St. Paul, during a Minnesota Nurses Association press conference Wednesday, March 18.

He and other nurses urged medical industry and political leaders to move faster and set up patient operations in large scale sites in the Twin Cities, such as U.S. Bank Stadium in Minneapolis and the Xcel Energy Center in St. Paul.

“Our training is to attack a problem,” Willmeng said.

Lisa Niess, a spokesperson for U.S. Bank Stadium management with the Minnesota Sports Facilities Authority and venue operator ASM Global, said no one in government or industry has reached out.

Jim Ibister, a general manager of the St. Paul RiverCentre, the city’s convention center, said that facility could be activated if need be in any emergency. The RiverCentre adjoins the Xcel Energy Center.

“The RiverCentre has always been a site for the Metro Regional Healthcare Resource Center,” Ibister said. “We sort of stand at the ready for that. There really hasn’t been much discussion. We’ve been reconnected, obviously, so that everybody knows who we’re talking to. Given the right situation, we are there to help.”

Emily Allen, a nursing supervisor in the intensive care unit at St. Joseph’s Hospital in downtown St. Paul, said segregating sick patients suspected of having the virus from the general patient population is difficult enough. Many patients will arrive suffering from the regular seasonal flu.

“We’re having to decide should we be putting patients that don’t have anything to do with COVID together with patients that are potential for being COVID positive,” Allen said. “There’s a potential for spreading it. (For people being tested), they’ve kind of made a ‘quarantine unit.’ I also understand that unit is full … My unit is almost full right now.”

Tim Burke, a spokesman for United Hospital owner Allina Health, said coordination between health organizations will be key, and is underway.

“On the beds question, we are fortunate to have a robust regional healthcare coalition to coordinate needs,” Burke said. “We expect that cooperation between the area healthcare systems will allow us to better manage any surge. We already do this when we have surges at high volume time for flu.”

Cutbacks add to concerns

Compounding matters, coronavirus — which medical experts say is more contagious than the flu — has crept through the U.S. at a time in the hospital industry when health chains were cutting back, merging or refocusing services, which impacts both beds and staffing.

M Health Fairview, for instance, had in recent weeks reduced beds and staffing at the Bethesda Rehabilitation Clinic in downtown St. Paul, with the total number of patient beds dropping from 90 to 50.

After internal discussions about a possible hospital closure at St. Joseph’s Hospital within the next three years, the healthcare network issued a request for proposals, asking for other service providers’ assistance in serving the indigent and mentally ill at the downtown medical center.

Recognizing a potential shortage in the face of the pandemic, and the need to segregate coronavirus patients from the general patient population, Fairview this week announced it would restore capacity to 90 beds and convert Bethesda into a specialty care unit focused specifically on severely ill COVID-19 patients.

The process of grouping similar patient types together — officially known as “co-horting” — includes 55 medical-surgical beds and 35 intensive care beds.

As a public service, we’ve opened this article to everyone regardless of subscription status.