For Duluth hospitals, a race between vaccinations and the next COVID-19 surge

DULUTH – Donna Hipsher found out she had COVID-19 on Wednesday and was in the St. Luke's emergency room by Thursday morning — not to check in and go on a ventilator, but to avoid needing to in the future.

Hipsher, 61, received a monoclonal antibody infusion, an emergency-authorized treatment meant to reduce the likelihood of hospitalizations due to coronavirus infections that is available for patients over 65 or those with certain health conditions. With a compromised immune system, Hipsher said she was grateful to receive the hourlong infusion and head home to Iron River, Wis., with her husband to recover.

"If I survive it, it gives people hope," she said, "because I thought if I get [COVID-19] I'm going to die for sure."

Providers say the relatively new treatment is one of the most promising weapons against the virus, especially as vaccine supplies remain limited for the foreseeable future and another wave of serious infections could still be on the horizon in Duluth while hospitals remain near capacity.

"It wouldn't take much for us to be there again," said Dr. Jonathan Shultz, an emergency room doctor at St. Luke's. "It's a little bit of a race between getting people vaccinated before the next surge hits. And I'm not sure exactly what's going to win the race."

St. Louis County added an average of 62 cases per day in the first three weeks of January, a welcome lull following a harrowing fall. In the last three weeks of November the county averaged 225 new cases a day, pushing regional health systems to the brink and leading to a cascade of deaths.

COVID-19 deaths in the state's sixth-largest county have more than doubled, to 245, since the beginning of December, according to state data. That trend is finally slowing as the spread of the virus and hospitalizations return to pre-surge levels in the region.

"Our community transmission rates continue to decrease," Amy Westbrook, St. Louis County's public health director, said at a news conference this month. "We're still in this gray area of not being able to say we're good in our community. … We could see our numbers jump quickly if we're not careful."

In a quiet room Thursday, Shultz reassured Hipsher that statistically she would likely survive even without antibody treatment, though she was "exactly the kind of patient this medicine is for."

"There's more to the story than just are you going to live or die," Shultz said later. "Getting critically ill would be a life-changing event for a high-risk patient."

Thursday was relatively quiet in the St. Luke's emergency department, a far cry from the crushing surge of COVID-19 cases in November that nearly overwhelmed area hospitals.

For several weeks the county reported more than a dozen new COVID-19 hospitalizations a day — on top of the normal ebb and flow of trauma patients and those who may have fallen behind on routine care due to the pandemic.

There were times when Shultz had a phone in each ear as patients needed to be flown in or redirected.

"It was running right at red line for at least a week or two," he said. "We've had patients die of COVID in this emergency room before they could even get upstairs to an ICU because our hospital was full."

He warned that despite the low level of spread right now, those suffering from "COVID fatigue" need to keep their guard up.

"Our hospitals are still at or near capacity," he said. "I think it's a very dangerous period right now."

The antibody infusions that could help keep coronavirus patients out of the hospital are so far being underutilized, with more supply than demand at St. Luke's, Essentia Health and other health systems in the state. More patients have been willing to go through with the infusion recently compared with its initial launch late last year, however.

"This is really the only tool we have in our toolbox right now to support patients with mild to moderate disease," said Stephanie Nixon, the anti­microbial stewardship program manager at Essentia Health. "It's a matter of explaining that to them."

The monoclonal antibody treatment — similar to what former President Donald Trump received — has been available in Minnesota since November and was shown in one study to reduce the risk of hospitalization from 3 to 10% in some patients, Shultz said.

At St. Luke's, several rooms in the new emergency department that opened last year have been set aside specifically for the infusion therapy, with providers donning full protective gear during every interaction with patients.

Hospitals are reaching out to patients who qualify for the treatment — which works best if administered soon after symptoms arise. Area providers typically have appointments available daily.

"Our focus has been getting this to as many eligible people as possible," said Kate Dean, executive director of the Essentia Institute of Rural Health. "It's actually something that makes a difference, and there's been so little of that out there."

Just over 10,000 people have received at least the first dose of the COVID-19 vaccine in St. Louis County — about 5% of the county's population. About 2,800 residents have received both doses.

Even as state guidelines open up the vaccine to more residents, the county is still trying to reach all of those first in line.

"The vaccine rollout remains a challenge due to the extremely limited amount available," Westbrook, the county health director, said in a statement. "We remain encouraged to see the strong demand for the vaccine because every dose we administer moves us a step closer to putting this pandemic behind us."

Brooks Johnson • 218-491-6496