Home COVID-19 care easing pressure on Minnesota hospitals

At its worst, COVID-19 forced Kathleen Stewart awake at 2 a.m., gasping for air, praying to God.

" 'I need help. I can't breathe!' " she prayed. "I asked him to calm my body down, and it did calm down."

The episode in mid-November might have sent Stewart, 60, back to the emergency room, but instead she talked with a doctor assigned to her through Hennepin Healthcare to monitor manageable cases of COVID-19 at home.

Dr. Jane Hess had Stewart check her blood oxygen with a pulse oximeter, listened to her breathing over the phone, suggested hot water with lemon and honey, and urged her to use the inhaler she prescribed to open her airways.

"I deal with this every day, whereas this patient has never experienced this constellation of symptoms," said Hess, an osteopathic family practitioner who volunteered for the COVID-19 home-monitoring role. "What constitutes something to be worried about is hard to know as a patient.

"I also just do a little cheerleading because it is kind of a marathon for these people to feel rotten day after day."

Hennepin Healthcare COVID-19 Home Monitoring started in May, but has grown this fall amid a pandemic surge that is filling hospital beds. The state's COVID-19 Response Capacity dashboard on Tuesday showed that a record 37% of 1,075 patients in Minnesota hospital ICU beds had COVID-19.

Hospital leaders believe home monitoring programs have helped keep some pressure off. Among 1,700 COVID-19 patients in the Hennepin program, only 10% went to ERs during their monitoring and 5% needed inpatient hospital admissions.

Home monitoring is "making space" for patients who need hospital beds the most and getting people into ER care faster when needed, said Natalie Ikeman, a physician assistant and coordinator of the Hennepin program.

Patients receive pulse oximeter monitors that are key because COVID-19 patients sometimes are unaware of dangerous drops in their blood-oxygen levels. Readings at or below 90 can indicate a need for hospital care.

"If their levels are dropping below a certain mark, that's their cue to go into the ER — getting their care sooner rather than getting worse and having to call an ambulance or something like that," Ikeman said.

The program enlists alternative care providers such as acupuncturists and chiropractors to screen medical records of COVID-19 patients to assess whether they could benefit from home monitoring after their ER visits.

Participating patients also receive referrals for food deliveries from the Open Arms of Minnesota food bank to help them stay at home and remain in isolation while infectious.

Stewart has progressed since her scare with COVID-19 — going shopping for the first time just before Thanksgiving, albeit with a motorized scooter. She is impatient but trying not to rush recovery.

"They told me it would be 10% per week that you would get better," she said.

Stewart was selling her house when she was infected and living temporarily with her daughter, who also contracted COVID-19 along with one of two grandchildren. She admitted she probably delayed testing when symptoms emerged because she was afraid to discover that she introduced the infectious disease into her family.

"I just didn't want to know," she said, "because I didn't want to be sick."

Stewart had breathing problems and could barely sit up when friends and her son persuaded her to go to the ER.

COVID-19 is caused by a novel corona­virus that wasn't discovered until late 2019, so doctors had no clear guidance about whom to hospitalize and whom to send home. More home monitoring programs have emerged during the pandemic, though, as research has defined the course of COVID-19 and the symptoms that differentiate the treatments patients need.

M Health Fairview is using an algorithm developed at the University of Minnesota that predicts the severity of COVID-19 to screen patients for its new care-at-home program launched at its busiest ER at Ridges Hospital in Burnsville last week.

The ER sent 21 patients with COVID-19 home with pulse oximeters, instructions to report their daily symptoms online and a follow-up telehealth appointment. Only one has needed to return for a hospital admission.

All probably would have been admitted out of an abundance of caution in the spring, when it wasn't as necessary to conserve bed space because of the statewide deferral of nonurgent surgeries, said Dr. David Milbrandt, vice president of M Health Fairview's ED services.

"Now, it's absolutely necessary," he said. "We're struggling."

Southdale Hospital added the Home Virtual COVID-19 Monitoring Program this week and other M Health Fairview hospitals will as well.

Doctors at Mayo Clinic believe they have decreased ER visits and hospitalizations since the start of the pandemic with a program that's regularly checked on 14,000 outpatients with COVID-19, including enhanced home-monitoring technology for those at higher risk. Mayo facilities in northwest Wisconsin also are testing at-home technology so patients can be discharged from the hospital more quickly, said Dr. Amy Williams, executive dean of the Mayo Clinic practice.

"The goal [eventually] would be that individuals who qualify for advanced care at home would not need to go to the hospital first," Williams said.

Stewart is nowhere near full strength but relieved she was able to get through COVID-19 without a hospital admission or supplemental oxygen.

Stewart said calls from the doctor made a difference. One day she had chest pain, and Hess told her it could be due to blood clots and to take blood-thinning aspirin. Hess bonded with Stewart from the beginning — telling her to keep her phone close and pick up so she wouldn't worry that she was incapacitated by COVID-19 and in need of an ambulance.

Their last phone call was two weeks ago.

"I'm so grateful to her," Stewart said, "because she really helped me understand … what's going on with your body and how this virus goes through your body."

Staff writer Christopher Snowbeck contributed to this report.

This is the fourth in a series on Minnesota hospitals' response to the surging COVID-19 pandemic.