Nine weeks before Minnesota documented its first COVID-19 patient, Carrie Bergquist of Polk County pretended to be one.
With a fake cough and fever, she sought help at an emergency room in a rural hospital about 30 miles north of her hometown, Crookston. With the trip, she could avoid running into anyone she knows.
The idea behind the ruse was to help future patients of the novel coronavirus: Bergquist is the coordinator of regional health care in northwestern Minnesota. And by posing as an undercover patient, she was able to measure the hospital staff’s response to COVID-19 symptoms.
“We’re evaluating, do they mask me? Do they mask themselves? Do they isolate me? Or do they let me cough all over everything in the waiting room?” said Bergquist. “Some disinfected the counter and the chair and everything I touched, and that’s exactly what we want to see.”
Bergquist is among the thousands of workers in Minnesota’s hospitals, nursing homes, public health and emergency management agencies who are on the front lines of the state’s response to the unprecedented crisis — whether undergoing the so-called “mystery patient exercise” or working in overdrive to draft emergency staffing plans. Though the state of Minnesota is leading the response effort, it’s people like Berquist who are responsible for implementing the top-down directives for containing COVID-19.
“We’re trying to educate as many facilities that we can,” Bergquist said. “We know what we’re doing.”
On the front lines, worries about resources, burnout
Like Bergquist, Eric Weller wears two hats: one as a trainer of first responders in the Mankato area and the other as the coordinator of Minnesota’s South Central Health Care Coalition.
The coalition is one of the state’s eight geographically based health care coalitions, which coordinate all parties — including private medical care providers and county public health departments — and serve as a liaison between health care professionals on the ground and the state during health crises such as COVID-19.
In the latter role, Weller is coordinating how ambulances, hospitals and county departments in the southwest corner of the state prepare for more cases of COVID-19. As of Tuesday morning, his health care partners were responding to two cases of the novel virus in Blue Earth and Waseca counties.
He said while health care coalitions across Minnesota face similar workloads with the outbreak — preparing messaging for patients and staff, developing 24/7 staffing plans and keeping medical supplies stocked — staff at hospitals and clinics in his region’s rural areas are stretched particularly thin. “In Greater Minnesota, we have challenges because we have less resources, of course,” he said.
In Hennepin County — Minnesota’s epicenter of COVID-19 cases (22 of the state’s 54 cases as of Monday) — staff in the trenches of the pandemic are working under what’s called incident command.
In that stage of emergency response, employees across the county’s clinical services, human services, epidemiology and emergency preparedness departments let go of their usual job duties and focus all of their energy on trying to prevent the virus’ spread, said Dave Johnson, the county’s epidemiology manager.
The coronavirus “pandemic is the type of thing that we, in public health, have been planning for many, many years,” he said. “We are working to get the resources that we need in order to respond and … [make] sure we are protecting people who are most at risk of poor medical outcomes.”
Among those who are most at risk of catching COVID-19 are people who sleep in groups, and public health workers in Hennepin County are teaming up with human services to figure out how they would address a confirmed case of the virus among people sleeping in emergency shelters or outdoor encampments.
“We’re working with shelter managers to prepare for that eventuality, and how they would implement those strategies of keeping people isolated and separated from others,” Johnson said.
County staff is visiting facilities across the Hennepin Healthcare system to catalog units’ existing supplies, such as masks, gloves and medical gowns, and assess their needs. Anyone who visits potential COVID-19 patients in their homes must wear personal protective equipment including disposable face shields and filtering facial respirators, under CDC guidelines.
Local officials are also trying to gauge the toll such efforts take on workers. As the response progresses, Bergquist, who also works as an administrative assistant at Crookston’s Altru Clinic, said she’s concerned about the staff’s workload. “I’m just worried about staff realizing, ‘Hey, I need to just sit down for five minutes and just breathe,” she said. “We want to make sure that we aren’t burning our staff out.”
Figuring out how to deliver essential services
City and county departments across Minnesota are also grappling with the prospect of eventually banning in-person meetings. To limit people’s exposure to the virus, local municipalities are preparing plans internally for what would happen with the services they provide residents should administrators, staff and elected leaders have to stay home.
“For the most part, a lot of services that we provide, they need to continue,” said Andersen of St. Paul-Ramsey County. “Home visiting, the food stamp program — those we will continue to provide. We’re certainly exploring what would be possible for telecommuting for our employees. We’re working with state leaders on what that would be.”
Other local municipalities have already taken steps to limit residents’ opportunities to expose government workers to the virus.
On Monday evening, Hennepin County declared a local state of emergency and announced the temporary closure of its 41 libraries, human service centers and licensing services centers beginning Tuesday. For customers of those services and others, the county said it is looking for “creative solutions” that do not require person-to-person contact but allow people to get the help they need.
By declaring local states of emergencies, local governments’ emergency management departments can request funding from and coordinate with other layers of government, including the counties, state and the U.S. Department of Homeland Security. In addition to Hennepin County, the cities of St. Paul and Minneapolis made the announcements earlier this week.
“We have not taken this decision lightly and understand the hardship this creates for our customers, clients, and residents,” Hennepin County said in its announcement. “Our government services continue to function, but in a very different way in these times.”
In northeastern Minnesota’s St. Louis County, the state’s largest county by area, public health leaders and medical staff are trying to be especially proactive. Scott Lesnau, the county’s emergency preparedness coordinator, said county staff is in the process of figuring out how they would deliver essential county services to residents who must involuntarily isolate or quarantine themselves, should the virus spread to Duluth or surrounding rural areas.
As in Hennepin County, St. Louis County set up an incident command system. It also identified how it would run an emergency operations center and created a response plan for county employees whose jobs may expose them to the virus. The county has also relaxed the rules for its employee sick leave policy. “We have an algorithm for essential services,” said Lesnau. “We have a staff on-call rotation already set up.”
Amid that logistical work, Lesnau said one aspect of his job feels out of his hands: misinformation on social media. He said people are calling continuously about lies they see on Facebook, claiming a St. Louis County resident tested positive for COVID-19. “I wish I could deactivate Facebook right now,” he said. “It’s just so hard to control.”