Mourners left Bob Cameron's funeral Friday with grab-and-go packs of bars and treats — offered in place of a social lunch because of the pandemic — and also with a lingering question.

Would the 87-year-old still be alive if he had received intensive care on the Sunday he was hospitalized rather than 48 hours later when an ICU bed opened up?

Cameron spent two days in his hometown hospital in Hallock, Minn., where caregivers searched nonstop for space in a larger hospital that could find and fix the source of his severe gastrointestinal bleeding and treat his COVID-19. He died Oct. 13.

"We can't say for certain, of course, that if he got to an ICU bed sooner that he would have survived, but we just feel in our hearts that he would have," Cameron's granddaughter Janna Curry said. "He was more stable on Sunday and Monday when they could have run the proper tests and given him the extended care that he needed to determine where the issue was."

Cameron's delayed transfer is one in a series of frustrations this month for greater Minnesota hospitals, which for a three-week stretch were caring for more COVID-19 patients than Twin Cities hospitals. That reversal hadn't happened before and reached a peak Oct. 12 when hospitals outside the Twin Cities had 521 COVID-19 patients admitted to inpatient beds compared with 471 in metro hospitals.

The trend correlates with higher coronavirus infection rates in rural counties with fewer COVID-19 vaccinations, but doctors also questioned whether aggressive action by large hospitals could have lessened the burden on small ones.

COVID-19 hospitalizations in Minnesota peaked in the latest wave at 1,008 on Oct. 15 — below the 1,864 reported Nov. 29 during last fall's more severe wave. However, the 8,005 hospitalizations from all causes on Oct. 15 was higher than the 6,991 on that peak date last fall, when hospitals responded to the COVID-19 demand by delaying nonurgent surgeries.

"I don't think we would be in as bad of a situation as we are in if we had reinstated" more of those measures, said Dr. Arden Virnig, supervisor of a five-bed ER at Mille Lacs Health System in Onamia, Minn.

Some deferrals have occurred. Minneapolis-based Allina Health isn't performing surgeries that can safely wait 90 or more days. Alomere Health in Alexandria, Minn., is spreading surgeries throughout the week to prevent a buildup of recovery patients.

More deferrals could free up more beds, but with a cost, said Dr. Deborah Dittberner, Alomere's chief medical officer, who suspects that delayed procedures last spring and fall resulted in sicker patients now. "We've got a lot of health care backed up right now."

The pressure starts with crowding that has forced metro hospitals to close their ERs to ambulances. An average of 22 ER diversions orders were issued per day by metro hospitals in the two weeks ending Oct. 11, forcing ambulances to pingpong among them as they brought in patients for emergency care.

That doubles the average of nine temporary ER closures per day by hospitals at the peak of last fall's COVID-19 wave, according to state data.

HCMC in Minneapolis even closed trauma and burn units at its busiest points. That hadn't happened before.

The pressure then trickles to Minnesota's regional and critical-access hospitals, which provide quick and local access to care but must transfer patients whose needs exceed their capabilities.

Transfers often are brokered by the state's C4 call center, which tries to relieve staff of the burden of finding open beds. But its success rate plummeted in the latest wave, and it completed none of the 27 transfers requested Sept. 28.

The result could be seen this week in the Mille Lacs ER, where patients awaiting delayed transfers occupied three of the unit's five beds.

"We're playing tag back and forth between Aitkin, Crosby, Brainerd and Princeton," Virnig said. "Basically, we're calling each other all day long to say, 'Who's got a new bed open?' "

Another hospital had three COVID-19 patients on ventilators awaiting intensive care in its ER, said Dr. Pete Olsen, a physician with Acute Care Inc., which provides ER care in rural Minnesota hospitals. "This is a unique challenge that has never been encountered in rural medicine."

Cameron was taken by ambulance Oct. 10 a few blocks to Kittson Healthcare Clinic and ER after feeling weak and suffering a fall, his daughter Julie Lindegard said.

Caregivers diagnosed his gastrointestinal bleeding and need for critical care elsewhere. But they struggled to find a bed because he tested positive for COVID-19, and that limited his options. The infection occurred despite Cameron receiving a booster dose.

"At one point [the doctor] held his hands up in frustration. 'We can't find anywhere to send him! Nobody will take him!' " Lindegard recalled.

The bleeding exhausted the hospital's blood supply, so state troopers shuttled new units 130 miles from Fargo to Hallock to keep Cameron alive. A bed was secured Oct. 12 at Sanford Health in Fargo, but his condition worsened after surgery there to find the source of his bleeding.

Relatives couldn't be with him because of visitor restrictions, and his wife of 64 years was isolated at home with COVID-19 as well. Cameron died with a nurse holding his hand, Lindegard said.

COVID-19 hospitalizations declined from 1,008 on Oct. 15 to 915 on Thursday. Hospital leaders say they believe last weekend was a turning point, but they encouraged more vaccinations as data continue to show that unvaccinated COVID-19 patients are far more likely to need ICU care and ventilators.

Twenty-one of 30 Minnesota counties with the highest seven-day COVID-19 hospitalization rates Oct. 19 had fewer than 50% of their populations fully vaccinated.

Staffing shortages have increased hospital pressures — limiting when ambulances can transfer patients and skilled nursing facilities can take patients who no longer need inpatient care but aren't healthy enough to go home.

The Mille Lacs hospital kept a patient with a fractured ankle and COVID-19 hospitalized for three weeks because of the lack of nursing beds. Staffing shortages at the adjacent 65-bed nursing home left it with only 42 available beds.

"It leaves you no place to put patients," Virnig said.

State solutions have included hastening discharges from psychiatric facilities so that patients placed in ERs with mental health crises can be transferred in. The Minnesota National Guard also has readied more than 300 specially trained members to provide temporary staffing in nursing facilities as needed.

Rural caregivers also must provide COVID-19 testing, vaccinations and monoclonal antibody therapies, which reduce inpatient staffing but hopefully reduce patient demand, Dittberner said. "If you don't give the monoclonal antibody therapies, you end up with more hospitalizations."

Alomere has responded with videoconferencing so that remote intensivists can oversee patients awaiting ICU transfers. It also is cooperating with neighboring hospitals on a triage system to prevent any one from getting overcrowded.

Video consults as of Oct. 4 have kept more patients safely at Allina's Cambridge Medical Center because the high-definition images allow intensivists at Abbott Northwestern Hospital to see such details as how hard they are breathing and how their pupils react.

Curry said that rather than dwelling on the reasons for her grandfather's death, she is focusing on how her family's loss can help others protect themselves from COVID-19 because that's what he would have wanted.

Known for his smile and wave as he drove around Hallock in his truck, Cameron served in the Army and maintained sobriety for 43 years while sponsoring others in Alcoholics Anonymous. He announced local hockey games and was a volunteer firefighter.

After managing a lumberyard, Cameron found a second career as a veteran service officer and brought $1 million in unclaimed benefits to Kittson County before he retired at age 84.

"We don't want another family to go through this," Curry said, "and we feel like this can be prevented if all of us work together. My grandpa was all about helping others."

Jeremy Olson • 612-673-7744