The recent surge in COVID-19 cases hit metro area hospitals so hard in November that at one point, most intensive care units were near capacity and in danger of being overwhelmed.

"That was really the scary point," said Jennifer Myster, president of Methodist Hospital in St. Louis Park who, trying to avert a crisis just after Thanksgiving, stayed in contact with other hospital leaders as the situation changed almost hourly.

Just how perilous the threat became is spelled out in weekly occupancy data that hospitals report to the federal government.

During a five-week stretch between late October and early December, 11 of the 13 largest Twin Cities area hospitals reported at least one week where intensive care unit capacity was at or above 95%. Four hospitals hit that mark in each of the five weeks — and one was at 100% capacity throughout the surge.

At one point, just after Thanksgiving, so many ICUs were full that the state's hospital emergency coordination center scrambled to find bed space for 32 ICU patients each day, on average.

"The patients in the ICU were so sick and they just didn't have any beds available," said Dr. John Hick, a Hennepin Healthcare physician who helped coordinate Minnesota's response to the pandemic. "No question, every hospital was having to make decisions about who went to intensive care."

Although the pressure on hospital beds eased in December, the threat of continued virus spread and another surge in cases after the Christmas holiday hasn't.

In the week leading up to Christmas, 25% all of emergency department visits in the major metro hospitals involved COVID-19 patients or people suspected of having the disease, which requires the same level of precaution. That's down from a high of 30% in mid-November, but still much higher than the 14% from the Labor Day week in September.

In the larger hospitals outside the Twin Cities, 8% of emergency trips around Labor Day were COVID-related, peaking at 23% in mid-November and falling to 16% before Christmas.

"Our hospital was on divert more often than it wasn't on divert," said Dr. Cindy Firkins Smith, co-CEO of Carris Health in Willmar. "We were trying to figure out where those patients go."

"Thanksgiving was awful and by Christmas we had room and were not on divert," she added. "At that point in time we thought we were living in a nightmare."

Statewide, the number of COVID-19 patients in hospitals has been cut in half since Dec. 1, with about 900 occupying beds.

Average weekly case growth has fallen to about 35 new cases per 100,000 residents, a number not seen since late October.

On Saturday, health officials announced 2,543 more COVID-19 infections and 54 additional deaths, bringing the state's totals to 417,832 cases and 5,377 fatalities.

Mercy Hospital in Coon Rapids, which also has a campus in Fridley, was one of the busiest during the recent surge. Its ICU was at 100% capacity for each of the five weeks during the fall surge, according to reports made to the federal government.

"We had some of the highest overall COVID patient volume throughout the state," said Dr. Ryan Else, Mercy's vice president for medical affairs. "It was challenging for several weeks."

Many of the hospitals in the state are part of larger parent systems, which can comprise large facilities that provide specialized and critical care, community hospitals, and free-standing surgical and urgent care facilities.

Most systems used their networks to manage their patient populations across their facilities.

"We were able to level the load a little bit in the system by having some of the community hospitals take care of COVID patients," said Dr. Mark Sannes, an infectious disease specialist and HealthPartners' senior medical director.

About 25% of the system's COVID-19 patients remained in HealthPartners community hospitals in Minnesota and western Wisconsin, a strategy that was developed with the first surge of coronavirus in the spring.

Back then, HealthPartners topped out at 105 COVID-19 patients. In the fall, the peak was 232.

"The peak even exceeded some of what we thought the worst-case scenario might have been," he said.

As part of St. Cloud-based CentraCare, Carris Health, which has hospitals in Willmar and Redwood Falls, would try to send patients to the system's flagship hospital.

"A lot of times it took a while to find a place," said Firkins Smith. If there were no critical care beds in St. Cloud, "then we would be looking at the Twin Cities or outside Minnesota."

But having available beds was just one limiting factor. So much virus was spreading in November that many health care workers fell ill from it or had to quarantine because of a high-risk exposure. Those who were parents sometimes stayed home to care for sick children.

"The combination of the high number of people needing hospitalization and our staffing needing to be out made for a very challenging November," said Myster.

Front-line workers often were asked to take on additional shifts, or intensive care nurses would pair up with other nurses to staff the ICU beds, Myster said. Hospitals also called in nurses from staffing agencies.

The state's Critical Care Coordination Center, or C4, also helped manage the crisis.

"With the C4, hospitals partnered together in ways that we really hadn't done in the past," Else said.

Hick said each day presented a different set of options on where to transfer patients, depending on the number of ICU and non-ICU beds available.

Some patients that normally would be sent to intensive care were sometimes admitted to other units.

"During the weeks when we got really tight, those patients were going to intermediate care … but it was the best we could do under the circumstances," he said. "We certainly had to think really carefully about how we use the resources, and right now we are back to much more of a conventional status.

"I hope that we are through the worst of this and am more optimistic starting the new year here than I was a month or six weeks ago."

Glenn Howatt • 612-673-7192