Wednesday was the slowest day of the week in St. Cloud Hospital's emergency room — only 11 people were in the waiting room at noon while 38 patients filled every available treatment bay.

Minnesota's busiest hospital — by occupancy rate — has been at the epicenter of the state's COVID-19 wave for three months, treating an escalating number of infected patients while seeing no slowdown in everyday emergencies. The pressure culminated last week with Minnesota's announcement that 22 federal emergency health care workers would shore up staffing in St. Cloud or other hospitals in the CentraCare system this week.

"COVID just overwhelms the system," said Dr. Andrew Winter, an ER physician who zips from traumas to infections to mental health crises. "No matter how big you build it, there are still more patients than you can take care of."

Winter's first ER patient Wednesday afternoon was a homeless man experiencing swelling on a leg marked with open sores and spider bites.

"It's hot; does it feel hot to you?" Winter said.

"Yeah, it burns," replied Bobby Stewart, 46.

Winter reviewed the man's medication and health history and told him to be patient.

"We're going to get some lab work, we'll get an ultrasound of this leg, we'll figure this out, OK?"

A surge of COVID and non-COVID patients has differentiated the latest hospital crunch in Minnesota from earlier pandemic waves. CentraCare and other hospital systems have pushed back surgeries that can be delayed, but inpatient admissions are rising, possibly because people put off needed care earlier in the pandemic.

Minnesota has tallied 55 days since May 2020 when hospitalizations exceeded 8,000, a benchmark for overcrowding — and 28 were in the last two months. The 8,220 hospitalizations on Wednesday included 1,382 COVID-19 patients.

St. Cloud has averaged 99% occupancy of its 390 adult inpatient beds since July, according to federal hospital data, making it the busiest during that period in Minnesota. In the week beginning Nov. 5, it was one of four to report almost 100% occupancy along with CentraCare's Monticello hospital and HealthPartners' Regions Hospital in St. Paul and Methodist Hospital in St. Louis Park.

St. Cloud averaged 74 adults with confirmed or suspected COVID-19 in inpatient beds at any point that week, ranking fourth for pandemic cases behind Mercy Hospital in Coon Rapids, Abbott Northwestern Hospital in Minneapolis and Mayo Clinic in Rochester.

The trickle-down effect was apparent Wednesday afternoon in the St. Cloud ER. Six of 38 patients tested positive for COVID-19, while five in the waiting area had confirmed or possible infections.

Several patients were "boarders," meaning they needed inpatient care but no beds were available.

Sylvia Bennett, 89, arrived in the ER after a nine-day bout with COVID-19 that left her dehydrated and with pneumonia. She had been waiting hours for an inpatient bed, which is typical, said her ER nurse, Carrie Zeigler-Erickson.

Bennett needed her diabetes monitored and help taking medications, eating and going to the bathroom — all commonplace on inpatient floors but not in ERs where nurses have higher patient volumes.

"It takes a great deal of our time and takes away from other patients," her nurse said.

Transfers between hospitals can relieve pressure on ERs, but nobody has openings. Minnesota's cooperative C4 system received 195 requests in the seven-day period ending Tuesday to transfer patients and completed 17. Another 32 ended with the requesting hospitals eventually finding space.

Four COVID-19 patients in the St. Cloud ER were vaccinated, reflecting a new double whammy on hospitals.

The majority of COVID-19 hospitalizations have been among unvaccinated Minnesotans — even though they make up a minority of the population — but waning immunity from shots early this year is sending more vaccinated people in for care.

"It's coming fast and furious," said Seth Royce, director of the St. Cloud ER. "And the patients are getting younger."

Statewide, the median age of COVID-19 hospitalizations has dropped from 65 last fall to 51 this summer — though it is expected to increase as breakthrough infections become more common among early, elderly vaccine recipients.

ER providers aren't as anxious about getting sick or protecting themselves when entering COVID-19 patient rooms, but they have a healthy respect for the infection and how it attacks the lungs.

Winter examined a chest X-ray of one COVID-19 patient.

"It's, like, full of cotton," he said. "It's, like, smushed."

Winter dashed down the hall to see Pat Werschay, 84, who had gotten up from watching "Jeopardy" on TV at home in St. Cloud and felt pain in her hip that sent her tumbling.

"If I bring this leg up and move it around, does it hurt your left hip or leg at all?" he asked, checking for signs of a hip fracture.

"No," she said.

"Does it hurt over here when I move this one?" Winter asked, with the wince on her face telling him everything he needed to know.

Full ERs caused by full inpatient units have a downstream impact on trauma care because hospitals close to ambulances if they don't have space.

Twin Cities hospitals were averaging eight or fewer diversions per day in fall 2020, each shutting ERs for a few minutes or hours until they had the space to open again to ambulances.

In the seven-day period ending Tuesday, the Twin Cities was averaging 22 diversions per day — with the average lasting two hours.

After OK'ing one patient with headaches for discharge, Winter cut across the ER workstations to stabilization room 1, where another patient was tired of all the delays.

Four-year-old Tatum Johnson didn't understand what was going on. She fractured her arm diving from her bed onto what looked like a pile of stuffed animals.

"I want to be done," she told her dad, who stroked her hair and tried to distract her with cartoons on his mobile phone.

The girl's eyes widened at the syringe with anesthesia and the nasal cannula a nurse was going to put in her nose.

"No! Not yet!" she screamed, but soon the anesthesia kicked in and her eyes glazed.

"She's out," Winter said, before working with a colleague to fit a plaster cast on her arm.

An hour had passed in the ER. There were 22 people in the waiting room and another three in a triage area.

One goal is just to make sure patients are seen. Normally, it's a problem if more than 2% of patients register for care and leave the ER before being evaluated. Lately the rate has been higher, Winter said.

In all on Wednesday, 187 patients passed through the St. Cloud ER, including 26 with COVID-19. Most waited 40 minutes on average to be seen, and that wasn't so bad.

It was, after all, a slow day.

Jeremy Olson • 612-673-7744