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COVID-19 prevention, treatment spurs innovation in health care industry VACCINE BEGINS ROLLING OUT IN DETROIT LAKES GYMS ENDURE UPS AND DOWNS







Health care in the time of COVID-19


Vaccine begins rolling out in Detroit Lakes

How a global pandemic is reshaping the future of medical care in Detroit Lakes

COVID-19 prevention, treatment spurs innovation in health care industry

Front line workers get first doses of COVID-19 vaccine



Kyla Halvorson, left, a nurse at Sanford Health clinic, administers an influenza vaccine to patient Dede Vettleson. Photo courtesy of Sanford Health


Gyms endure ups and downs Each COVID-19 executive order was different, requiring a different response

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ABOVE: A patient at Essentia Health’s Detroit Lakes clinic has her temperature checked as part of the screening process before being admitted inside the clinic. Temperature checks are no longer being used as part of the screening process, however. LEFT: Bethany Nies, RN, performs a curbside vitals check on an obstetric patient at Essentia Health's Detroit Lakes clinic. Photos courtesy of Essentia Health St. Mary's

Health care in the time of COVID-19 How a global pandemic is reshaping the future of medical care in Detroit Lakes By Vicki Gerdes | vgerdes@dlnewspapers.com

The global pandemic known as COVID-19 has had a significant impact on the way medical services are provided in Detroit Lakes over the past year. Both Essentia Health St. Mary’s and Sanford Health in Detroit Lakes have seen a dramatic increase in virtual visits between providers and patients, health screenings for both staff and patients as they entered clinic and hospital facilities, and aggressive cleaning and sanitizing of all offices, patient care rooms and waiting areas. Essentia Health’s Chief Medical Officer, Dr. Richard Vetter, says the health care provider was already planning on introducing a new “virtual visit” health care pilot program last April. “It was going to be rolled out slowly,” said Vetter — but after COVID-19 shut everything down in March, “we rolled it out in about three days,” he added.

It’s almost like a hospital-at-home concept, Dr. Richard Vetter, ESSENTIA ST. MARY’S ON REMOTE MONITORING

Essentia heralded as a ‘Trailblazer’ by BCBSM In June, Essentia Health received Blue Cross and Blue Shield of Minnesota’s Trailblazer Award for that effort. According to a June 17 press release, the award was presented to Essentia “for its nation-leading efforts to improve access to virtual care during the COVID-19 pandemic.” The new program “encouraged Essentia Health teams to provide an opportunity for patients to receive care from their health care provider virtually using a phone, tablet, laptop or PC from the comfort of their home,” the news release stated — and it was rolled out a full month ahead of schedule, on March 18, due to “a need to keep patients and staff safe from the virus.”

continued on page 4 HEALTH BEAT | 3

continued From page 3 “We literally went from zero to about 3,000 virtual visits per day in less than three weeks,” said Essentia Health’s Chief Executive Officer, Dr. David Herman, “and we ramped up more quickly and have done more volume than just about anyone in the country.” The new approach to care was welcomed among more than 1,200 primary care providers, as well as physicians and advanced care providers within as many as 60 specialties. Patients also responded positively. “Analytics indicate that as many as 69% of total Essentia Health visits were conducted using virtual visits, e-visits and video visits between facilities,” the press release noted.

“As we’ve gotten into a new system as far as cleaning our facilities and screening patients, we’ve had more in-person visits,” Cox said, “but we’re still doing way more virtual visits than we would have done pre-pandemic.”

As we’ve gotten into a new system as far as cleaning our facilities and screening patients, we’ve had more in-person visits, but we’re still doing way more virtual visits than we would have done pre-pandemic. Dr. Nicole Cox, SANFORD HEALTH

An early May survey of 1,500 patients found more than 90% said they received the care they needed and would consider virtual visits in the future. Nearly 100% of patients said they had a great experience seeing their provider virtually.

In-person clinic visits making a comeback

Sanford’s same-day surgery center in Detroit Lakes had a significant decrease in patients coming through its doors during the first months of the pandemic, Dr. Cox noted. “Initially when the pandemic hit there was concern regarding personal protective equipment and supplies, so we did have about a month or so’s hiatus from doing any elective surgeries here,” she said, “but once they had enough PPE and supplies to care for patients, we were able to resume (normal operations).”

Patient volumes at the same day surgery center are now “pretty much back to prepandemic levels,” Dr. Cox added.

Demand for drive-up testing replaced by vaccine requests

At the peak of the pandemic shutdown, about 70-75% of Essentia’s provider-patient visits were being done virtually, Vetter said, though that has since dropped to around 15%.

Also back in April, Sanford Health began rolling out drive-up coronavirus testing, along with scheduling extra time between medical appointments to allow for more aggressive cleaning and sanitizing efforts.

“That (15%) rate has remained stable,” he said, adding that he believes this virtual method of health care is “here to stay.”

Patients would call ahead, and upon arriving at the clinic, their vehicle would be met by a gowned and masked nurse, who took nasal swabs that were then sent off for processing at Sanford’s facilities in Sioux Falls, S.D. — a process that took 24-48 hours.

“It won’t replace face to face visits, but it could grow to maybe 30-40%,” Vetter said. He also expects use of mail-order pharmacies to remain popular even after the pandemic has subsided. Around the same time as Essentia rolled out its “trailblazing” virtual visitation platform, Sanford also began increasing its virtual consultations in an effort to reduce the need for in-person clinic visits. “We’re using MyChart,” says Sanford Health Detroit Lakes physician Dr. Nicole Cox, “which is Sanford’s online patient chart. That’s been working really well to connect with patients.” Doximity is another online video streaming application that they’ve been using to make those connections, she added. “It’s similar to Zoom, but more secure.”


Today, the turnaround time for testing has decreased, and the accuracy of the testing methods has also improved significantly, Dr. Cox noted. The clinic was doing up to 168 tests per day at peak volume, but public demand for drive-up COVID-19 testing has now been all but superseded by the demand for a vaccine. “I think the biggest shift now is initially we had a lot of requests for testing, and and now the focus has gone from testing toward the vaccine,” Cox said. “We were hoping it would come out faster than it is … we’re handling close to 100 phone calls a day, throughout the clinic, from patients asking about the vaccine and when it’s going to be available to them.”

Patients going home from hospital sooner, with at-home monitoring Another innovation at Essentia Health that was accelerated by the advent of COVID-19 was remote monitoring of patients. Dr. Vetter says that things like patients’ blood pressure, pulse, weight and oxygen levels can now be monitored from home, considerably shortening the length of hospital stays for many patients. “That data is fed in to us through our nurse care line,” Vetter said, “which is staffed by RN’s 24/7.” If a problem is found, a virtual visit can be scheduled ASAP, and doctors can also reach out to their patients to see how they’re doing on a day-to-day basis. “It’s almost like a hospital-at-home concept,” he said. “People we may have not felt comfortable sending home (without monitoring) can always be called back in if they start to deteriorate.” Patients with chronic diseases like congestive heart failure, chronic lung disease, chronic obstructive pulmonary disease (COPD) or emphysema can now be monitored this way as well, he added, thus lessening the need for frequent clinic and/or hospital visits, which is particularly helpful when they are at high risk of contracting an illness like COVID-19. These days, even the need to draw blood for testing can be handled by a community paramedic, who goes out to patients’ homes and brings back their blood samples for testing at the clinic. “We have two of them (community paramedics) within the west market,” said Dr. Vetter, noting that Essentia’s west market includes “everything within a 125-mile radius of Fargo.”

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Vaccine begins rolling out in Detroit Lakes Front line workers get first doses of COVID-19 vaccine By Michael Achterling | machterling@dlnewspapers.com

One of the most coveted substances on the planet is in Detroit Lakes and has finally begun making its way into the community. It’s not a precious metal, like gold, or a vital component of world commerce, like oil, or even priceless rare gems created by specialized processes deep within the Earth. It’s a vaccine. A vaccine created by scientists to combat one of the most deadly pandemics in our country’s history and bring the hope of normalcy back to communities around the globe. On Dec. 18, Essentia Health St. Mary’s - Detroit Lakes began administering the first doses of Pfizer’s COVID-19

Here to help today for a better tomorrow. Carla Hansen, registered nurse at Essentia Health St. Mary's - Detroit Lakes, receives her first dose of the Pfizer COVID-19 vaccine from Melissa Peterson, regional nursing director at Essentia Health. Submitted photo

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We have doctors and nurses that have been working with COVID patients for months now. And to be able to help coordinate this and see them get their vaccine, and be grateful for that, and send messages thanking us for the work, and caring for them, to me, it’s like, that is much more emotional than when I personally received the vaccine. Angie Olson, ESSENTIA HEALTH ST. MARY’S

vaccine to direct caregivers, emergency medical services personnel and skilled nursing facility staff members. From Dec. 18 to Dec. 30, Essentia Health St. Mary’s vaccinated 560 individuals with their first of two doses of the COVID-19 vaccine.

coalitions to direct providers, like Essentia Health St. Mary’s,

One of the 560 recipients was Dr. John Belk, an emergency medicine practitioner at Essentia Health St. Mary’s - Detroit Lakes.

providers, and the Minnesota Department of Health in

“Receiving the first dose of the COVID-19 vaccine was a relief knowing that I’m protecting my family, my patients, and myself,” said Belk. He also said he hasn’t experienced any side effects and looks forward to receiving his second dose after the required 17 to 25 day waiting period between doses. “I remember when we did our first dose, it felt like it was the most epic thing we’ve done at this facility,” said Cole Helbling, pharmacy operations manager at Essentia Health St. Mary’s - Detroit Lakes. “It was so cool, just really exciting and what a great thing to be a part of.” Helbling also said the responsibility associated with this vaccine is heavy, but it’s a weight that he, and his co-workers, are more than happy to carry because, for many, these types of situations were exactly why they wanted to get into the healthcare field in the first place.

as to who is next in line to receive the vaccine Essentia Health St. Mary’s has been working with the Northwest Health Services Coalition, one of eight regional state health care coalitions made up of various healthcare an effort to ensure no vaccine is wasted in their push to vaccinate as many people as possible. “We’ve been working with our northwest coalition,” said Helbling. “We’ve got a coalition lead...so when we’re asking, ‘we’ve got some more doses, who are the next people we should get,’ we’re working closely with that coalition to determine what group of people fall into that category that we should vaccinate next.” In Minnesota, Helbling said, hospitals, and health systems, are getting the Pfizer vaccine because they have the capability to hold the vaccine in the -76 to -112 degree Fahrenheit temperatures required for storage, where as, the Moderna vaccine is going to pharmacies, and different public health facilities, such as long-term care facilities, because ultra-cold temperatures are not required for its storage.

continued on page 8

“I want to be in a place where I’m doing valuable work,” he said. “And this feels like something that I was definitely called to do.” Helbling also said, when he and a co-worker went to pick up the vaccine from the northern Minnesota distribution site, it felt like they were transporting a heart for a transplant. “But this is more important than a heart because a heart can only save one life,” said Helbling. “The vaccine can save many, many lives.” However, the process for distributing the vaccines are not uniform across all 50 states. Each state determines how to distribute, and administer, their own allotment of COVID-19 vaccines differently. Minnesota has been using state health


Detroit Lakes Police Sgt. Robert Strand receives a COVID-19 vaccine shot on Tuesday, Jan. 5, from Becker County Public Health registered nurse Lindsay Bozovsky. Nathan Bowe/Tribune

continued From page 7 “A vast majority (of vaccinations) have gone to just health care workers,” said Ryan Hill, interim vice president of operations at Essentia Health St. Mary’s Detroit Lakes. “We have had some residents of long-term care facilities that have received some of these doses, in part, in our effort to ensure that we don’t waste a single dose.” In fact, the 96 vials of Pfizer vaccine received by Essentia Health St. Mary’s since distribution began were supposed to hold five doses per vial, but, health care workers discovered a sixth dose in a majority of the vials they received, which increased their dose total so they could vaccinate more individuals in the first priority group. “We have a limited time, so this is a five day immunization before it expires,” said Hill. “There are a lot of logistics and planning for administering, so all in all, things have gone very smoothly.” Helbling said Essentia Health St. Mary’s has not wasted a single dose, which is a testament to the resources, and care Essentia Health has put into this important rollout. Hill also said, by late-January, all of the skilled nursing facility residents in Detroit Lakes will have been offered the vaccine. As far as a large scale community rollout of the vaccine, the plans are still being determined, Helbling said. “We’re still waiting on a lot of those operational decisions from the state, as far as, how is it going to be distributed,”


said Helbling. “A big part of the general public might be that public health and some allocation pharmacy-type distribution plans … you just haven’t got that clear direction as far as when is it open to the general public.” Angie Olson, operations director for ambulatory services at Essentia Health St. Mary’s - Detroit Lakes, said she is also one of the Essentia Health St. Mary’s staff who have been vaccinated. Olson has been a part of the COVID-19 testing team and has been administering some of the vaccinations, which put her in the first group for receiving the vaccine, but, she said she still didn’t want to take any vaccine away from someone else who might have needed it more. But, she wasn’t going to let it go to waste. “I used one of those extra doses because I still feel like in my role, I’m not at a super high occupational risk for getting COVID, but it was one of those things where at the end of the day, you have a dose and you have a person that is eligible, try to give it rather than waste it,” said Olson. She also said she was more emotional when she saw her co-workers, and other staff members, receive their vaccinations. “We have doctors and nurses that have been working with COVID patients for months now,” said Olson. “And to be able to help coordinate this and see them get their vaccine, and be grateful for that, and send messages thanking us for the work, and caring for them, to me, it’s like, that is much more emotional than when I personally received the vaccine.”

Helbling echoed many of the same sentiments. “I feel like the emotional level is super high with this,” he said. “Just because we are in health care, and we do care for patients that are COVID-positive, and our exposure risk is high, it feels like you have a shield now. There is finally something, besides an N95 and an air exchanger, there is something that can finally protect you from getting (COVID19), or passing (the disease) to others.” Hill also said the COVID-19 vaccine is optional for their health care workers, unlike the flu vaccination, which is a requirement for employment at Essentia Health St. Mary’s. In trying to combat misinformation about the vaccine, Helbling said he wants to assure the public that the vaccine does not contain microchips, it won’t change your DNA, and it is safe. “If you are worried about being microchipped, you should probably not carry your phone around everyday,” he said. “I think people are realizing that my co-worker didn’t start glowing red, or some goofy thing like that, they’ve seen that their co-workers are doing fine and this is no worse than what we’ve seen from other vaccines.” Helbling admitted they have seen some vaccine hesitancy, but, many health care workers are still excited to receive their vaccine because they have seen so many negative COVID-19 outcomes.

“There are going to be some anti-vaxxers that you are just never going to persuade,” he said. Helbling also said one of the more effective ways to reach someone who is hesitant about the vaccine is to share stories, positive and negative, about COVID-19. He agreed some people will never get the vaccine, but if health departments can get the vaccine into enough arms, they will have some form of protection by being part of a vaccinated community.

Receiving the first dose of the COVID-19 vaccine was a relief knowing that I'm protecting my family, my patients, and myself. Dr. John Belk,


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Dalton VonRuden of Detroit Lakes was working out at the Detroit Lakes Community Center on Jan. 4. Masks are required even during strenuous exercise. Nathan Bowe/Tribune

Gyms endure ups and downs Each COVID-19 executive order was different, requiring a different response By Nathan Bowe | nbowe@dlnewspapers.com

Fitness experts say working out and getting enough exercise improves both physical and mental health, which is especially important during the COVID-19 pandemic. But to prevent the spread of COVID-19, fitness centers and gyms in Minnesota have been shut down for extended periods and heavily restricted during other periods throughout the pandemic. “The sad thing about these shutdowns is that people are so devastated,” said Robert Strand, who owns Snap Fitness in Detroit Lakes. “They’ve been working so hard for whatever reason, to lose weight or for their mental health, that to have that outlet shut off is not good.”


Are gyms open or closed? A yo-yo year Strand bought the gym in November of 2019. With treadmills, ellipticals, recumbent bikes, weight machines and free weights, all available 24 hours a day, it seemed like a natural fit for the Detroit Lake police sergeant, who needs to stay strong for his job anyway. The gym also has an infrared sauna, which safely uses light to create heat. Two months later, on Jan. 9, the World Health Organization announced the outbreak of a mysterious coronavirus-related pneumonia in Wuhan, China. Needless to say, it’s been a bad year to own a gym: Strand said Minnesota gyms and fitness centers were ordered closed on March 17, in the first sweeping shutdown ordered by Gov. Tim Walz, and stayed closed until June 10.

“It’s pretty sad when I go back (through the calendar) to look at this year,” he said of 2020. Snap Fitness operates on month-to-month membership contracts, and there were still bills to be paid even without any revenue coming in, he said. “The media’s got everybody so scared of COVID, I’ve lost over 140 members since the start of COVID,” he said. “I have 253 members now.” Minnesota gyms and fitness centers were able to open and operate normally for five months, from June 18 until Nov. 20, when they were shut down again for about a month. “We just opened back up Dec. 18,” he said in early January.

Working out while wearing a mask The Detroit Lakes Community Center “recognizes the importance of physical activity on mental health,” said Kim Bettcher, marketing director for the fitness and aquatic center at the Detroit Lakes Community and Cultural Center. As of early January, the center was open again, but this time around (as required by the state) masks are required even while people are working out, running or playing basketball or pickleball in the gym, Bettcher said. That can be a challenge, said Dalton VonRuden of Detroit Lakes, who said he works out five or six days a week. “It’s tough to keep up the same intensity you’re used to, because

Snap fitness owner Robert Strand stands in front of his fitness center's Myzone screen. His gym offers members the option to use the Myzone group fitness digital technology system, with wearable fitness trackers. Nathan Bowe/Tribune the oxygen flow is restricted,” he said. “But you’ve got to do what you’ve got to do — suck it up and go for it.” Also exercising in early January was Joyce Holm of Detroit Lakes, who was working out on an elliptical machine. “Whenever they’re open, I’m here,” she said. “It doesn’t matter (about wearing a mask). I’m used to it.”

continued on page 13


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continued From page 11 In addition to masks, a 12-foot distance is required between members while exercising, and the operating capacity is at 25%. “If you do the math, you can have 100 people at a time here,” Bettcher said.

Trying to keep the customers satisfied The 25% capacity at Anytime Fitness in Detroit Lakes was 21 people in early January, said co-owner Alicia Lokken. “We’re seeing an increase in people interested in joining, we’re seeing our members starting to come back in — it’s starting to pick up,” she said. The public is pretty divided over mask-wearing in general, let alone while exercising at a gym, and that makes it tough on small business owners who are trying to keep all of their customers satisfied, she said.

have lived in the area for more than five years, and are CrossFit members themselves. Why buy a gym during the time of COVID-19? “All four have started out as members of CrossFit Detroit Lakes and grew a passion for the community, have built strong relationships with other members inside the gym, and have embraced the methodology of the sport,” the four said in an email. “We were given the opportunity to take over ownership of a business with a strong foundation that was built by the dedication of the previous ownership and continue to grow the community that we have become attached to.”

We’re seeing an increase in people interested in joining, we’re seeing our members starting to come back in – it’s starting to pick up. Alicia Lokken

With more than 60 members and growing, the new owners of CrossFit Detroit Lakes have reconfigured the gym to accommodate COVID-19 guidelines, as well as ANYTIME FITNESS CO-OWNER adding on an additional 2,000-square-foot building “People are still afraid of for athlete transition in COVID, just because of the between classes, stretching, stigma put on it,” she said. and future expansion. “We “Others just want to live are working on additional offerings to support the health of their lives and not let COVID drag them down. Most of our our community and will roll out our kids/teens programs members respect us and want us to stay open, so we will be coming soon.,” the new owners said in the email. following those rules.” “We have had to adjust to meet ever-changing state Online Zoom classes offered by Anytime Fitness to guidelines as far as spacing, social distancing and mask members are still very popular, and there are no plans requirements,” they added. “Since the initial shutdown, we for now to offer live classes again. Only three people at a have had a detailed COVID plan that consisted of providing time could participate anyway, with the current distancing virtual classes, loaned gym equipment and increased rules, she said. community engagement activities.” Anytime Fitness is open 24 hours, and has treadmills, ellipticals and exercise cycles, as well as free weights, and personal training. But even before the shutdown, she said, “we had more people connecting virtually (for exercise classes) than we had in the club. People love the convenience of being at home and wearing what they want...”

Once open again, they “increased the amount of cleaning supplies and sanitizer available, frequency of cleaning the gym, expansion and reconfiguration of our gym space to ensure proper social distancing, purchase of additional equipment to make sure no one shared equipment and all equipment could be kept within the designated workout space.”

In general, with schools reopening, new COVID-19 case numbers decreasing in Minnesota and North Dakota, and vaccines being rolled out, Lokken is optimistic about the future. “Things are moving in the right direction,” she said.

The new owners describe CrossFit as a fitness lifestyle, characterized by safe, effective fundamental movements used in everyday life. It can be used as a goal for anything from improved health to weight loss to better life outside of the gym.

Buying a gym during the time of COVID-19 The CrossFit fitness center in Detroit Lakes has news owners: Bob and Onika Allen of Detroit Lakes, and Josh and Ashley Erckenbrack of rural Detroit Lakes. Both couples

People are happy to be exercising again At the Detroit Lakes Community Center, people are eager to be exercising again.

continued on page 14 HEALTH BEAT | 13

continued From page 13 “I came in here Saturday morning and every piece of equipment that could be used due to spacing, was being used,” said Sallie Eikren, aquatics and wellness director at the Community Center. Both Bettcher and Eikren encourage people to enjoy the community center, but to also get outside when the weather allows and have fun on foot, ski or snowshoe. “We’re really looking to keep the community engaged, and not everybody is comfortable inside,” Bettcher said. So what was open at the Community Center, as of early January? The swimming pool was open, with some restrictions, but the sauna and whirlpool were closed. There was limited lane swimming, and the Sunfish swim club and high school dive team were using the pool, but there was no open swimming yet. The track, treadmills, ellipticals, stationary bikes, weight machines and free weights were open, with spacing requirements. And the women-only workout room was open. But in-person exercise classes were not yet available — those were still being done remotely over Zoom. Personal trainers, however, were available. Youth basketball had restarted, but without the usual parent spectators for games. Pickleball was back, and “it was fun to hear the pickleballs hitting the floor again this morning,” Eikren said in early January. Racquetball was limited to two people per court. The Backyard play area for kids remained closed. “We’re missing our kids around here,” Bettcher said.

They want us to be open – to be open we need to keep our numbers down and wear masks. Kim Bettcher, DETROIT LAKES COMMUNITY AND CULTURAL CENTER

“They just change it up a little bit,” she said. Instead of jogging on a treadmill, maybe they intensely walk on an incline. “They change the intensity.” High school kids from Detroit Lakes, Lake Park and Frazee were using the community center again, and Bettcher and Eikren were impressed with how well they followed the mask mandate. “The kids have been great,” said Eikren. “The kids have been fantastic,” Bettcher added. “They appreciate the fact that they can be in here.” Although staff keeps an eye on things and enforces the state mandates, adults at the community center tend to police themselves, she added. “They want us to be open — to be open we need to keep our numbers down and wear masks.”

The Community Center touches a lot of lives, “from infants to 100-year-olds,” Bettcher said, “and we try to make sure we have something for everyone.”

Keeping a fitness center up and running in the time of COVID-19 requires a lot of patience, and the ability to troubleshoot, Bettcher said. “We haven’t had one executive order the same as another. That’s not a bad thing, but you have to make sure you’re staying on top of it.”

“From chair-based yoga to HIIT (high-intensity interval training) classes,” added Eikren. Working out while wearing a mask can be a challenge, but people have been adjusting their workout routines to make it work, she said.

That’s why “pivot” became the word of the year amongst Community Center staff, she said. “We need to be able to pivot (with the changes). The whole staff did a good job trying to adjust.”

The CrossFit gym in Detroit Lakes, as set up in early January for COVID-19 restrictions. Submitted photo







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