Cross-border comparison complicates Minnesota's COVID-19 response

Minnesota is showing signs of progress in the COVID-19 pandemic, reporting its lowest daily counts of deaths and hospitalizations since April on Monday, at a time when more than 20 other states are reporting rising case counts.

"We want to celebrate every day that those numbers are low," said Kris Ehresmann, state infectious disease director.

But Minnesota has a Wisconsin problem.

While both neighbor states show declining growth in COVID-19 cases and deaths, Minnesota has reported 1,304 deaths so far in the pandemic compared with Wisconsin's 694. And Wisconsin achieved its progress despite being more populous and having its stay-at-home order lifted prematurely on May 13 via a Wisconsin Supreme Court ruling.

The variation has grown from a statistical curiosity to a source of political tension that could upend Gov. Tim Walz's pandemic response, which included a 51-day stay-at-home order followed by a gradual reopening of businesses and activities. Late last week, Republican lawmakers used the variation to oppose an extension of peacetime emergency powers giving the governor sweeping authority over the state's response.

"It is difficult to make that case when Wisconsin has been doing fine without emergency powers for 4 weeks," said Rep. Pat Garofalo, R-Farmington, in a tweet.

Minnesota health officials have reached out to their cross-border counterparts to learn what has worked, but state Health Commissioner Jan Malcolm said on Monday that it is too simplistic to use the Minnesota-Wisconsin comparison as a referendum on whether stay-at-home orders are worth the economic pains they cause.

"Even as the state restrictions [in Wisconsin] were relaxed, the more significant population centers, the cities, kept restrictions in place," she said. "So it wasn't like a complete, all-at-one-time reopening for the most part."

Minnesota was the 22nd of 39 states and the District of Columbia to declare a stay-at-home order, according to data from the Institute for Health Metrics and Evaluation in Washington. Among 29 states that ended those orders, Minnesota's ranked 12th in length at 51 days.

Walz was cautious in scaling Minnesota back following the order, though. Limited retail shopping wasn't permitted until June 1, and limited indoor restaurant and bar service wasn't allowed until June 10.

Wisconsin reopened fully when the court lifted its order after 49 days, but cities such as Milwaukee imposed local restrictions. Arizona reopened fully as well on May 16 after 47 days — specifically barring local restrictions — and it has seen a near tripling of daily case counts that prompted some health officials to call for renewed restrictions to slow the spread of the virus.

"That doesn't mean you need to close down the state ... but if you wait too long that could become the only choice," Andy Slavitt, a former Medicare administrator and health care adviser who lives in Edina, said in a news conference for Arizona media on Monday.

The takeaway from the varied experiences is that it is foolhardy for now to compare Minnesota with any state, especially when the pandemic is "in the second inning of a nine-inning game," said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

Osterholm agreed that Arizona and other states need to take action on their rising COVID-19 cases, but that doesn't mean that every other state should do the same.

"I see far too many people out there making conclusions based on one state or comparing one state to another," he said. "I think we're way short of being able to do that with any scientific accuracy."

Osterholm predicted the virus would spread at different rates in different states but would ultimately infect at least 60% of the U.S. population unless a vaccine is developed.

The muddled national picture is reflected on the COVID Exit Strategy website, which lists 27 states as trending poorly, 18 states including Minnesota as making progress and six states including Wisconsin as getting better.

The key difference between Minnesota and Wisconsin, per this website's analysis, is that Wisconsin has more capacity in its available intensive care beds right now.

Minnesota as of Monday had 1,053 of its 1,253 available intensive care beds filled by patients with COVID-19 or other unrelated medical needs.

The state has another 944 ICU beds that could be readied if needed within 72 hours, though, and on Monday received final clearance to use a former long-term care facility in Roseville as an overflow facility for non-COVID-19 patients if needed.

The state on Monday reported a daily low since April 12 of six deaths and 353 COVID-19 patients who were hospitalized — below the peak of 606 hospitalized patients on May 28.

Minnesota has now reported 30,693 lab-confirmed cases of COVID-19, compared with Wisconsin's 22,932.

Malcolm said outbreaks in several food-processing plants — including the JBS pork plant in Worthington that contributed to 1,620 cases in Nobles County alone — could explain some of Minnesota's increased case count.

Almost all of the deaths in Minnesota involved the elderly or people with underlying health conditions such as asthma, diabetes or diseases of the lungs, heart, kidneys or immune system. And 1,034 of the deaths involved residents of long-term care or assisted-living facilities.

Malcolm said it is a relief that Minnesota's case growth is declining, but that it is unclear if the state could follow others such as Arizona that showed eventual increases.

The impact of recent events in Minnesota on disease transmission are unclear. Health officials expect to know by week's end whether the protests over the May 25 death of George Floyd in police custody resulted in an increase in cases.

Diagnostic testing is recommended for anyone involved in the mass events, regardless of whether they have any symptoms. Results of free testing for such people at four sites in Minneapolis and St. Paul last week found the virus in 1.8% of 3,200 people. HealthPartners reported a positivity rate of .99% in the recent testing of 8,500 asymptomatic people.

The state's current rate of positive COVID-19 tests is 3.5%. That higher percentage in part reflects the symptomatic patients who seek testing from their doctors and are more likely to be infected.

Health officials stressed that it is too soon to assess any increase in cases in Minnesota related to the relaxation of restrictions on June 1 and the latest steps on June 10 that allowed for the reopening of movie theaters and bowling alleys and for group meetings of 10 people indoors and 25 people outdoors.

Ehresmann said it probably takes 21 days to see an effect based on the incubation period of two to 14 days for the novel coronavirus that causes COVID-19, and the usual delay before people who get sick seek medical attention.

Slavitt highlighted recent research showing higher average COVID-19 case growth in states that reopened faster. However, he said state comparisons aren't very meaningful right now and that Minnesota can benefit more by improving its strategies to prevent outbreaks in food processing plants and nursing homes, and its ability to respond to virus hot spots.

"We should understand that the virus, biologically, goes to the places where it hasn't been," Slavitt said. "So anyone that looks at New York or Arizona and says, 'Ah, we're smarter, we're better,' they're missing that fundamental understanding."