Minnesota is prepared for COVID-19's second act

Minnesota leaders said they are prepared for a resurgence of COVID-19 if the state follows the pattern of others where cases of the infectious disease increased after relaxation of social distancing and stay-at-home restrictions.

Compared with the start of the first wave, Minnesota now has more capacity to test for and track the novel corona­virus that causes COVID-19, along with more hospital beds and at least stable supplies of masks and gowns to protect doctors, nurses and other caregivers.

"There's no question in my mind but that we're better prepared," said Jan Malcolm, state health commissioner. "We also know a lot more about the virus than we did four months ago."

And it's not that the state is finished with the first wave. While the pandemic ebbed in June, the state on Friday reported 25 COVID-19 deaths — the highest daily total in the last week — along with 490 new cases.

Daily reports of COVID-19 deaths have tended to be higher on Fridays, but the latest tally increased the overall death toll to 1,274 and pushed the number of deaths involving long-term care residents above 1,000. The total of known cases is now 29,795 — though that includes 25,028 people who have recovered.

It's possible that a second wave could be worse, as was the case in the Spanish flu epidemic of 1918-1919, or could come as a double whammy in the fall with the start of influenza season.

About a dozen states including Arizona, Florida, Texas and Utah have seen recent case growth, with some growth in severe COVID-19 cases requiring hospitalization.

Risk of death or hospitalization is highest among the elderly — with 82% of Minnesota's deaths in people 70 or older — and among people with chronic health conditions such as asthma, diabetes and diseases of the lungs, heart, kidneys and immune system.

Leaders with the U.S. Centers for Disease Control and Prevention on Friday said that they have investigators in states with upticks to determine the underlying reasons and to inform others in their long-term preparations.

"It's important that we remember this situation is unprecedented and that the pandemic has not ended," said Dr. Robert Redfield, the CDC director.

CDC officials cautioned that some states are only seeing an increase in cases — not hospitalizations — that could reflect more testing and identification of mild infections that were missed in the past.

Minnesota on Thursday reported 13,391 diagnostic tests — its second-highest daily tally so far.

Free testing took place this week at four sites in Minneapolis and St. Paul following protests over the May 25 death of George Floyd in police custody.

The state recommended testing for anyone involved in these mass demonstrations, regardless of whether they have respiratory symptoms that suggest COVID-19.

More than 3,200 tests were conducted at these sites this week. Results from the first 1,300 showed a positivity rate of 1.4%.

Testing has continued at long-term care facilities throughout Minnesota as well as part of a state strategy to reduce deaths in those facilities by quickly identifying and responding to outbreaks.

The state has orchestrated testing of nearly 36,000 residents or workers in 217 long-term care facilities that have had outbreaks.

Health officials believe that has slowed the growth of infections in long-term care facilities, which in Minnesota includes nursing homes, assisted-living and other group-living facilities.

The number of these facilities reporting outbreaks declined from 23 per day five weeks ago to five per day last week.

Hospitalizations of COVID-19 patients in Minnesota dropped slightly on Friday to 403 — including 191 needing intensive care.

Malcolm said it is encouraging that the ICU usage number has declined by 70 since late May, when some Twin Cities hospitals briefly ran out of these critical care beds and had to divert patients.

Leaders of Twin Cities hospitals reported stable levels of personal protective equipment such as masks to protect doctors, nurses and others treating COVID-19 patients — though the state lists large orders, including 2.4 million highly protective N95 masks, as overdue for delivery to the state stockpile.

Allina Health's preparations for COVID-19 were unexpectedly tested by the protests and riots following Floyd's death, which occurred near Abbott Northwestern Hospital in Minneapolis.

Patients in Abbott's mental health unit were transferred because of concerns about their anxiety levels with loud or even violent protests outside.

Births tripled to 41 within 48 hours at United Hospital in St. Paul, as expectant mothers switched there from Abbott.

Medical helicopters diverted to the Crystal airport because some protesters were reportedly using laser pointers that could potentially blind pilots landing atop Abbott.

Emergency staffing plans were enacted as many caregivers couldn't make scheduled shifts because of unrest near their homes or around the hospitals.

Preparations for COVID-19 aided in the response to that crisis, but the real-life experience also provided lessons that could help with the next surge of cases, said Lisa Shannon, Allina's chief operating officer.

"It really put our COVID readiness to the test," she said.

Health officials stressed that the best way to prevent hospitals from becoming overwhelmed is by having individuals maintain social distancing that reduces virus transmission.

A May CDC survey suggested that most people are still supportive of mask wearing and keeping 6 feet from others to reduce virus transmission, but it's likely that many are tiring, said Dr. Jay Butler, the CDC's COVID-19 response incident manager.

"We recognize that we're all getting tired of staying at home," he said. "People long for the lives that they had back in December."

Malcolm said she worries that Minnesotans will suffer from "mitigation fatigue" and stop complying with social distancing. Gov. Tim Walz mentioned fatigue along with economic concerns in his gradual scaling back of a statewide stay-at-home order, which ended May 18 after 51 days, and his allowance this week for limited reopenings of indoor restaurants, fitness clubs, movie theaters and other entertainment venues.

Minneapolis-based Medica surveyed more than 18,000 of its health plan members and found that nearly one-third ranked mental health as their top concern in the pandemic — with anxiety and depression being particular problems.

Prolonged isolation has been a growing problem for long-term care residents as well, and the state Health Department is exploring ways to protect them from infection but allow friends and relatives to visit — perhaps through windows or outdoors.

That separation "has been one of the most heartbreaking parts" of the pandemic, said Kris Ehresmann, state infectious disease director.

Sticking to social distancing will help everyone and allow more activities to resume, she said. "We all want to keep things moving in the direction of reopening. For that to happen, we need all Minnesotans to do their part ... The less people follow this guidance, the greater chance we will see more spread and have a harder time toward greater reopening."

Jeremy Olson • 612-673-7744