New drug, contact tracing part of Minnesota's next COVID-19 phase

Minnesota health officials are preparing for what's next after the end of a statewide stay-at-home order to limit the spread of COVID-19, even if they don't yet know when the end is going to be.

The Minnesota Department of Health is on track by week's end to employ 460 contact investigators to identify cases early and try to keep small COVID-19 clusters from exploding among entire businesses or communities.

Cases are expected to surge when the stay-at-home order ends, and testing along with contact investigations will be needed to try to prevent exponential growth of the novel coronavirus responsible for the pandemic, said Kris Ehresmann, state infectious disease director. The state might even launch these contact investigations before suspect cases get their results back.

"We anticipate that there will be many, many more positive cases identified," she said, "and so we want to make sure that we are doing outreach even before an individual receives their test results."

Exactly when the stay-at-home order will end is unclear, but it fueled political tensions among state leaders Monday.

While the order technically ends May 18, Gov. Tim Walz has hinted at some form of an extension with exemptions for more businesses, including small retailers, that have adequate social distancing plans to protect workers and customers. Walz's decision is expected this week, perhaps Thursday.

The decision will have to balance the rising case count against a state growing weary of restrictions as well as a temporary shutdown of businesses that has caused 642,000 Minnesotans to file for unemployment benefits.

Cases of COVID-19, a respiratory illness caused by a novel coronavirus, reached 11,799 statewide on Monday. Minnesota's death toll of 591 has surpassed counts in states such as Wisconsin, largely due to outbreaks in long-term care facilities and among people who are most at risk because of their age or health status.

Researchers from the University of Minnesota and the Minnesota Department of Health are slated this week to release version 3.0 of their modeling of the impact of the outbreak, in terms of deaths and use of hospital resources, state Health Commissioner Jan Malcolm said.

That data will help inform that final decision, she said. "We're very much in the compiling-all-the-data stage."

Republican lawmakers in Minnesota lobbied for an end to the stay-at-home order by Walz, a Democrat.

Sen. Michelle Benson, R-Ham Lake, said a newly published scenario under the older version 2.0 modeling showed no progress for Minnesota if the order was extended through May.

Benson had asked for more of the modeling that had informed the governor's decision, which prompted state health researchers to post this scenario online.

"We want to work with the governor, but it is important that we understand the data that is driving the decisionmaking. … We know there are a lot of things beyond the model that might impact the decision, but if we're going to be good partners we all need to be singing from the same hymnal," Benson said.

Malcolm said the new scenario under the old model "was out of date almost as soon as it was posted." State Health Economist Stefan Gildemeister asked for patience until model 3.0 comes out.

The newly published 2.0 scenario affirmed existing assumptions about the impact of the stay-at-home order, he added.

"Extended stay-at-home orders for a reduction in contact push the curve out, generally without necessarily affecting the peak of it."

Walz has expressed concern over people sticking with social distancing if he extends his order. A new Gallup poll on Monday found compliance slipping nationally; 74% of people avoided small gatherings in the past week, down from 84% in late March.

How Walz announces the next steps could make a difference. Chicago researcher Guglielmo Briscese and colleagues published results of surveys in Italy and found that people were less likely to comply with extended lockdowns if they felt they had been promised that they would end.

"Willingness to comply decreases in cases of bad surprises," he said. "The key takeaway is learn how to manage people's expectations and be careful when giving out specific deadlines."

Politics matter, too, though, as Briscese and other researchers found through U.S. surveys that Democrats were more likely to support lockdown measures "for as long as needed" than Republicans.

Walz's order was largely designed to delay the peak of the pandemic and to buy time for hospitals to add critical care beds and ventilators. As of Monday, 1,024 of the state's 1,244 ICU beds were occupied by patients with COVID-19 or other medical conditions unrelated to the pandemic. Hospitals have another 1,351 ICU beds that could be readied within 72 hours.

The state's care providers also received supplies this weekend of an antiviral drug, remdesivir, that has received emergency-use authorization from the U.S. Food and Drug Administration.

The state's initial supply of 1,200 vials could serve about 109 patients based on a standard 10-day course, and the state is expecting more on Tuesday that could serve another 36 patients, Dr. Ruth Lynfield, state epidemiologist, said.

The U has been part of a federal study of the drug, which has been shown to reduce hospital stays for patients who recover from COVID-19.

There are 452 Minnesotans hospitalized for COVID-19, including 194 in intensive care due largely to severe respiratory symptoms and difficulty breathing.

Given that demand for the drug will outstrip supplies, Lynfield said the state has published ethical guidance. Priority will be given to people with severe COVID-19 cases requiring respiratory support with a ventilator, but who have been on it for less than five days. The guidance also calls for doctors to consider the likely prognosis of the patients.

"We are making this allocation with an eye for maximizing the number of lives saved," Lynfield said, "taking into account both risk and expectation of benefit."

Testing for COVID-19 is gradually increasing in Minnesota as part of a $36 million deal with the U and Mayo Clinic to ramp up toward capacity for 20,000 diagnostic tests per day.

Another 4,693 tests were reported on Monday, bringing the state total so far to 115,781.

If testing reaches that level, state officials said there could be need for thousands more contact investigators.

A Minnesota House committee on Monday morning advanced a $300 million plan to use a staffing company to hire as many as 4,200 more investigators. The bill, with funding from the federal Coronavirus Aid, Relief and Economic Security (CARES) Act, would allow furloughed health care workers to be hired temporarily to conduct these investigations.

"It does very little good to just test if we don't follow up with public health measures to control the virus," Rep. Tina Liebling, DFL-Rochester, said.

Several House Republicans on the Ways and Means Committee objected and said it would be ineffective because the virus can be spread by people who don't have symptoms.

"We would be far better off protecting vulnerable populations," Rep. Pat Garofalo, R-Farmington, said. "With a large number of people being asymptomatic carriers for this I don't understand this change in strategy."

Health officials acknowledged that contact tracing presents challenges with COVID-19, especially now that there is evidence that infected people can spread it before they have symptoms.

At the start of the pandemic, investigators asked infected people to list those they had been in contact with after they had symptoms. Now, they ask about those they had been with as long as 48 hours before their first symptoms.

Glenn Howatt and Torey Van Oot contributed to this report.

Jeremy Olson • 612-673-7744