Now with 2,000 COVID-19 deaths, Minnesota health leaders consider what state has learned and lost

The COVID-19 pandemic has inundated people with waves of numbers about infections and positivity rates and diagnostic test performance, but the milestone Minnesota reached this weekend is sobering.

Two thousand deaths.

That's the population of Hinckley, Eyota, or Warroad.

"Two thousand is a big number," said Dr. Rahul Koranne of the Minnesota Hospital Association. "That's heartbreaking."

Minnesota took about two months to reach its first 1,000 COVID-19 deaths in late May, but then four months to reach the next 1,000 — a slowdown that reflects changes in the spread of the virus, improvements in oxygen management of hospitalized patients, and interventions that cut outbreaks in long-term care facilities that were particularly deadly.

State health leaders paused silently at a meeting Friday to absorb the death toll and contemplate what Minnesota has learned amid the pandemic and what it has lost.

"We want to acknowledge the positives, but I also think people need to realize that COVID did not magically go away or get to be a better virus over the last few months," said Kris Ehresmann, state infectious disease director. "There just have been some other factors that have contributed" to slowing the death rate.

Many trends held from the first 1,000 deaths to the second. Age was the dominant risk factor, with 81% of deaths involving people 70 or older. Minorities continue to suffer more deaths at younger ages, representing 61% of COVID-19 deaths under age 65.

Residence type mattered, as long-term care residents constituted 72% of deaths — although that has changed. Since Aug. 1, those residents made up 55% of COVID-19 deaths.

Lost in the collectivity of the numbers is the individuality of the victims and families.

They included Thomas Stelter, 77, a former Como Golf Course greenskeeper who tinkered with cars and made wooden crosses for child cancer victims and family occasions until he became unexpectedly ill at home in St. Paul. Daughter Colleen Young buried him on Thursday, after losing one father-in-law in her extended family to COVID-19 on April 22, and another father-in-law to the infectious disease on May 7.

"My girls have lost all three of their grandfathers in just under five months," she said.

John Castillo, 59, of Coon Rapids, was a quality assurance technician for medical devices and the inventor of the "whacker clapper," a rectangular foam noisemaker for sporting events. Castillo resisted going to the hospital for a week after getting sick but then was rushed to the emergency room and placed on a ventilator before he died Sept. 14.

"He was trying to see what his body would do on his own," said his daughter, Tiffany Jahangiri. "He was a tough guy."

David Brehm was police chief in Wayzata in the 1980s and worked in the sheriff's departments in Anoka and Hennepin counties. He was living in a nursing home when he contracted COVID-19 and died in late May at age 75.

"When he died, the fact that we couldn't have a funeral and memorialize how he was a great public servant — it just breaks my heart," said Wendy Surprise, his daughter. "It should not have happened unnoticed."

The state on Saturday reported 1,478 newly lab-confirmed infections with SARS-CoV-2 and 10 deaths, bringing the totals to 95,659 infections and 2,004 deaths.

Crude math indicates that 2% of all people with lab-confirmed infections in Minnesota have died from COVID-19, but the pandemic isn't that simple. Only 53 COVID-19 deaths have involved people younger than 50, making the death rate from lab-confirmed infections only .08% in that age demographic.

Federal health officials have also estimated that every one known case represents 10 unknown infections that were never tested due to mild or no symptoms.

If correct, the death rate from known and unknown infections is well below 1% — and also below the estimate of 3.4% that first emerged in China along with the coronavirus this winter.

Minnesota's first COVID-19 death on March 19 was Luningning Mariano, 88, of St. Anthony Village, a Filipino woman who may have been infected amid contact with visitors from outside the country.

At the time, there was no proven treatment, and doctors were hastening patients to ventilators because other less-invasive forms of oxygen management could cause coughing or gagging that could blow the virus into the air and infect medical personnel.

Since that time, doctors have found that early and less-invasive oxygen management improves outcomes; the antiviral remdesivir has been proven to help in hospitalized cases; and the steroid dexamethasone has shown an ability to counter the immune system overreaction that instigates many COVID-19 deaths.

Stelter received all of those treatments during 27 days of hospitalization and two trips into intensive care. An infusion of donor plasma appeared to help, but then he suffered pulmonary embolisms due to blood clots that are common with COVID-19.

Known ironically as "Evil Tom," Stelter was a fair roller-skater in his earlier years and doted on his grandkids — attending one's first birthday party and being with his entire family four days before falling ill. Relatives and his doctor suspect he was infected days earlier, perhaps chatting with friends outdoors when he was less likely to wear a mask.

This spring, he cashed his COVID-19 stimulus check and split it up among the teenagers at the McDonald's where he went for his regular coffee.

"He didn't have a mean bone in his body," his daughter said.

May was the deadliest month of the pandemic in Minnesota, with 705 deaths, according to 1,974 death records analyzed by the Star Tribune.

The highest one-day death total of 32 fatalities occurred on May 1 as well — weeks before the peak in infections that clogged Minnesota's hospitals and intensive care units over the Memorial Day weekend.

At the time, COVID-19 was sweeping through many nursing homes and assisted-living facilities, places that house those who need assistance because of illnesses or frailties. But those conditions make residents particularly vulnerable to the new coronavirus and most who died had several underlying health conditions.

At least 800 of those who died had some type of cardiovascular condition, including 526 with hypertension. Heart disease, congestive heart failure and atrial fibrillation were noted by doctors on the death certificates.

Hundreds had chronic lung or kidney diseases. In addition, 344 had diabetes, 130 had a cancer history and 63 were noted to be obese.

They worked or retired from industries deemed essential in the pandemic age. More than 175 worked in Minnesota's health care sector.

Nearly 160 were in education, 126 in manufacturing and 90 in government positions, according to occupational data listed on death certificates.

Some held distinctive jobs — watchmaker, milk truck driver, sports referee, and psychic — while others were employed by former brands such as Dayton's, Northwestern Bell, and Donaldson's that are part of Minnesota's history.

To protect Minnesotans from the virus, Gov. Tim Walz and state health leaders took extreme measures, including a 51-day statewide shutdown that put thousands of people out of work, an indoor mask mandate, and restrictions on crowds at bars, restaurants and group events that are still in effect.

"We have to work together to slow the spread of this pandemic," Walz said in a social media post Saturday marking the deaths.

The unsettling part of public health is that state officials will never know whether or how well the efforts worked. Koranne said he believes the state would have been much worse off without the interventions, which bought hospitals time to add staff and protective equipment and ventilators and to avoid the nightmare scenario in Italy this spring when people died because no treatments were available.

"Minnesotans did stay at home and did physical distancing and did buy us those months," Koranne said.

Castillo, who died Sept. 14, was Hispanic and knew his prior heart problems increased his risk. He wore masks constantly and turned back hugs from his children to be safe. Nobody is entirely sure how he got infected.

A dedicated fan of the Minnesota Timberwolves and a member of the Vikings World Order fan club, Castillo amassed a network of friends through work and life that his children came to fully comprehend after he died. Castillo will be missed at Vikings games but isn't gone.

"We got the Vikings cutout for him," his daughter said. "So he is at the game."

Staff writers MaryJo Webster and Chris Snowbeck contributed to this report.