4-21-2020 COVID-19 Update from the MN Department of Health

Minnesota Department of Health COVID-19 Update 4-21-2020

Today, Tuesday, April 21, Minnesota Commissioner of Health Jan Malcolm, Infectious Disease Division Director Kris Ehresmann, and Health Regulation Division Director Michelle Larson provided a situation update on the Minnesota Department of Health’s response to COVID-19, including new cases and investigation findings. 

This is a summary of that conference call with the media:

Update from Minnesota Commissioner of Health Jan Malcolm:

• Globally, 2.5 million cases of COVID-19 and 171,000 deaths
• 788,000 cases in the U.S. and 43,000 deaths
• 2,567 cases in MN and 160 deaths
• 1,254 patients in MN out of isolation. Currently, 237 hospitalized and 117 people in the ICU
• There are a large number of long-term care facilities in MN with at least one case of COVID-19. The MDH is closely tracking these cases.

Update from MDH Infectious Disease Division Director Kris Ehresmann:

• Residents of congregate care settings (nursing homes, group homes, etc.) are at high risk of getting COVID-19
• When we’re made aware of COVID-19 potentially being introduced into these settings, we take rapid action
• Even before COVID-19 being introduced in these settings, we’ve been actively working with leadership of these facilities to provide them with guidance.
• Our most recent call was attended by almost 1,500 participants
• When we’re notified about a confirmed case of COVID-19 in one of these congregate care settings, we begin a comprehensive investigation. We start by having a call with administrators and clinical staff of that facility, as well as representatives from the Department of Health’s surveillance infection prevention team. Initially, our goal is to do an extensive case interview to learn more about the case and who their contacts may have been so we can identify potentially exposed staff, residents and other health care personnel.
• Based on these investigations and interviews we will make recommendations for isolation, quarantine, and/or work exclusion.
• We also go over infection prevention and outbreak control measures (isolating ill residents or making sure ill residents are placed together)
• We go over the type of precautions that the facility should use when caring for these residents.
• We also talk about the type of PPE that should be worn when caring for ill residents.
• We recommend universal masking for source control to limit the opportunity for the wearer to share droplets with people around them in the long-term care setting.
• We make sure that visitor restrictions are in place and group activities have been canceled.
• We also provide guidance on disinfection and cleaning
• We also provide tools on monitoring of health care workers for potential symptoms of COVID-19
• We provide management with the letters and talking points to use with families of residents.
• Each facility that has an outbreak is assigned a nurse case manager, who’s in contact with them daily. That nurse case manager is the “boots on the ground” for the facility.
• We’re also helping facilities with the safe transfer of patients with COVID-19. The goal is to ensure that these facilities have the resources and tools they need to care for those residents.
• We need more resources and we need to do more forward thinking.

Update from Health Regulation Division Director Michelle Larson:

• The MDH is also part of the state Emergency Operations Center 
• If there’s a major staffing problem at one of those facilities with COVID-19 patients, they may get additional resources.
• In order to help with immediate response, there’s a crisis team model being built made up of local and state staff.
• There’s a lot of different types of long-term care facilities across the state. Not one size fits all in this scenario.
• There’s an information line being developed just for long-term care facilities. 
• Long-term planning continues to go on and we’re thinking about how we can sustain this from a state resource side. It’s our goal to get in front of these vulnerable facilities proactively.
• We’re trying to look at facilities that have infection control problems on a non-COVID-19 day. We want to contact them before they have an issue that gets out of hand.

Additional notes from the meeting:

• Recommendation for families who are thinking about putting their loved-one into a long-term care facility is that… it depends on the facility. The family member should have access to the services and care that they require. Oftentimes a long-term care facility is the best place for that to be provided. Ultimately, it’s a family decision. 
• The epidemic is growing in a way that’s not exceeding the state’s capacity to respond.
• “We’re absolutely going to see more cases,” Ehresmann said.
• This shelter in place has allowed the MDH to deal with the situations in the congregate care settings in a more meaningful way. “We’re learning and growing,” said Ehresmann.
• The goal is to grow testing. “It’s not growing as fast as it needs to be,” Malcolm said. The MDH believes the state has the capacity to ramp up testing, but they want to make sure the tests are reliable and of good quality. 
• The MDH received a question about whether all of the residents in long-term care facilities (where there’s been a positive COVID-19 case) are being tested. Ehresmann said “In some facilities, they have had the capacity to do additional testing. In others, less so. But the guidance we have for many of the recommendations for infection prevention, they can be implemented in the absence of those test results.”
• Transmission of COVID-19 in the long-term care facilities is coming in from the community, according to Ehresmann. “It’s entirely possible you can have a staff person or a health care worker, who is working in good faith, and may potentially have exposed residents,” she said. Those people could be passing it onto residents before they even started showing symptoms. There should be no assumptions made that people are working while they’re blatantly ill.
• We see rapid transmission in long-term care facilities because of the close contact of people in these settings. That’s why the MDH is trying to intervene as quickly as possible.
• We are not ready to loosen a lot of the stay at home restrictions in Minnesota until we have had 14 consecutive days of declining cases, according to Malcolm. Governor is working hard to figure out where it’s more safe to reopen segments of activity that would seem to be less risky for rapid and large scale transmission.
• Of the 160 COVID-19 deaths in Minnesota, 113 are associated long-term care facilities.
• Malcolm says “a very, very small percentage of the public has been infected so far. And so we think the potential for a pretty rapid spread still exists unless we’re very careful, and unless we continue practice good preventive measures, good social distancing, good personal health behaviors. The potential for it to spread quickly and widely and have some very negative consequences in the broader population is still there.”
• Race and ethnicity data related to COVID-19 in Minnesota:
  • Challenges of race/ethnicity data — we have race/ethnicity data for a number of variables, but the labs don’t provide racial data on people who have negative tests.
  • Many of our populations were initially underrepresented in our testing, and they remain underrepresented in our data. 
  • Our race data is based on both the availability of testing, based on occupation and living situation.
  • But if you look at the percent of our cases, 13 percent of our cases have occurred in black people, and black people also make up 5 percent of the deaths
  • 61 percent of the overall cases are white and 71 percent of Minnesota’s COVID-19 deaths are white 
  • We’re seeing a higher proportion of deaths in Minnesota’s white and American Indian/Alaska Native population than we’re seeing in other populations. But it’s important to note that our American Indian and Alaska Native population is a very small proportion of our cases, so the MDH has to be careful in how that’s interpreted. 
  • Certainly we’re seeing an incident rate in our black population that’s higher than what we’re seeing in our white population.
  • The MDH says there will be continued outreach into communities of color because of the existing health disparities and health inequities that tend to make those populations more vulnerable.

Brooklyn Center | Brooklyn Park | Crystal | Golden Valley | Maple Grove | New Hope | Osseo | Plymouth | Robbinsdale