4-28-2020 COVID-19 Update from the MN Department of Health

Minnesota Department of Health COVID-19 Update 4-28-2020

Read the April 29th Update Here

Today’s Topic: Situation Update

Tuesday, April 28, Commissioner of Health Jan Malcolm and Infectious Disease Division Director Kris Ehresmann provided a situation update on the Minnesota Department of Health’s response to COVID-19, including new cases and investigation findings. 

The following is a summary of that conference call with reporters:

Update from MDH Health Commissioner Jan Malcolm:

• Globally, more than 3 million cases and over 211,500 deaths
• In the U.S., more than 1 million cases and 56,000 deaths.
• In MN, 4,181 positive cases of COVID-19 and 301 deaths 
• 1,912 patients released from isolation, 314 patients are currently in the hospital and 120 patients in the ICU 

Update from MDH Infectious Disease Division Director Kris Ehresmann:

• With the increase in testing, as well as the intensive testing that has been done at various agri-business plants across the state, we are seeing a big increase in our case numbers. 
• With more testing, we will see more cases
• In the coming days, we will continue to see more and more cases. People should not be shocked or concerned. Early in the pandemic when we had less testing capability, we talked about how each case represented just a portion of what was happening in the community. Now that we have more testing, the state is now getting the opportunity to more appropriately measure what’s happening in the community.
• The deaths in MN represented a higher proportion of cases than were being seen in other states. Part of the reason for that is a higher proportion of vulnerable, at-risk people who are predisposed to more severe disease, and unfortunately, death — those the ones who were being tested. The numbers we were seeing were not a true representation of an assessment of the total population.
• Yesterday, Minnesota’s deaths represented 7.9% of the total cases, and today with an increase in cases within other sectors of our population, that has dropped to 7.14% so we will continue to likely see that change as we’re doing more and more testing in what would be considered a less vulnerable population.

Assistant MDH Commissioner Dan Huff:

• Update on testing strategy as the state launches the governor’s “moonshot” to increase testing statewide to everyone that needs it.
• A week ago, reported 927 tests done in a day.
• Since the governor’s announcement, we’re exceeding 2,000 tests a day (more than double from a week ago)
• We’re not where we need to be on testing, but we’re increasing capacity every day.
• We’re now developing an integrated testing system statewide with every health care system in the state — so instead of being dependent upon your particular health care provider, we now have a statewide network so that if one provider is low on capacity, we’re able to tap into others.
• By contracting with Mayo and the U of M, we are opening up that excess or surge capacity.
• The state has a testing coordination center that is working with representatives from our various health care organizations, and Mayo, and the U of M, and MDH to make sure that they’re integrating and providing tests statewide
• MDH has launched a website where clinics can send information of where they’re doing testing. That website changes every day as clinics come on board or if they run out of supplies. 
• Also beginning to ramp up other parts of the testing program — one is looking at contact tracing. MDH is now moving into unprecedented levels of testing, and needs unprecedented levels of test investigators. MDH is training more people within the department and local public health to expand that network.
• How do we target our priority populations? We have hot spots in long-term care, and in our food production areas. We want to test people in congregate care settings, long-term care, prisoners in jails, homeless shelters, and in communities of color (MDH knows they have been disproportionately impacted by COVID-19 nationwide).
• MDH also looking at testing workers in critical infrastructure — transportation, child care, food production, grocery store employees, utilities, etc. All of these workers are critical to the functioning of our society, and MDH is prioritizing them for testing as well.
• As we develop this moonshot approach, we’ll have some “jumps and starts” as we launch into this. We’re making good progress. We do not have the capacity to test everyone we want to test today, but we’ve doubled that in the past week and we will continue to increase that. 

Update from State Epidemiologist Dr. Ruth Lynfield:

• Serology — it measures antibodies or an exposure to something
• In order to measure that, it takes time to build up antibodies. 
• There are different types of antibodies: IGM, IGG
• It can take about a week to measure the IGM levels, it can take 2-3 weeks to peak the IGG levels. 
• Depending on when after exposure one does the test, one may or may not be able to detect antibodies.
• Another issue is whether the antibody is protective or not. There are certain kinds of serological tests that are measuring antibodies but they are not measuring what we call neutralizing antibodies. In order to do that, you need to have cells that have virus growing on it and you put the person’s solution at different dilutions and you see if the antibody that is present can prevent that virus from replicating, or neutralize the virus. That can help us understand, does someone have protective immunity? It’s not an absolute correlation, but it is a good one.
• There are not may tests that have viral neutralization. Many of the tests are just measuring whether there is binding to a viral protein.
• We also don’t know that if someone has antibodies, they’re exposed to COVID… to the virus that causes COVID-19, if they will be protected from disease. People are actively doing research on this now. And we just don’t have that information yet.
• We also don’t know, if there is protection, how long it lasts. Does it last for 6 months? Does it last for a year? Does it last for 2 years? We don’t know. This is something that we’re all learning.
• How do we use antibody tests against the virus that causes COVID-19? Right now, a good use would be to understand on a population level how many people may have been exposed to this virus. That can help us understand the scale of the current pandemic in Minnesota communities. 
• Another use is there is a research study going on right now on utilizing people who have had lab-confirmed SARS-CoV-2 infection because they were PCR-positive, and it is looking at whether using their convalescent plasma to help other patients who have COVID-19, and for that purpose, it is helpful to figure out who has antibodies.
• We do not know at this point in time, how to use antibodies for individual decision-making. And that is because of a number of things — there are now more than a hundred serological tests out there, they have a variety of performances, and some are not as accurate as others. In fact, there is a national group that is evaluating the various tests that are out there. But even if you have a test that has very good sensitivity so it can detect the antibody, and very good specificity, which means that it’s detecting SARS-CoV-2 and not one of the other human coronaviruses, and not cross-reacting with something else, the accuracy is going to vary with how many people have been exposed because these tests are not 100% sensitive or 100% specific.
• When there are fewer people in the population who have been exposed, the chances are that the positive is a true positive, or what we call the positive predictive value, falls. And we will have a certain number of people who test positive who aren’t truly positive.
• Finally, the other thing is, again, we don’t know what it means. We don’t know if somebody has antibody present… we cannot say that “you are not going to get infected again,” because we don’t know that. We don’t know, if you get infected again, you may still be able to shed virus and transmit to other people. 
• So at this point in time, really the uses for serological testing are for seroprevalence, and we are going to be doing some of these studies in Minnesota to determine how widespread the infection has been, and for use in identifying people that have an antibody response that can serve as convalescent plasma donors.  

Additional notes from the meeting:

• As we’re ramping up testing volumes, we still need to set some priorities for testing. MN has been prioritizing testing in long-term care facilities, and we’re continuing to do that because of their vulnerabilities. But capacity is not yet where it needs to be to do widespread testing across the board in every long-term care facility.
• Testing is not just a question about getting a result. There are implications of those results. We need to have plans for staffing or housing for those people who test positive. 
• MDH is providing long-term care facilities with tools they can use in communicating with residents and family members when positive tests are found.
• We are learning about COVID-19 as we go. We do know that there are other infections where the immunity is much more short-lived. Some of that is because there are changes in the virus, like influenza, it has the capacity to change more frequently. That’s why there’s a new flu vaccine every year. What we’re hoping with coronavirus is that there will be protective immunity because that’s what will get us out of this pandemic. When there is a high enough proportion of the population has protective immunity, then transmission of the virus fizzles out. Oftentimes we would see that, if for example we have an effective vaccine. That’s how we’re able to eliminate measles from the U.S.  
• Dr. Lynfield says if someone has a positive antibody test that they shouldn’t stop social distancing. 
• Regarding an executive order by President Trump to keep meat processing plants to stay open, Commissioner Malcolm said “while we appreciate the importance of these industries to the farmers and the food supply”…it seems problematic to say the least. We want to make sure that if these businesses are open, that their employees are staying safe. 
• Will Minnesota be ready to reopen Monday if testing continues to ramp up? “I can’t say if we’re at 4,500 it will be ‘no’ and 6,000 it will be ‘yes.’ It’s much more complicated than that.” said MDH’s Jan Malcolm. Governor Walz expected to make decision later this week.
• MDH officials can’t give a number as to how many tests they’ll be able to implement on Monday 

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