5-13-2020 COVID-19 Update from the MN Department of Health

Minnesota Department of Health COVID-19 Update 5-13-2020

Read the MN COVID-19 Update for 5-12-2020 from the Minnesota Department of Health Here

On Wednesday, May 13, the Minnesota Department of Health held a WebEx briefing to present members of the media with the latest version of modeling that is used to inform public health and state policy decisions in response to COVID-19. 

This is the summary of that presentation on the Minnesota COVID-19 Modeling 3.0

State Health Economist Stefan Gildemeister:

• COVID-19 Modeling
• Version 1: March 2020
  • Based on early data available at the time
• Version 2: April 2020
  • Included more specifics about Minnesota cases, factors
• Version 3: May 2020
  • Integrates new details and capabilities
• Ongoing model updates panned with available capacity
• The U of M and MDH created the MN COVID-19 model as a tool to inform response strategies and resources planning
• Updated model documentation is available online, including:
  • references for parameter values
  • underlying data
  • Model equations governing transitions of the population through COVID-19 health states
• COVID-19 remains in early stages and new evidence is emerging
• Ongoing model updates are needed to:
  • reflect the growing understanding of COVID-19 transmission and outcomes 
  • Incorporate new emerging data from the US and MN
  • Refine projections by fitting model MN data on observed mortality and hospitalization data
  • Add new model capabilities to illustrate potential mitigation strategies
• Epidemic and evidence still very new 
• Extent and impact of key metrics uncertain
• Evolving clinical protocols with halting dissemination of evidence 
• U.S. case data are limited and incomplete, affecting availability of robust estimates 
• Limited U.S. Data
  • first studies with U.S. patients in late March and April
    • 4,226 cases in U.S. study: outcomes (illness and death) were unknown for 2,001
    • 5,700 patients hospitalized with COVID-19 in NYC area: discharge or death status was only known for 46%
    • Among hospitalized in MN COVID-19 patients: nearly 32% remain in the hospital
• 1) Structural changes to address
  • Asymptomatic infections
  • Deaths occurring outside of hospital
• 2) Restricted ICU metric to ventilated cases
• 3) Updated parameter estimates using newly available U.S. Data 
• 4) Incorporated new calibrated parameters, including:
  • Proportion of 70-plus year olds dying in non-hospital settings
  • Reduction in contacts under social distancing and under stay-at-home order
• 5) Fitted model to Minnesota deaths and hospitalizations through April 25

• What?
  • Less time to peak epidemic
  • Some upward movement in estimates for:
    • ICU demand
    • Full-epidemic mortality
• Why?
  • Calibration to rising MN deaths
  • Mitigation less effective than assumed for: 
    • initial physical distancing (38%, not 50%)
    • Stay at home order (59.5% not 80%)
  • Changes to ICU mortality assumptions and data 

Model Changes: “Stay at Home Order in Place for 6 Weeks”

Unmitigated and Extended Stay at Home Orders:

Extended Stay at Home Orders and Testing:

Extended Stay at Home Order, CDC Guidelines for “Opening Up” and Medical Advancement

Daily Deaths — All Scenarios

Consideration for Next Steps

• More and better data from U.S. epidemic
• Refined Scenarios
  • Treatment: evidence on home treatment
  • Testing: Incorporate impact of contact tracing
• Enhancements: cycling mitigation

Additional notes from the presentation:

• For a look at all of the slides from the MDH presentation, you can go to: https://mn.gov/covid19/assets/MNmodel_PPT%205.13.20_FINAL%20915AM_tcm1148-431824.pdf
• For a technical document that explains the model in more detail, you can go to: https://mn.gov/covid19/assets/MNmodel_TechnicalDoc_5.13.20_tcm1148-431812.pdf
• “We hope these are pessimistic estimates, but it’s certainly a plausible outcome,” said Stefan Gildemeister, state health economist.
• 1,441 deaths through May under scenario 5, scenario 6 – 1,388 deaths (currently at 638 deaths in MN as of 5/13).
• Deaths would fall if testing ramps up (goal 20,000 tests per day)
• Reopening businesses – would reduce peak, but spread a higher number of cases over longer time
• Models will continue to be revamped to indicate better testing and contact tracing.
• “Just buying time without using it will not dramatically change of the disease,” said Gildemeister, referring to testing and other options to improve mortality totals and cases
• Better treatment options and contact tracing and better care situation will help save more lives.
• Deaths haven’t reached more than 30 per day.
• When asked whether the model will quickly go out-of-date, Commissioner Jan Malcolm said, “The model is never really going to be able to be refined enough to pick up all of those effects about intervention.” 

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