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

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

Read the Recap from the 5-18-2020 COVID-19 Update from the MN Department of Health Here

On Tuesday, May 19, the Minnesota Department of Health held a conference call to brief members of the media on the latest public health information regarding COVID-19.

The following is a summary of that media briefing.

Update from MDH Commissioner Jan Malcolm:

• Global there are 4.8 million cases of COVID-19 and 318,000 deaths
• In the U.S., there are 1.5 million cases and 90,000 deaths
• In Minnesota, there are 17,029 cases and 748 deaths. Of the 17 additional deaths reported yesterday, 13 were residents of long-term care facilities. 
• The case doubling time is now at 13 days, which is compared to 8 days to double a couple of weeks ago. The MDH focuses on this case doubling rate as a measure of how quickly the epidemic is growing relative to the underlying volume of cases and population.
• The MDH is tracking 8 counties now with food processing plant outbreaks. While the number of cases in these counties per 100,000 puts the incidents of COVID in some of these areas on par with Hennepin and Ramsey Counties — and puts it on par with some of the fastest growing counties in the nation — these 8 counties currently represent only 12 percent of the new cases day over day. So that’s an indication to the MDH that hopefully the situation is stabilizing in these communities.
• Hospitalizations — 57 additional people have been added yesterday (the increase is the highest day-over-day increase in the number of people hospitalized). Currently, 545 patients are in the hospital and 229 are in intensive care.
• Today, all flags in MN will be flown at half staff at all state and federal buildings in honor of the people who have died from COVID-19. This will be repeated on the 19th of every month through the remainder of the year.
• Deaths due to COVID-19 are disproportionately affecting indigenous communities, people of color, the homeless, the elderly, people in long-term care, congregate care facilities, individuals with pre-existing conditions, and disabilities. Now more than ever, we need to come together to support those most vulnerable and to honor and support the families of those lost. 
• 5,229 COVID-19 tests processed by all the labs reporting yesterday. Tuesday is typically the lowest volume day of the week.
• Quite a few targeted facilities such as long-term care facilities, prisons, jails, and other congregate settings in the queue to be tested for the rest of the week.
• When people test positive or are awaiting test results, they should stay at home.
• People should wash their hands, cover their cough, keep a 6-foot distance from others and wear masks to protect each other whenever you’re away from your home.  
• It’s especially important for higher risk people to social distance and pay attention to health guidance.

Update from MDH Infectious Disease Director Kris Ehresmann:

• There is a decline in well child visits during the pandemic
• With the decline in those visits, the MDH is seeing a decline in the recommended childhood vaccinations.
• If your child missed an important visit to the doctor during the stay at home order, please reach out to your health care provider to get that scheduled.
• In addition to vaccinations, the doctors perform important developmental assessments, tests and evaluations on children during those visits.

Additional notes from the media briefing:

• When told about testimony from nurses who say they’re concerned about their amount of PPE, Commissioner Malcolm says the guidance that was put out for allowing more elective procedures requires that providers have a plan for how they would monitor their PPE and how they would assure that their staff has the equipment that’s required. Malcolm says that she’s aware that many providers are still conserving PPE (for example, staff members being asked to wear a mask and keep that mask for multiple days). MDH has been clear that health providers should expand their services when they have the ability to assure that they have a plan in place for appropriate use and conversation of PPE.
• When asked whether Minnesota is “cutting corners” in some areas regarding PPE, Commissioner Malcolm said that the MDH needs to be focused on the front lines and “we will continue to be in close dialogue with the health systems on these issues of appropriate use, conservation, etc.”
• Commissioner Alice Roberts-Davis of the MN Dept. of Administration says that in the twice weekly reporting they’re receiving from hospitals, PPE inventory is relatively flat. She says they’re not seeing any increases in usage at this point in time. What they’re seeing is that, in general, hospitals have at least 3 weeks of inventory for all PPE items, including gowns, which were difficult to for the state to source at a point in time. Although MN has quite a bit of inventory in the warehouse stockpile for the state, the expectation is for hospitals to purchase through their normal supply chains and then make requisitions to the state when they reach 4-7 days inventory. The state has the ability to supply their needs if they requisition it, and they’re happy to help whenever they can. 
• When asked whether hospitals have to ration Personal Protective Equipment below pre-COVID standards, Roberts-Davis said that hospitals are setting their own guidelines for how PPE is being used. What the state sees on their end is that when hospitals reach a certain supply level, they have the ability to requisition, but if they don’t reach that supply level based on their usage and the independent hospitals then, “we’re not seeing that the need is there.” Hospitals can supply the PPE to the nurses as needed and then requisition the state if they reach low levels. 
• The CDC put together “relaxed” guidance on how PPE should be used if providers are in a position where they don’t have all the necessary PPE. The MDH wants to make sure that people have all the protection that they need, but because of the situation with the global shortage, there have been changes made in terms of how PPE can be used in this current pandemic. Hospitals have been following this guidance. However, the MDH has not had a reason to differ on the CDC’s guidance on the prioritization and conservation of PPE. Malcolm says technology has been created to sterilize and reuse some of this PPE, such as the N95 masks or washable gowns.
• Commissioner Roberts-Davis says the state has requisitioned and are hoping to receive Battelle units that will allow them to decontaminate N95 masks and reuse them. They are using washable and disposable gowns, and hospitals are ordering both of those different types of gowns for their use. But Roberts-Davis says she continues to see tightening in the supply chain. It’s not as stabilized as it was pre-COVID, so the state is definitely cautious about ordering and ensuring the things they order are coming in. So hospitals should continue to use them conservatively to the point that they’re comfortable, and allow the state to continue to find the PPE that they’re looking for in the supply chain and bring it to the state. 
• The commissioners received a question about who should get serology tests. Ehresmann says people can get tested in many different situations, but these tests are not FDA approved. If they’re getting testing done, it should be done through an FDA approved lab like Mayo or the U of M. There are still so many unknowns that the MDH is not recommending these tests for people right now. People should recognize that until there is better oversight and better information, they may not be getting the information that they think they’re getting. For instance, a test could show that someone has antibodies, but it could be antibodies for the cold you had last October, as opposed to SARS-CoV-2.
• As for the jump in hospitalizations over the past day (57 patients), Ehresmann says it could just be a function of the increase in cases we saw last week, but she couldn’t say for certain.
• Commissioner Malcolm says there’s a distinction between “elective” and “medically necessary” surgeries. There’s a growing concern of necessary procedures that were being put off. So professional clinical judgement needs to be applied. But the MDH is always willing to be in dialogue with the providers to see how it’s going with regards to Personal Protective Equipment and whether it’s necessary to revisit the elective procedure guidance. “Nothing is off the table,” according to Malcolm.
• Regarding the testimony from nurses day about PPE, Commissioner Roberts-Davis said, “Our relationship is with the hospitals and the requisitioning is coming to us from them. Certainly listening to the nurses today on the health hearing was troubling, disturbing, very heartbreaking stories that we heard, and a lot of empathy for them. But what we are dealing with right now is a situation where the hospitals are trying to balance the ability to get supplies with the need for supplies immediately. And along with that, also anticipating what we might need in the future. So I think that all of these things become a balancing act and they’re doing the very best that they can to provide what the nurses need today with an eye to the future of what they might need tomorrow.”
• The state just closed on a St. Paul facility yesterday that was a former grocery distribution warehouse It’s a roughly 71,000 square foot facility built in 1997. It will be used as a temporary morgue. The purchase agreement is for $5.4 million on the building and land, and there’s also funding for improvements and maintenance that would bring the total price tag to $6.9 million.

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