From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

Minnesota’s response to the COVID-19 Pandemic: The August Update (2020)

Ayotunde Uko

Since the last update in May 2020, Minnesota has been a beehive of activity. Similar to its neighbors in the Upper Midwestern Region of the USA, COVID-19 positivity rates, hospital admission and ICU admission rates peaked, waned and are trending upwards again. More recently, Wisconsin, Iowa and North Dakota are experiencing a steeper rise in their case positivity rates within their populations compared to Minnesota. This could be as a result of higher intensity of testing within hotspots especially in states with smaller populations (Iowa and North Dakota). Minnesota’s death rate from COVID-19 peaked in May and is steadily trending downwards. Iowa has seen the highest death rates in this region.  Racial events during this time have drawn the most attention to the state from around the world.

Minnesota’s governor, Tim Walz, is cautiously reopening the state following initial lock down. On May 17th a phased process to reopen the economy began. Limited gatherings of less than ten individuals, restaurants and bars conducting business as delivery or take out only were mandated. The second phase allowed for more customers and physical distancing. Phase three is the current stage and includes full opening up of most services. Schools currently offer a hybrid of both virtual and on-site educational services for students in the fall. Face coverings, financial support for cleaning, screening supplies for COVID-19, efficient W-Fi technology and paying attention to the mental health of staff, will help to ensure a safe and effective reopening of schools. A Democratic majority in the House of Representatives has helped support Walz in implementing his agenda to reopen the state and this is in stark contrast to the experience of its neighbor, Wisconsin.

Minnesota has seen a steady increase in COVID-19 testing capacity with a total cumulative number of over 1 million tests performed so far. The percentage of positivity peaked at the beginning of May to 23% and has steadily declined over the months of June and July. This trend perhaps speaks to the effectiveness of the lockdown measures that were instituted. As testing becomes more widespread the percentage of positivity typically tends to fall. When the testing is focused in areas that are hotspots the percentage positivity may rise. Hennepin County has the highest total confirmed cases of COVID-19 and deaths in the State with 17,316 individuals and 813 by mid-July, respectively. Newer hotspots are beginning to appear across the state, for example, Beltrami County currently experiences a 7 day percentage change at 28.8% compared to 9.5% in Hennepin County. The total confirmed cases are still concentrated (24%) in 20 to 29-year-olds, while 80 to 89 year olds represent 34% of deaths in Minnesota.

The impact of COVID-19 on race has been significant in Minnesota. As a result of systemic disparities, communities of color and indigenous communities are at a significantly higher risk of multiple health issues such as diabetes and heart disease. This puts them at a higher risk of severe illness from COVID-19. Black, Latina and indigenous Minnesotans test positive, are hospitalized and admitted in ICU at higher rates compared to the overall population. Communities of color have increased exposure to COVID-19 because of the nature of their work as essential childcare providers, meat packers and grocers. These jobs are typically low paying, lack adequate health benefits and have little or no worksite protections. To encourage testing, Minnesotans are being tested for COVID-19 without needing proof of health insurance or identification. Information about the pandemic is also multilingual.

Racial tensions have erupted in Minnesota during the pandemic. Thousands of individuals demonstrated to protest against decades of systemic racism and police brutality and to demand justice for the death of George Floyd while in police custody. The economic cost from the damage to property (from riots) is reported to be over $25 million in insurance claims in May alone. Significant risk posed to the lives of these demonstrators in the form of tear-gas and rubber bullets is compounded by the unseen threat of COVID-19. The close proximity of demonstrators, little mask wearing, as well as exposure to COVID-19 in jails (for those arrested) constitute a real threat. By the onset of the riots in Minnesota daily confirmed cases of COVID-19 had peaked with corresponding plans to reopen the economy. However, the number of confirmed cases have gradually increased since mid-June. Amongst demonstrators, only 1.5% of tests at designated community test sites in early June turned positive. This is compared to rising numbers attributed to opening up the economy according to contact tracing reports. Outdoor locations of activities could be a factor in the low impact of the demonstrations on the pandemic. Many Minnesotans view the current situation as a “Syndemic” of racism and COVID-19 that could galvanize the community to collaborate and deconstruct the toxic systemic infrastructure spotlighted by these events.

Minnesota’s response to the coronavirus pandemic – Update (May 2020)

Ayotunde Uko

In the five weeks since the initial report on the COVID-19 Pandemic, Governor Tim Walz has actively led efforts to increase capacity within the health system, reduce demand and shore up the economy of Minnesota.

Capacity building of acute care services has been a priority. The State Emergency Operations Center (SEOC) was created to support government agencies. Amongst its roles, the SEOC evaluates alternate care facilities to increase capacity of health care services. In total 29 alternative care sites within the state have been identified to create additional clinical capacity. There are 996 ICU beds in use currently across the state, with a further capacity of 1,241 beds. An additional 1,300 beds can be made available. There are 549 ventilators currently in use with a further capacity of 1,439 ventilators. Supplies of PPEs have ramped up from donations, Federal Government supplies and procurement. While these numbers seem reasonable, a surge of COVID-19 infections could cause significant shortages. In collaboration with Mayo Clinic and the University of Minnesota, the State Government has led a drive to provide rapid widespread testing for COVID-19 in Minnesota. All symptomatic persons will be tested and confirmed cases isolated to limit spread. Surveillance tools have been expanded to support public health officials and to aid research. A central lab with capacity of 20,000 molecular and 15,000 serological tests per day has been created with a virtual command center established to monitor daily testing needs and enable adequate response to outbreaks. To bolster medical staffing, out-of-state healthcare professionals are permitted to practice in Minnesota.

Policies to curb infection spread include an extension of Stay-at-Home orders for all Minnesotans until May 17^th. This excludes workers providing essential services and critical care. This order also pertains to the temporary closure of bars, restaurants and other places of public accommodation. An executive edict in April allows residents of the state to engage in safe outdoor recreation with members of their household. Distance learning edicts for school districts are extended until June 30^th while face masks and coverings are encouraged (along with all CDC guidelines) at all times when residents leave their homes.

The economic and financial impact from the COVID-19 pandemic has been significant on Minnesotans.  In partnership with the Department of Employment and Economic Development and the Department of Labor and Industry, the Minnesota Government prepares Minnesotans to return to safe work environments. Healthcare organizations are not immune to the financial impact of COVID-19. Stopping elective surgeries and procedures across the state is projected to cost hospitals alone $3 billion over three months according to the Minnesota Hospital Association. Hospitals on average have lost approximately 55% of revenue in the month of April. Severe cost cutting measures in healthcare institutions include pay cuts, furloughs and lay-offs. Minnesota projects a $2.42billion in budget deficits for May in the wake of COVID-19. The state has a rainy-day savings account of $2.36 billion but Governor Walz and his finance commissioner caution against the use of these funds at this point. Economic conditions during the COVID-19 pandemic could easily worsen as the nation’s peak arrives thus making these reserves vital when most needed.

Seasonally adjusted payroll employment dropped by 14,400 jobs in March while the Private sector lost 15,400 jobs during the month. The sharpest declines in the economy occurred in the Professional & Business Services sector and Leisure & Hospitality. The unemployment rate held steady at 3.1% in March in comparison to the US unemployment rate of 4.4%. April figures will more accurately capture the impact of job losses. The Federal Families First Coronavirus Response Act allows employees unable to work due to a need to provide care for their child to claim 14 weeks of paid leave. Unemployment benefits and benefits from Federal CARES Act offer support.

A total of 614 Minnesotans have died as a result of COVID-19 since the first death was announced on March 21^st. Minnesota has the highest death rate adjusted for population amongst the Upper Midwestern states. The highest daily death toll of 30 patients was on May 6^th. Numbers tested have quintupled in number from 20,000 over 4 weeks to over 120,000 today. The cumulative number of confirmed cases has risen to 12,494 on May 12^th showing an upward trend from approximately 500 cases in March.

Re-opening Minnesota’s economy is a daunting task. Collaborative efforts amongst Mid-Western states will aid this process. The set of principles guiding this collaborative includes control of infection rates, testing, contact tracing, healthcare capacity and best practices for the workplace. With upward trends in COVID-19 cases, a strategic approach to reopening Minnesota’s economy could save lives.

Minnesota’s Response to the Coronavirus Pandemic – Original post (April 2020)

Ayotunde Monica Uko

Preparation & Response
On the 6^th of March 2020, COVID-19 was confirmed in the state [1]. According to Center for Disease Control and Prevention (CDC) reports, there were at that time 214 cases with the virus diagnosed and 16 deaths in the USA [2]. The announcement includes details of the first case of COVID-19, a presumptive diagnosis, with symptoms that began in the individual on the 24th of February. This resident is described as an older adult who had recently returned from a trip aboard a cruise ship. MDH had anticipated this diagnosis with a number of strategies such as community public health announcements for hand washing, social-distancing and stay home orders for those who are sick [1]. Crowd avoidance, routine cleaning of ongoing schools and preparation for emergency were also included. Two more presumptive diagnoses of COVID-19 are made on March 8^th and March 10^th associated with international travel. The first case of death in the State from the virus is announced on March 21^st. State and local public health measures scale up at this time with a series of community interventions [3]. Today, the 4th of April, total cases of COVID-19 have increased by 146 to 935. It’s the largest single-day increase in cases so far. In total, 451 cases, about 50%, have been released from isolation. A total of 106 people are currently hospitalized with COVID-19, with 48 cases requiring ICU care.

Minnesota State Government response to COVID-19 includes 26 Emergency Executive Orders (EEO) issued by Governor Tim Walz between the dates of March 13th to March 31^st, 2020 [3]. MDH is designated as the lead agency to liaise with all other state agencies, the federal government and the CDC on COVID-19. Collaboration is also mandated between medical providers, such as Mayo Clinic, and Minnesota Department of Public Safety’s Division of Homeland Security and Emergency Management to help communities prepare for, respond to, and recover from the COVID-19 emergency.

On March 15, an EEO is proclaimed to direct the commissioner for education to temporarily close schools and realign childcare services to support children of emergency workers and providers. Other directives include protection for Minnesota Veterans homes and temporary closure of bars, restaurants, and public accommodation punishable by a fine up to $1,000, or by imprisonment up to 90 days. Additional provision gives immediate relief to employers and unemployed workers during the COVID-19 pandemic. There are also EEOs for a delay in all inpatient and outpatient elective surgeries and procedures. Citizens are ordered to stay at home except to engage in work within the critical sector. Other executive orders provide relief for small businesses and guidance for critical sector workers during this emergency. Legislative pushback by members of state congress occurs on March 17 citing the catastrophic impact that EEOs could have on businesses. In response, on March 26th, through a bipartisan effort, Governor Walz signs a $330 Million COVID-19 Response Package bringing the state’s total response to more than $550 million to manage the COVID-19 pandemic.

Diagnosis & Contact Tracing
MDH, in collaboration with the CDC, provides up-to date guidance on the diagnosis of COVID-19, testing and contact tracing within the state. Individuals with mild illness of cough, shortness of breath and fever are expected to recover at home. Cases with worsening of symptoms, confusion and chest-pain are advised to seek urgent medical attention. Due to national shortages in supplies MDH prioritizes testing for COVID-19. Highest priority is given to hospitalized patients and healthcare facility workers with symptoms. Next it gives priority to those at highest risk of complication of infection including those 65 years or older or living in a long term care facility. The least priority is given as resources allow, to test individuals in a community with rapidly rising hospital cases to decrease community spread, and ensure health of essential workers. MDH tests for COVID-19 through the public health laboratory and several commercial labs across the state. Most hospitals have the ability to collect specimen for lab testing based on referrals from a healthcare provider. Test results are reported to MDH and CDC.

MDH works closely with county public health departments to perform contact tracing on any contacts of an infected person. These contacts are asked to quarantine themselves for 14 days from their exposure and are monitored for fever and respiratory symptoms. If an individual in a household is determined to be a close contact of a lab confirmed case of COVID-19, the MDH contacts the person directly about staying home for 14 days after exposure. If exposure occurred to a close contact (e.g., household or intimate contact) who is diagnosed with COVID-19, but not laboratory confirmed, the directive is to monitor health for 14 days after that exposure.

Communication & Politics
Governor Walz is very visible during the COVID-19 pandemic. His communication is delivered through live video press conferences, audio and print releases. His language is uncomplicated and easy to understand by the citizens of the State. So far, he has been able to rally bipartisan political support to manage this emergency. The Governor has a comprehensive website summarizing the state’s preparedness and response to COVID-19.

Perspectives
Minnesotans are known for their strong family ties and deep sense of community. Minnesota is also well known for its beautiful lakes, agriculture and manufacturing industries. Citizens feel the impact of COVID-19 in a number of ways. Significant incomes have been lost especially due to lay-offs in the service industry while scarcity and steep prices occur across the state. Retirees are anxious about the economic effect on their pensions which fluctuate with the markets. There is growing mistrust about the ability of Wall Street to rally round in the future following these unprecedented events. Communication from Governor Walz is effective and sets expectations for the challenging months to come. Social distancing and closures are well accepted and self-enforced in the state.

By the 6^th of March there were 214 cases of COVID-19 diagnosed in the USA. This number excludes untested symptomatic patients and asymptomatic cases [4]. By the 21^st of March when the first death occurred in Minnesota, there were 24,583 cases of COVID-19 in the USA. Overall, the state’s response to this crisis has been reasonable but somewhat slow. Criticism lies in the absence of a coordinated state or regional response to institute measures in a robust way. A well-coordinated interstate or regional effort is likely to incur significant cost. To ease the financial cost of such measures, perhaps employees in manufacturing companies should be allowed to return to work under strict conditions of hygiene, donning of facemasks and social distancing.  Their products could support the COVID efforts. The lapse in implementing coordinated measures allows transmission of COVID-19 across the USA and misses opportunities to pool resources in a strategic way. The financial costs of inter-state collaboration and pooling of resources to tackle COVID-19 could be significant but the costs from death is catastrophic to the whole economy and would be damning to leadership for generations to come.

References

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