“In this business, we never want to say we are ready,” said Dr. John Hick, who manages health care coordination in the State Emergency Operations Center. “There’s always more we can do. Yes, we are in the ballpark.”
Restrictions on businesses and gatherings, a now-expired “stay-at-home” order, and repeated pleas from state leaders for social distancing and mask-wearing have slowed the spread of the coronavirus enough in Minnesota to give hospitals time to prepare. Those community mitigation efforts also helped drive down the number of patients needing hospital care and deaths.
As of Saturday, Minnesota recorded 16 consecutive days of COVID-19 daily deaths in the single digits — the last daily double-digit death toll was July 1, with 13 fatalities reported. Hospitalizations — currently at 265 with 117 in critical condition — are steadily rising, but still less than half of what they were when serious cases last peaked at the end of May.
Minnesota has about 2,200 intensive care beds with fewer than half currently in use and nearly 3,000 ventilators with only about 500 currently in service. There are also modest stockpiles of respirator masks and other supplies medical workers need to stay safe.
Despite those positive signs, state health officials say it is not the time for Minnesotans to become complacent in the fight against COVID-19.
“That can change in a heartbeat,” said Dr. Rahul Koranne, president and CEO of the Minnesota Hospital Association, of the current rate of serious and fatal cases.
To illustrate Koranne’s point, one only has to look to states in the Sunbelt where infections are setting daily records and health officials are putting freezer trucks on standby to handle an expected flood of fatalities. Serious infections and deaths are expected to rise as cases spread from younger, healthier patients to their older and sicker family members and acquaintances.
“Deaths are a lagging indicator,” said Dr. Ruth Lynfield, Minnesota’s state epidemiologist. “I’m sad to say that I do expect to see an increase in deaths in the coming weeks.”
A SHIFT IN CASES, BETTER TREATMENTS
Minnesota’s coronavirus outbreak has skewed younger and younger since mid-June after restrictions on bars, restaurants and other places that people gather were largely relaxed. Minnesotans in the 20 to 29 age group now have recorded the most coronavirus cases with more than 10,000 infections, nearly a quarter of all the state’s cases.The median age of Minnesota’s COVID-19 patients has fallen from 42 years old in late May to about 37 years old.
State health officials have blamed some of the growing infections on 20-somethings disregarding social-distancing rules and packing into bars near college campuses. They warn that while younger patients may not be at high risk for serious infections from COVID-19, they can easily pass it to family members or others they come into contact with who could face serious, even deadly, consequences.
Minnesota has not seen a COVID-19 death in someone under the age of 20 and, with two deaths among people who are 20 to 29, the death rate for that age group is just 0.02 percent.
Mortality grows considerably for infected older patients.
For patients in their 70s, 15 percent of cases were fatal, or 292 deaths out of 1,914 infections. For patients in their 80s, the fatality rate rises to 31 percent, or 520 deaths out of 1,697 cases.
Of Minnesota’s more than 1,500 COVID-19 deaths, about 77 percent have been residents of nursing homes and assisted-living facilities that house the elderly. State officials say leaders of congregate care have worked hard to control coronavirus infections in their facilities.
In the five short months that Minnesota physicians have been treating coronavirus patients, they’ve learned a lot about how to save lives, said Drs. Hick and Korrane. Those treatments include using steroids, antivirals like Remdesivir, enriched oxygen and even “proning” patients on their stomachs to make breathing easier.
“The standard of care is rapidly developing,” Koranne said. “We always look around to see the latest evidence and science and we adapt our practices on a daily basis.”
Those methods likely play a role in the decline in patients in critical care and deaths, but there is still a lot doctors do not understand about the virus.
CONCERNS ABOUT STAFFING, SUPPLIES
In the short term, having enough qualified doctors and nurses to treat a possible surge of COVID-19 patients with serious infections is the leading concern of state health officials.Hospitals can convert space for intensive care units fairly easily and the state now has 2,400 ventilators that are not being used. But having enough medical workers to care for those patients may be tough, especially since many have already been working long hours with few days off for months on end.
“You can’t invent an experienced ICU nurse or a critical care physician,” Hick said. He added that, if Minnesota needs to call on other states for staffing help, those requests could go unanswered if they’re also experiencing a surge in cases.
Koranne is increasingly concerned the ongoing national surge in cases will have a dire impact on an already stressed national medical supply chain. Supply shortages don’t just impact protective gear — they can mean medical workers may have to wait days to get coronavirus test results back, which means they are unable to care for patients.
“We are absolutely concerned, and have been, about having enough specialized caregivers in the event of a surge,” Koranne said. He noted that hospitals are trying innovative ways to care for coronavirus patients with the staff they have available.
A COMING ‘DOUBLE WHAMMY’
Minnesotans can soon expect “get a flu shot” to be added to the ongoing pleas from health officials to wear a mask, practice social distancing, stay home when you’re sick and wash your hands.The coming flu season, which could begin by late September, has health care providers and state leaders fretting. Influenza and the coronavirus have similar symptoms and methods of transmission, and a bad flu season typically can pack Minnesota’s intensive care units.
“This year, it will be a double whammy,” Koranne said. “Those two infections on top of all the other patient needs. … That is part and parcel as to why we need to be super diligent and to prepare with our head down.”
A key piece of that work, Koranne says, is wearing a mask in public to protect others. The Minnesota Hospital Association Koranne leads urged Gov. Tim Walz on Thursday to require masks in public places statewide.
“This is a sign of leadership,” Koranne said of wearing a mask to help slow the spread of COVID-19. “It’s a sign that you care about others around you.”
Doctors and state leaders stress Minnesota is still in the early stages of the pandemic. Despite a hard couple of months, there’s still a marathon ahead.
“You might be tired of coronavirus, but the coronavirus isn’t tired of you,” Hick said.
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