Minnesota Department of Health COVID-19 update March 17 and 18

As of March 18, there are 77 reported cases with 2762 tested. Cases are in Anoka, Benton, Blue Earth, Carver, Dakota, Hennepin, Martin, Nicollet, Olmsted, Ramsey, Renville, Scott, Stearns, Waseca, Washington and Wright counties.

There are a total of seven cases that were hospitalized. Only four remain hospitalized. One remains in critical condition with no deaths in Minnesota. They now have six cases through community transmission. They have 13 cases in healthcare workers that did not acquire COVID-19 in the work setting. Theirs was related to travel. They also had 9 individuals who are school employees and one school aged student.

The Minnesota Legislature unanimously approved a $200 million dollar package for emergency COVID-19 response, earlier this morning that amount includes 50 million into the healthcare contingency fund and 150 million in grants for hospitals emergency responders and long term care providers in terms of outreach from the department.

The Department of Public Safety has a hotline to field questions about the issues associated with community mitigation, including school and childcare impacts. The number is 1-800-657-3504 from 7 a.m.-7 p.m.

Due to a national shortage of COVID-19 laboratory testing materials:

“We were forced to make adjustments to our testing criteria. So we are focusing on the highest priority specimens that is patients who are hospitalized. Then healthcare workers, and those in congregate living settings such as long term care. The reason for this is that we need to be focusing on testing those individuals for whom the positive test will make a significant difference, either in their care,” explained Infectious Disease Division Director Kris Ehresmann.

Additionally, hospitalized patients who test positive for COVID-19 are eligible to participate in a number of drug trials for antivirals. It’s important for healthcare workers to be tested, because of the potential that they may have infected, or exposed high risk individuals in a high risk setting. And those in congregate living settings such as long term care. These are both individuals who are at highest risk of severe complications of COVID-19.

The question is, don’t people need to know if they have COVID-19?

“It would be lovely, if we could know everyone that has COVID-19. But in reality, for individuals in an outpatient setting a positive diagnostic test does not make a difference, either in their care and treatment or in the recommendations for isolation,” said Ehresmann.

There is no treatment aside from the clinical trials that are underway, that are only appropriate for patients with severe illness that are hospitalized. Patients who have an undiagnosed fever and acute respiratory symptoms should self quarantine for seven days after illness onset, or 72 hours after resolution of fever, whichever is longer, without taking fever reducing medications.

If symptoms become severe, they should seek medical care and reach out to their health care provider.

Patients who are isolated and who are asked to isolate should also be careful to isolate themselves from their household in intimate contacts as much as possible and should limit their activities in public for 14 days.

“One other thing that I want to acknowledge, is that we have also gotten questions, well, if you can’t track the number of COVID cases, how will you be able to know what is happening in Minnesota? That’s an excellent question. I think as many of you are aware, we conduct influenza surveillance throughout the flu season, from October through May, and as part of that surveillance we have sentinel providers from across the state, who weekly provide us with information about the proportion of patients that they have seen with influenza like illness. And I think as everyone recognizes symptoms for COVID-19 are fairly nonspecific and so would fall into that category of influenza like illness. We also track the proportion of influenza tests that are positive. And so, we will be able to look at both the proportion, or the percentage of patients that are presenting with influenza like illness, as well as the proportion of influenza tests that are positive and if we see our influenza illness proportion go up, and our test positive go down,” said Ehresmann.

She explained they’re learning about COVID-19, and it’s possible that it may be a disease that continues to circulate. COVID-19 is not influenza.

Ehresmann explained the confirmed cases of COVID-19 in the state is an undercount.

“There are many cases of COVID-19 that have gone undiagnosed,” said Ehresmann.

They have been able to get the tests completed in approximately 72 hours.

“This is a new virus. So unlike some other diseases that we’ve dealt with that have been scary this is a disease that we’re not familiar with. When we dealt with Ebola a few years ago that was obviously very concerning, but it was a disease that we knew about. With COVID-19, you know we’re less familiar with that. Certainly, the level of community mitigation that’s been undertaken is unprecedented. In my entire career in public health we have never had this level of community mitigation activities that have been enforced. I was here for Ebola, measles, and the level of fear and concern in the public that we have seen with COVID-19 is also unprecedented,” said Ehresmann.

If an online tool suggests that you may have COVID-19, that does not constitute confirmation of disease. That does not mean that you should be putting something on social media. That does not mean that you should be telling people that you have a case.

“People are posting things and causing a great deal of aches. And I think it’s important that we recognize that we know Covid is circulating. And so, it’s not necessary to inform the world of your health status, we would rather you focus on isolating yourself and staying home. And please do not interpret the information that you get from an online tool to mean that you have a confirmed case of disease,” said Ehresmann.

The fact of the matter is that if you are able to manage your symptoms in an outpatient setting, having a laboratory confirmation does not change our recommendations, nor does it change any type of recommendations you would receive from your provider. There is no treatment at this time for COVID-19.

Ehresmann said it’s too early to tell if Minnesota is succeeding in holding down the curve compared to other states.

“We’re certainly seeing the number of cases, you know, increase. But the good news is we’re not seeing a doubling of cases every day. We know that there’s community transmission so we know that there are many more cases than what we’re able to detect through the laboratory,” said Ehresmann.

She explained the problem with the shortage of tests as their lab has identified multiple methodologies that they can use and so they’re shifting between methodologies because each methodology uses slightly different supplies, but they are finding it difficult to have all the necessary supplies to be able to conduct unlimited testing, hence the decision to focus on the highest priority patients.

They wish to reassure those people that test results are not necessary in terms of identifying that you need to be isolated.

“This is unprecedented decisions in our state and in our country and I would really admonish them to heed our request to stay home when you’re sick and take this social distancing message very seriously,” said Ehresmann.

There’s a lot of modeling that’s been done nationally and globally. And some of their experts have started to work on that.

“The challenge with modeling is that the quality of your model is based on the quality of the assumptions that you put into it. And there’s a lot that we don’t know about COVID-19 and a lot that we’re learning about it, as this pandemic progresses,” said Ehresmann.

They have not seen clustering of cases, with the exception of households. They are seeing the disease in all parts of the state. All labs have to report positive COVID-19 cases. The number of negative cases is unclear as they don’t have to be reported.

“As a nurse myself, I understand that when you’re the person that’s providing direct patient care, you are concerned about your own health and well being. And I would say that our collective desire is that we are working with the healthcare system to make sure that we have what’s needed to keep our healthcare workers protected. That is our number one priority,” said Ehresmann.

She added that employers should not be requiring confirmation of COVID-19 for their employees to have sick time.

“We need people to stay home when they’re sick, regardless of whether or not they are able to have a test result,” said Ehresmann.