Minnesota officials cautious after first week with fewer COVID-19 deaths

COVID-19 deaths in Minnesota saw their first weekly decline since the global pandemic swept into the state, but officials cautioned Saturday that it could be an aberration rather than the start of a welcome trend.

A large one-day jump in patients needing ICU beds buttressed the note of caution as the state's stay-at-home order expires Monday and more businesses and retailers reopen.

"We want to be out. We want to just get back to life," said Kris Ehresmann, the director of infectious disease at the Minnesota Department of Health. "But it's really important that people continue to maintain social distancing — continue to be cautious — because our goal is to make sure that our system always has the capacity to care for people who need care."

With 17 deaths reported Saturday, a total of 700 Minnesotans have now died in the pandemic. The Health Department also reported 740 new cases, with the number of patients needing intensive care growing from 200 as of Friday's data release to 225 Saturday.

Rules that have kept people at home and closed businesses have been tough on Minnesotans, so the modest changes easing restrictions starting this week are understandable, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

But he called the upward trend in cases "a real challenge" and the rise in ICU patients "very concerning."

"The public just needs to know, for their own decisionmaking, that this is the time we've probably seen the most virus activity in the Twin Cities, right now, since this whole thing began back in January," Osterholm said. "From that standpoint, people need to make decisions: What are they going to do? The governor's not forcing anybody to necessarily be in public."

COVID-19 is a viral respiratory illness that brings the greatest risk to those 65 and older as well as residents of long-term care facilities. The chance of serious illness is also greater for those with a number of underlying medical conditions ranging from lung disease, heart problems and cancer to severe obesity, diabetes and certain kidney ailments.

Minnesota reported its first death from COVID-19 eight weeks ago, on March 21. Since then, weekly death counts have been on the rise, reaching more than 150 during each of the past two weeks. For the seven-day period ending Saturday, Minnesota reported 142 deaths from COVID-19, falling below the trend.

Earlier this month, Gov. Tim Walz suggested Minnesota was on pace to record 1,000 deaths by the end of May. Ehresmann said it would be good news if the state didn't hit that mark, though it's too soon to predict.

"Even though we may have had things slow down a little, I don't know that that's a sustained thing," Ehresmann said. "It's a little too early to say that that is a trend."

Residents of long-term care facilities accounted for 14 of the 17 deaths announced Saturday, and roughly 80% of all deaths in Minnesota so far. State policies for handling the pandemic won't change based on a one-day jump in ICU cases, Ehresmann said, but it's a reminder of the stakes for health care.

'Stay safe' starts

Walz said last week that he would allow more stores to reopen and let Minnesotans leave the house more starting Monday, while setting the stage for loosening restrictions June 1 on bars, restaurants and other businesses. While not a wholesale reopening, the changes will put an end to the statewide stay-at-home order in place since late March.

The restrictions were designed to build supplies of ventilators, protective gear and ICU beds so hospitals can treat COVID-19 patients without becoming overwhelmed. Hospital leaders endorsed the governor's move.

"We support Gov. Walz's 'Stay Safe' plan as a measured, responsible strategy for balancing protection of health and safety with Minnesotans' need for economic and financial security," Andrea Walsh, chief executive of Bloomington-based HealthPartners, said in a statement after Walz announced next steps in the COVID-19 fight. Walsh's organization runs eight hospitals including Regions Hospital in St. Paul and Methodist Hospital in St. Louis Park.

Dr. Gianrico Farrugia, chief executive of the Mayo Clinic, said that his health system "used the time afforded by the shelter-in-place order to ensure that we have an adequate supply of hospital beds, ventilators and personal protective equipment (PPE) to respond to this pandemic in both the short- and long-term."

But hospitalization trends in Minnesota raise a concern that even limited steps to reopen the economy could stress hospital capacity, said Pinar Karaca Mandic, a health economist at the University of Minnesota's Carlson School of Management.

States that have been hit harder by COVID-19, such as New York, New Jersey and Michigan, tend to have much higher rates of per-capita hospitalizations than Midwestern states such as Minnesota, said Karaca Mandic. What's concerning is that the hard-hit states seem to have hit their peaks of hospital utilization, while Minnesota is still climbing.

"There is no flattening," said Karaca Mandic, who with her colleagues launched a website in April to track hospital and ICU trends across states.

Case count concerns

Minnesota's ICU capacity looks pretty good according to a COVID tracking system followed by Dr. Georges Benjamin, executive director of the American Public Health Association.

But Benjamin said he was concerned by the growing number of COVID-19 cases in the state, adding that many states are opening up even though they haven't shown a sustained decline in cases.

"At least right now, there's probably rationale for doing some very careful things," Benjamin said Saturday. "I still think, in total, it's too early to reopen."

Pandemic flu in 1918 was "the last time we really had a big one like this in which we had no vaccine and no real therapies," he said.

Cities including Minneapolis that were more aggressive in closing schools and gathering places saw a lower peak and total mortality, said Alex Navarro of the Center for the History of Medicine at the University of Michigan.

Navarro said closure orders, bans on gathering and mandatory mask orders in 1918 were generally not as sweeping as the social distancing with COVID-19.

"The duration of the closure orders and gathering bans was generally on the order of three to five weeks, by which time health officers believed that their respective epidemics were under control and about to end," Navarro wrote by e-mail. "In about half of the cities we studied that was not the case, however, and the epidemic resurged with a second spike of cases and deaths."