Surgeries, other care set to resume in Minnesota

Gov. Tim Walz appears set to allow medical providers to resume elective surgeries and procedures, which had been temporarily prohibited so the state could conserve masks, gowns and other medical resources for its response to the COVID-19 pandemic.

Urged by financially struggling medical providers, and concerned by tales of sick patients getting sicker, Walz said he would likely act on Tuesday and amend his emergency order so that surgeons, dentists and other providers could resume work.

Minnesota is much better prepared for COVID-19 than it was when he issued the order more than a month ago — with stable supplies of personal protective equipment and more intensive care beds than larger Illinois, Walz said.

"We went into April in pretty tough shape in terms of beds and things like that," Walz said. "We came out of April ... well-positioned."

Walz extended a statewide stay-at-home order until May 18 to reduce the spread of the coronavirus that causes COVID-19, but he has been looking to exempt more businesses amid a growing pandemic.

The state's lab-confirmed COVID-19 case count is 7,234 and includes 1,040 health care workers. The state as of Monday also had a new high of 166 patients in hospital intensive care — a concerning number that doesn't fluctuate with increases or decreases in diagnostic testing.

Minnesota's death toll from COVID-19 has doubled to 428 in the past 10 days and now exceeds the count in Wisconsin. The Institute for Health Metrics and Evaluation in Washington nearly doubled its estimated COVID-19 national death toll to 135,000 and increased its estimate for Minnesota to 2,183 deaths by Aug. 4. The institute at one point predicted fewer than 200 deaths in Minnesota, though its modeling methodology has been modified since then.

"Cases are going up in the United States," Walz said. "Don't just watch New York City for where things are at."

Walz and his administration received added pressure on Monday from the state's doctors, represented by the Minnesota Medical Association and other trade groups, who had supported his original order to halt elective procedures but permit critical and lifesaving surgeries. "There are harms associated with COVID-19 morbidity and mortality as well as morbidity and mortality from delayed care and deferred access to needed services in non-COVID-19 patients," they wrote in a joint statement.

Financial harms of the shutdown include many health system workers being placed on furlough and counted among the nearly 600,000 Minnesotans who have applied for unemployment insurance benefits since March 15.

Hospitals are projected to lose $2.9 billion this spring due to the cost of COVID-19 preparations and the loss of revenue from elective procedures.

Supplies of personal protective equipment remain a concern, though, as the latest available predictive models by Minnesota researchers suggest that supplies could be exhausted by a summertime surge in COVID-19 cases.

Nurses have expressed concerns about efforts to conserve the most-protective N95 masks, therefore increasing their risk of exposure to the coronavirus when treating infected patients.

An investigation by the U.S. Occupational Safety and Health Administration last month, for example, had examined a complaint of expired N95 masks being used when new supplies were short at HCMC in Minneapolis. While health authorities have allowed for the use of such masks during the pandemic, some had faulty straps and didn't fit, so nurses refused to wear them, the report showed.

Before elective surgeries are allowed, which will deplete mask supplies further, the Minnesota Nurses Association said in a statement to state Health Commissioner Jan Malcolm that it first wants guarantees about the adequacy of PPE.

"The risks to resuming elective procedures before healthcare systems can prove that workers and patients in all settings can be protected from infection are deadly," wrote Mary Turner, a nurse who treats COVID-19 patients at North Memorial Health Hospital and is president of the MNA union.

State health officials said they have learned much in two months that is informing their response. There have been minimal cases of infections among child care workers looking after the children of health care workers, which bodes well for the possible resumption of youth summer activities and school next fall, Malcolm said.

On the other hand, the ability for people to spread this virus — even in the absence of symptoms — has fueled the pandemic and outbreaks in facilities like the JBS pork plant in Worthington, Minn., that had to shut down. Case counts in surrounding Nobles County have exceeded 1,000.

"The role of asymptomatic transmission was not something that was clear even a month ago — as clear as it is today," Malcolm said.

More than 9 in 10 COVID-19 deaths in Minnesota involved elderly residents of long-term care facilities or people with underlying health conditions — including asthma; diabetes; chronic kidney, liver or heart disease, or conditions that compromise the immune system. Officials say smoking is also a factor.

A Star Tribune review of records from 327 deaths associated with COVID-19 found heart problems in a third of the long-term care residents who died and kidney problems in a third of the somewhat younger victims who did not live in such facilities.

Walz said he is trying to address both the pandemic and business concerns by permitting businesses to reopen if they can provide social distancing measures and ensure predictable foot traffic that limits face-to-face contact and opportunities to spread the virus.

Roughly 91% of workers can remain on their jobs now, Walz said, when including as many as 100,000 workers from nonessential manufacturing and warehousing sites who were able to return last week, and as many as 30,000 retail workers who were likely to return as of Monday with the allowance of stores to offer curbside pickup to customers.

However, roughly 300,000 workers in the hospitality and lodging industry remain out of work, and Hospitality Minnesota President and CEO Liz Rammer said "many simply will not make it" unless they can reopen soon.

Beyond business concerns, medical officials have worried about a downstream surge of patients with exacerbated heart problems that haven't been managed and aggressive cancers that haven't been screened.

Doctors pursued novel solutions, with cancer specialists flip-flopping the order of treatment in many cases and starting with chemotherapy to shrink tumors with eventual plans for surgery.

Some care has just been deferred, but that can have consequences, said Dr. Michaela Tsai of Minnesota Oncology.

"We're all just very worried about what is going to happen when COVID ends," she said. "We're going to have this flush of people with cancer and heart disease who are far worse off."

Staff writers Glenn Howatt and Joe Carlson contributed to this report.