Coronavirus Daily Briefing: State leaders address congregate care living settings, preparedness for peak

Minnesota Gov. Tim Walz did not join state leaders in discussing updates Tuesday regarding the COVID-19 pandemic in the state.

However, many topics such as congregate living, testing, preparedness and where the state currently stands in combating the coronavirus were addressed by other state leaders.

Minnesota Department of Health (MDH) Commissioner Jan Malcolm noted that the state originally saw 18 deaths in the most recent MDH COVID-19 report but negated one death due to error. Earlier Tuesday, MDH said a total of 2,567 people have tested positive for the virus. State deaths have accumulated to 160, while 47,697 tests have been done. Walz said Monday his goal is to get to 50,000 completed tests this week.

The age breakdown of confirmed COVID-19 cases in the state is split between 20-44 years (33%), 45-64 years (33%) and 65-and-over (31%).

The area continuing to be focused on are congregate living areas, as a majority of the cases have come from that setting. Residents living in those areas are at an increased risk. The state takes rapid action when they hear of any possibility of COVID-19 entering a congregate-care facility. Kris Ehresmann, Director, MDH Infectious Disease Epidemiology, said the state has had weekly calls with those facilities.

Ehresmann discussed the process of working with congregate settings. She said the state initiates a comprehensive investigation when learning of COVID-19 in a congregate-care facility, and performs in-depth interviews with members of the facility to learn about and try to trace the virus. Based on the investigations, they make recommendations such as isolation, quarantine or work exclusion.

When asked if families should avoid congregate care settings for people who need them, Ehresmann said it should come down to the decision the family makes but added it’s important to understand what the family member in question needs and if the care facility can offer it. Typically, facilities will still be able to handle whatever is faced. Michelle Larson, Ph.D., Health Regulation Director at MDH, added to Ehresmann’s point, stating facilities can’t refuse to accept new patients, but family members should look into the facility and make sure the family member will get the care they need. As long as the facility isn’t overwhelmed and they cover the needs of the family member, then it’s fine.

According to Ehresmann, 113 of the 160 deaths in Minnesota from COVID-19 have come from long-term care facilities.

Many individuals still have to go in and out of congregate care facilities for care reasons, so even though visitors have been shut out of those facilities and officials have attempted to lock them down to limit community spread, it can’t be completely done, which presents a challenge. Malcolm said it’s wise to always look at the bigger picture, stating congregate care residents make up a smaller percentage of the people hospitalized and many people are in the intensive care unit who aren’t associated with congregate care facilities. Also, due to the high number of people who still haven’t gotten COVID-19, a great risk for a very rapid spread exists, Malcolm said.

Ehresmann said the spread of COVID-19 in congregate care facilities can differentiate between resident, community and other types of spreads. Visitor times have been stopped, but community spread is still possible. Officials believe direct contact is mostly to blame for the spread.

"We need to make sure we’re intervening as quickly as possible," Ehresmann said.

State health leaders also addressed infection prevention and outbreak control measures during the call Tuesday. Some of the control measures include isolating ill residents and keeping them together but away from non-ill residents.

The state has also set up an individual phone line for long-term care facilities, as they have been one of the bigger hot spots in the state. Larson added whenever a facility needs help, they have teams ready to help them for a few days and then figure out where to go from there.

Larson said the goal for long-term facilities is to get in front of those impacted and be proactive, see who can help, refine processes and communication. She said it’s also important to understand what is available in each community.

Malcolm said the pandemic in Minnesota is growing in a measured sense where it isn’t overwhelming care facilities or supplies, calling it a "stable situation" because the state has what it needs to deal with the caseload so far.

"Part of our challenge is to get better and better at a rapid response … because we know this is going to keep happening," Malcolm said, acknowledging more hotspots will continue to pop up in places.

"It’s growing but it’s growing at a pace we think we can manage," said Malcolm.

Ehresmann added, "While it may seem like we’re in a lull right now … we absolutely know we’re going to see more cases." The current pace is allowing the state to deal with things such as congregate care facilities and continue to make changes to improve the state’s response.

Regarding testing in Minnesota, Ehresmann said some facilities have done extensive testing but others have had more challenges with testing capacity, meaning all cases likely haven’t been identified. However, all facilities are following the correct safety guidelines to work to keep residents safe. Malcolm added that everybody has basically been on their own and now they’re trying to take a more systematic approach to ensure everyone who needs to be tested will be, including a more vigorous approach in congregate care settings.

Malcolm said many people are frustrated with the lack of testing and they have a right to be. She said it’s important these tests are high-quality and accurate. Talks involving the University of Minnesota, Mayo Clinic and the state legislature were expected Tuesday, with discussions centering on adding capacity and the variety of tests that are being looked at.

"I can tell you no one is more anxious and focused on that than the governor," Malcolm said about testing capacity.