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Coronavirus in one state (94)

Deaths attributed by the authorities to COVID-19 continue at a low level. Over the past two days have reported six new deaths (9/1, one in a long-term care facility) and 7 new deaths (9/2, six LTC). Hospitalizations likewise remain at a low level. The LTC share of all deaths hovers around 74 percent. As of the last weekly report (8/27), the median age of all decedents is stuck at 83.

The Department of Health held its regular press briefing yesterday (audio below). Infectious Disease Director Kris Ehresmann updated us on the Sturgis apocalypse. We’re up to 50 cases and one death (involving significant underlying medical conditions).

Commissioner Malcom addressed two questions asking variously about the goal of the authorities at this point. She discussed the suppression of new “cases.” She rambled at length, at one point holding out New York as a great success. Finding her remarks mind-boggling, I sought assistance from Kevin Roche on this aspect of the briefing. Kevin writes here at length, but these points are key:

The first and the last questions dealt with the goals of the current “strategy,” which is a woeful [misnomer] if I have ever heard one. The first questioner noted that the original strategy was all about building health resources and we accomplished that so what are we doing now. The honest answer, which is evident in the Incompetent Blowhard’s [i.e., Governor Walz’s] complete absence and invisibility in regard to CV-19 or anything (he apparently recognizes how unpopular he suddenly became), is that there is no strategy.

The answer we got was that yes we needed to do surge preparation (just so we are all clear, we had our “surge” in May, before preparations were far along and we never got close to capacity, meanwhile people missed cancer treatments and didn’t get treated for heart attacks. And remember the warehouse for corpses). Now we are concerned about the high level of cases and we have to reduce cases. Why–1) here is a new twist–because some people are suffering these terrible long term consequences of the disease; and 2) because we need to be able to keep schools open, etc., a gentler version of the blatant blackmail we heard on Monday.

Again, especially when testing levels are considered, we do not have a high level of cases. On any given day, about one in 10,000 Minnesotans is being “infected.” And that is ignoring false positives and ignoring very low levels of positivity which mean the person is not infectious. We don’t have information on the positivity thresholds the state is using, but if it is like NY and Mass, and I don’t know why it wouldn’t be, most of our cases aren’t “cases” that would warrant any attention or that could lead to any transmission. So I am baffled by the effort to convince Minnesotans that we have some case crisis. We don’t. The few cases we have continue to be relatively mild and lead to few deaths, again almost exclusively among the elderly, in or out of nursing homes.

The nonsense about serious long-term consequences is unsupported by any rigorous evidence. A small, very small, percent of people with serious illness are reporting some long-term complications. It is unclear if these are truly related to CV-19 or to underlying conditions the patient had. And this is true of any disease, it hits some people harder. Guess what, some influenza patients have very serious long-term consequences. To say your whole strategy is based on reducing cases so a few (and of course, the state gave us no information about how many, if any, of these patients exist in Minnesota) people don’t have some long-term complications is unfathomable and as usual, displays no recognition of the costs and harms of the measures taken to limit cases.

The last question was a follow-up in which the questioner said “it sounds like you are trying to completely eliminate cases.” The questioner has an accurate perception. The commissioner said, no, we know that isn’t possible, we just can’t have case growth this high (see response above and the actual data) and we need a manageable level of transmission, without spelling out what that is. So there you have it, our whole strategy now is to achieve manageable transmission, and we will know it when we see it.

As a side note, the commissioner referred to NY as being a stunning success in reducing case volume. Uhhh, several tens of thousands of dead New Yorkers may beg to disagree. (I am wondering if the commissioner is hiding for him that information on nursing home deaths that Cuomo can’t seem to find til literally two days after the election.)

New York has a low level of transmission because the virus was basically allowed to rip through the population before any serious mitigation efforts were made, and so the state has a prevalence as high as 40% to 50% in some areas, which under the most accurate and sophisticated models would suggest sufficient population immunity to slow transmission. Whoaaa, you mean that population immunity strategy can actually work?

Kevin has more here, all of it worth reading.