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Coronavirus in one state (134)

Playing catch up, the Minnesota Department of Health responded to my second and third sets of three questions consistent with the terms of my settlement agreement with MDH Commissioner Jan Malcolm and MDH communications head Michael Schommer. Kevin Roche comments on several of the answers in “A few more observations, some ranting involved.” I interrupt the flow only to comment on the answer to question 1 below. Here they are, more to come next week:

Question 1: Please advise how you have requested the tribal casinos and MSP International Airport bars and restaurants to conform to the governor’s shutdown order and what the responses were.

Answer: MDH does not have a regulatory role with respect to tribal casinos. The Executive Order (20-99) at paragraph 6 g. addresses Tribal activities and lands[. It] contains exemptions for tribal activities and activities within tribal lands.

Executive Order 20-99 7 c ii contains an exemption for restaurants and food courts inside the secured zones of airports. These are not considered Places of Public Accommodation so are not subject to the requirements for Places of Public Accommodation. You may contact MSP administration to find out what COVID safety measures it is requiring for businesses within its secured zones.

My comment: Please note the nonresponse response. Many Minnesota tribal casinos closed voluntarily following Governor Walz’s initial proclamation of emergency based on the COVID-19 epidemic this past March. Minnesota restaurants and bars throughout the state are now subject to another shutdown order that is presented as a matter of life and death. Are you telling me you haven’t even requested the casinos to conform voluntarily with the current shutdown regime? I think you are.

Question 2: According to the CDC data, Minnesota has a large number of deaths above average in 2020 from causes such as dementia, cancer, diabetes, heart disease and hypertension. I believe that there are currently at least 1500 such deaths this year. These are decedents without COVID-19 and appear to be deaths that are attributable to the state’s suppression efforts. Why aren’t you regularly reporting on these harms to Minnesotans?

Answer: The real-time reporting of COVID-19 deaths is an exception and is consuming a great deal of resources. Typically, MDH does compile death data through death certificates but there typically is a lag-time of a year or longer to account for the analysis of the cause or multiple causes of death listed on those death certificates and publication of the statistics. States work with the National Center for Health Statistics and the CDC. Currently, the most recent data they have posted [here] is from 2017.

It is also an efficient use of resources to refer those interested to the CDC data you mentioned, which is something we do when asked for this information. We send people to the CDC’s metric about excess deaths associated with COVID19. Excess deaths are deaths over the amount that are predicted or expected [citation here]. If you scroll down, you can see where Minnesota is at.

Question 3: The CDC reports deaths daily with week of occurrence. MDH departs from this practice. For the five weeks ending 11/7, deaths per MDH exceeded deaths per CDC by 88. It appears that you have the actual date of death information. Why don’t you report actual date of death statistics?

Answer: Our current practice provides the most up-to-date information with the least lag time to help track the course of the pandemic.

Question 4: With respect to hospitalizations, how many and what percent of the hospitalizations attributed to COVID-19 in your data derive from patients who first tested positive at or after the time of admission? How many and what percent are people admitted for another reason, but then tested positive? How many and what percent are people who acquired COVID-19 infection in the hospital?

Answer: We do not have this level of detail readily available at this time and we do not have the capacity to complete a custom data analysis.

Question 5: What is the mortality rate for patients hospitalized with COVID-19 and how has that trended?

Answer: We do not have this level of detail readily available at this time and we do not have the capacity to complete a custom data analysis. The issue was explored in the September/October article of Minnesota Medicine article here.

Question 6: A number of the tests now appear to be repeat tests on the same individual. How exactly are you calculating positivity rates. Is it limited to one positive result for one individual?

Answer: Positivity rate is the percent of tests positive out of the total number of tests. This does look at all tests, which includes people being tested multiple times. The case numbers and all counts other than tests do not count duplicate cases (so if someone tests positive twice, that case is only counted once.)

I think we are beginning to get somewhere. I will continue along these lines in the hope of adding depth to the coverage of the epidemic in Minnesota.

Governor Walz called another press briefing of the dog and pony show variety yesterday afternoon (video below). Commissioner Malcolm, Minnesota National Guard Adjutant General Shawn Manke, and two LTC executives joined Walz for the show.

Malcolm provided an update on the “5-point battle plan” to combat deaths in long-term care facilities. Her update included a set of Power Point slides illustrating the data. Malcolm proclaimed great progress that has succumbed to the current wave of community spread. Corey Bork took useful notes on the briefing that are posted here.

As usual, Governor Walz opened the briefing with a blizzard of verbiage. No one is ever going to outtalk Walz. Following all the presentations Walz returned to the lectern. With General Manke’s remarks in mind, Walz proclaimed: “Myself have worn that uniform for 24 years.” That’s what the man said.

After a two-minute break they took questions from reporters (audio below).