After more than 2,000 COVID-19 deaths and nearly 100,000 infections, there’s still a lot doctors and health officials don’t know about the coronavirus pandemic that has upended life in Minnesota and around the globe.
Doctors and health officials are confident that older people and patients with certain pre-existing conditions are at the greatest risk of serious coronavirus infections and dying of COVID-19.
In Minnesota, 92 percent of the state’s deaths were patients age 60 or older and most of those fatalities, at least 1,435 people, lived in long-term care facilities. About 95 percent of those who died had serious underlying health conditions.
But young, otherwise healthy Minnesotans are dying, too.
About 8 percent of Minnesota’s COVID-19 deaths were under the age of 60. State death records show that with at least 16 of those fatalities, the patient did not have an underlying health condition that put them at higher risk.
For another 13 deaths, the impact of other health problems was undetermined.
Minnesota’s pandemic has also had a disproportionate impact on communities of color. Black and Hispanic Minnesotans are more likely to catch the coronavirus, need to be hospitalized or die of COVID-19 than their white neighbors.
Additionally, doctors are discovering troubling, long-term health problems in some recovered coronavirus patients, even those who had mild cases.
Essentially, while scientists are learning more each day about this new coronavirus, there is much we still don’t know.
“I think we have learned a great deal in the last difficult eight or nine months,” said Jan Malcolm, Minnesota’s health commissioner. “Including the ways that risk for severity or even death might be more nuanced than we first thought.”
Malcolm noted that while most people who contract the virus recover, there are still a lot of unknowns about the long-term impact a COVID-19 infection.
“We have definitely learned about the disproportionate impact of the disease on certain communities and on vulnerable populations,” Malcolm added.
WHO IS GETTING SICK, WHO IS DYING?
When Minnesota first started identifying coronavirus infections in March, health officials aimed much of the state’s limited virus testing at older residents and those with serious underlying health problems.
Federal data suggest as much as half the U.S. population has underlying health problems of some kind. Heart and lung diseases, cognitive disorders and diabetes are among the most common conditions contributing to COVID-19 fatalities.
Early on, long-term care facilities, such as nursing homes, assisted living, group homes and rehabilitation centers, were the epicenter of the pandemic, accounting for most of the cases and deaths.
The long-term care sector already faced significant staffing challenges and facilities struggled to prevent and contain outbreaks. Minnesota has a larger percentage of its COVID-19 deaths in long-term care than all but two other states.
At its peak in mid-May, Minnesota was recording about two dozen deaths per day. Most of those deaths were older residents living in long-term care.
As testing capacity improved, it was clear younger and middle-aged Minnesotans were also transmitting the coronavirus in large numbers.
After Gov. Tim Walz’s “Stay at Home” order was lifted in June, Minnesota’s outbreak began to shift. Test results made clear that young and middle-aged residents were transmitting the coronavirus at gatherings, many of which were in defiance of public health guidelines.
In the spring, the median age of Minnesota’s coronavirus patients was about 44 years old, the median age of hospitalized patients was 61 and the median age of those who died was 83.
As autumn begins, the median age of virus cases is now 35, but the median ages of those who are hospitalized or died has only declined slightly.
Minnesotans in their 20s are now the age group with the most cases with nearly 22,000 infections. Health officials worry younger Minnesotans will infect older, more vulnerable residents.
“It can spread from people who don’t have symptoms, and it can result in the very rapid decline of patients who are older and patients who have (underlying health issues),” said Dr. Ruth Lynfield, state epidemiologist.
Throughout the pandemic, Minnesotans of color have been at greater risk of contracting COVID-19, having a serious infection and dying of the disease.
For example, Black residents account for about 6 percent of the state’s population and were 18 percent of coronavirus cases, 22 percent of hospitalizations and 10 percent of fatalities. Hispanics are 5 percent of the state population and 16 percent of coronavirus cases and 15 percent of intensive care admissions.
The disparity is even more stark in younger patients. Of those under 60 who died, 53 percent were people of color.
State health officials are working to uncover why those disparities exist. They believe barriers to health care and jobs with higher chances of work-related exposure are key reasons why Minnesotans of color are contracting COVID-19 at higher rates.
LIKE THE FLU, OR WORSE?
There’s been a ton of debate about SARS-CoV-2, the official name of the new coronavirus, and how it compares to seasonal influenza. There’s a lot of similarities in the symptoms and there’s a lot health workers still don’t understand.
In the past six months, Minnesota has seen roughly 100,000 coronavirus cases, 2,000 deaths and 7,335 patients who needed to be hospitalized.
In contrast, over the past six flu seasons, not counting the 2019-20 season, Minnesota has averaged 227 influenza deaths and 3,310 hospitalizations.
The severity of the flu season varies rather dramatically from year to year depending on which strain of influenza is broadly circulating and the effectiveness of that year’s vaccine. For instance, there were 6,446 hospitalizations and 440 deaths during the 2017-18 flu season.
Yet in 2015-16, there were only 1,538 hospitalizations because of the flu and just 76 deaths.
One of the key reasons COVID-19 fatalities have declined, in Minnesota and across the nation, is doctors are learning more and more about what treatments are most effective for the relatively new disease.
Simple things like providing oxygen earlier and placing patients on their stomachs to help them breathe have helped reduce deaths, as have drug treatments such as the antiviral remdesivir, steroids and anti-inflammatories.
The Food and Drug Administration provided an emergency authorization to allow the malaria drug hydroxychloroquine to be used as a treatment, but the authorization was revoked after studies found it wasn’t an effective treatment.
Lynfield compared efforts to treat serious COVID-19 cases to “building a plane while trying to fly it.”
“I think there have been advances in the care of patients,” Lynfield said. “People have really approached it from multiple angles.”
The coronavirus pandemic has revealed numerous shortcomings in both Minnesota’s and the nation’s plans to deal with widespread outbreaks. But none have been as clear as the issues with protecting residents in long-term care.
Minnesota struggled before the pandemic with oversight of the assisted-living sector. After COVID-19 hit, it was evident that long-term care facilities need to be much more prepared for widespread health challenges.
“One big takeaway, we have a fresh appreciation for the fact that long-term care is a vital part of the whole health care continuum,” said Malcolm, noting that past pandemic planning has focused mostly on hospitals. “That same intention needs to be applied to, and those resources made available to, long-term care as well.”
Health officials also emphasized the importance the public plays in controlling the pandemic. Wearing a mask, social distancing, limiting group sizes, routine hand washing and staying home when ill are still the best ways Minnesotans can control the spread of COVID-19.
A lot of older, vulnerable Minnesotans are dependent on residents following those guidelines.
“Each person who has died in our state was someone who was loved by someone. Someone who contributed to our society,” said Lynfield, emphasizing the importance of wearing a mask, social distancing and avoiding large groups to slow the spread and save lives.
“This will inconvenience people, we know that,” she added. “In a pandemic, we all need to pull together to make it through.”