The investigation of Minnesota's first case of COVID-19 has produced good news, state health officials said Saturday, as the infected person had minimal close contact with others.
Further communication with the elderly Ramsey County resident, who suffered the coronavirus infection during a cruise to Mexico, confirmed that the person had limited contact with others after returning home and then experiencing respiratory and other cold-like symptoms on Feb. 25.
"There were no exposures that lasted longer than 10 minutes that were within 6 feet of another person … which is wonderful news," said Kris Ehresmann, infectious disease director for the Minnesota Department of Health.
The person sought care on Thursday at an M Health Fairview facility, which took immediate steps to isolate the person from other patients and to obtain a lab sample to send to the state public health lab. Test results confirmed Friday afternoon that the person was infected with the novel coronavirus that emerged in China in December and has swept across the globe. The person is recovering at home in isolation.
Testing of nasal and saliva samples from suspect cases in Minnesota continued on Saturday. The latest posted results show that 48 other tests were negative for the coronavirus, which causes a combination of fever and respiratory symptoms that has been named COVID-19.
The unidentified patient had been on the Grand Princess for a cruise between California and Mexico. That ship was returning from a second cruise to Hawaii when testing linked the death of a 71-year-old man, who had been on the first Mexico trip, to COVID-19, according to information from federal and California public health authorities.
State health officials learned that a total of 26 passengers disembarked from that cruise Feb. 21 and returned to Minnesota. All but two had no symptoms, Ehresmann said. One ended up as the state's first COVID-19 case. The other tested negative. All of the asymptomatic passengers are now past the 14-day incubation period by which COVID-19 symptoms should have appeared, Ehresmann said.
The ship is now anchored off the coast of California, and passengers have been placed under quarantine. Testing as of Friday night had found that 19 crew members and two passengers on board had COVID-19, said Vice President Mike Pence, who is coordinating the nation's COVID-19 response.
State health officials had viewed Minnesota's first case as an inevitability following reports in late February that the coronavirus was spreading person-to-person in the western United States. The likelihood of a positive case increased after March 2, when the state Health Department started testing on its own for the virus.
Gov. Tim Walz on Friday urged calm and expressed confidence in the state's public health system as it seeks to identify others who had been in proximity to the infected patient and may be at risk. All of the patient's identified contacts will be asked to quarantine themselves for two weeks, and they will be monitored by public health officials for symptoms.
"The state of Minnesota has been working around the clock to prepare for this, and I am confident that our Department of Health is up to the challenge," Walz said.
The coronavirus has spread rapidly across the United States, and it has been linked to at least 233 illnesses and 14 deaths in the country. However, state Health Commissioner Jan Malcolm stressed that Minnesota's first case is associated with travel and is not a community-associated case of one person in the state passing the virus to another. That gives health officials a chance to contain the spread of the virus from this individual.
"Are we now suddenly going to go from one to hundreds or thousands?" Malcolm said. "It's certainly our hope to prevent that, and it is not necessarily the trajectory that we would see. Our colleagues in Wisconsin were among the first to report a case. They had one case several weeks ago. They still have one case.
"Our whole goal now is to work aggressively in containment mode to make sure we identify as many other potential cases that are out there as we can," she added.
The state's testing laboratory confirmed the presumptive case shortly before 1 p.m. Friday, and a sample will be sent to the U.S. Centers for Disease Control and Prevention (CDC) for final testing.
Malcolm did not disclose details about the infected person, partly due to privacy concerns, but said the person took steps after suffering cold symptoms to protect others and has been cooperative.
"The person largely has been at home and just sought care [Thursday]," Malcolm said. "As far as we know, this is a person who has not been out and about much."
The patient called ahead of time and put on a mask before going to an M Health Fairview facility. Staff in protective gear moved the patient straight to a room, minimizing exposure risks for others, Fairview said.
While positive cases in other states were placed in hospital isolation, state health officials allowed this patient to return home and to remain isolated there so as not to infect others. Ehresmann said that was a safety precaution.
"We're in influenza season," she said, "and we're sensitive to the fact that we don't want people in health care that don't need to be there."
St. Paul-Ramsey County Public Health officials will be available to support the patient through the isolation and to bring groceries or other essentials as needed.
The CDC had taken historic efforts this winter to prevent the virus from entering the U.S. and spreading — including the first mandatory quarantine of Americans at risk for exposure since a smallpox scare in the 1960s.
A Minneapolis IT worker was among those who were evacuated from the epicenter of the outbreak in Wuhan, China, and then held in isolation on U.S. military bases for 14 days to see if they developed symptoms.
While other coronaviruses cause the common cold, this new strain raised concerns because nobody has immunity to it. Initial estimates suggested that it spread about as easily as influenza — and that one infected person would be likely on average to spread it to 2.2 others. Health officials believe that people are most infectious when they have symptoms, but that it can take up to 14 days for those symptoms to emerge after they have been exposed to the virus.
If COVID-19 continues to spread, the Health Department and local public health authorities could take steps to minimize the chances of more infections, including temporary closures of child care facilities and schools, greater use of business telecommuting, and modifying, postponing or canceling mass gatherings.
Ehresmann said the state is not yet at that point. For now, state residents are asked to take steps to protect themselves and others by washing hands, covering coughs, avoiding face-touching, and staying home when ill.
"The most important thing Minnesotans can do right now to help protect themselves, their families and their communities is to take those tried and true, everyday steps to prevent respiratory illnesses," Ehresmann said.
Studies of the early stages of the outbreak in China suggested that 80% of COVID-19 cases were mild but that anywhere from 1.4% to 3.4% of people died from the infection.
Those death rates might be overstated due to undercounting of mild cases, but it also is clear that people who are elderly or have other health problems are at greatest risk.
Health officials hoped to improve on those statistics in the United States, which had the advantage of time to prepare for the outbreak and to stock up on supplies to protect its health care workers so they could continue to treat patients.
The Legislature is considering a $25 million spending plan so the Health Department can continue to test and track the spread of the virus and intercede as necessary with recommendations to limit public events and reduce exposure in communities.
No vaccines or specific medications exist for COVID-19, so treatment involves standard care to lower fevers and manage respiratory symptoms.
