State officials unveiled a "battle plan" Thursday to address the rising COVID-19 death toll in long-term care facilities, including universal testing in facilities with outbreaks and the use of incentives and even the National Guard to fill worker shortages when caregivers get sick.
Minnesota lacked testing and other resources to deploy this strategy until now. That partly explains why residents of nursing homes and long-term care facilities account for 15% of the state's confirmed cases, 23% of hospitalizations, and 407 of 508 deaths.
"We have been in what I would call a reactive mode since the beginning," said state Health Commissioner Jan Malcolm, though her agency has provided regular guidance to care facilities and instituted a visitor ban when the pandemic first reached Minnesota.
COVID-19 is a respiratory illness caused by a novel coronavirus, which presents the double blow of spreading easily in the confined quarters of these facilities and causing more severe symptoms and deaths among people who are elderly or have other health problems. These include heart, lung and kidney diseases, as well as diabetes.
Infections are probably due to workers being asymptomatic and bringing the virus into long-term care facilities without knowing it, Malcolm said. Some work at multiple facilities and may carry the virus from one to another.
Immediate testing of all staff and residents in facilities with known cases could limit the breadth of such outbreaks. Altogether, 330 long-term care facilities have seen at least one confirmed case among residents or staff. It has hit 1 in every 5 skilled nursing homes and 1 in every 10 assisted living facilities.
The new approach will consume as many as 80,000 to 90,000 diagnostic tests per month, but state officials believe they have the capacity through a $36 million partnership with Mayo Clinic and the University of Minnesota that seeks to provide 20,000 tests per day statewide. Until now, the state had only recommended testing of immediate contacts of infected residents or staff members.
Gov. Tim Walz said this strategy wasn't possible a month ago, but credited Minnesotans for helping to make it happen now by complying with a statewide stay-at-home order and reducing the number of infections in the community that otherwise would have exhausted state hospital and medical supplies.
A key component of the new plan is diverting more of the state stockpile of personal protective equipment to long-term care workers, who often didn't wear masks or gowns or gloves in working with residents before the pandemic.
Walz said continued compliance with the stay-at-home order, in effect until May 18, will dictate whether the long-term care strategy works — and how quickly the state moves beyond Thursday's tragic milestone of 500 COVID-19 deaths to 1,000.
"If you do it wrong, you're going to be way over 1,000," he said.
To that end, the governor said he is looking for more ways to safely allow people to leave their homes and return to work — with allowances probably coming next for small shops to reopen so they can compete with large retailers such as Target and Walmart that have been open all along.
With Major League Baseball finalizing a tentative plan for a shortened season, the governor said it is critical to find safe sources of entertainment for Minnesotans as well.
"We have to lean as hard into returning these things that we find joy in, so that we can do the other hard stuff that protects us," said Walz, noting that televised baseball from South Korea at 1 a.m. isn't the same as a Twins game.
"Without those things, that's what forces people to say, 'I can't take this anymore, I'm going to go out, you know. I'm just going to take my chances,' " Walz said. "That's the thing that I worried about, hunkering in place too long."
The COVID-19 virus has been confirmed in all but three counties in Minnesota — with northeastern Lake County reporting its first case — and has caused 9,365 lab-confirmed infections. Of those, 435 were hospitalized as of Thursday morning, and 182 were in intensive care.
About 1,400 residents of long-term care facilities have tested positive for COVID-19.
The new long-term care strategy received praise from one industry trade group, especially for increased testing and access to more personal protective equipment (PPE).
"This focused approach will make a big difference in minimizing the number of congregate settings that have multiple exposures," said Patti Cullen, chief executive of Care Providers of Minnesota. "Both the enhanced testing and adequate PPE gives our workforce greater confidence, which we hope translates to increased staffing levels."
State Sen. Karin Housley, R-St. Mary's Point, had previously called for universal testing of long-term care facilities and supported the plan.
"Some of these facilities are currently treating more COVID-19 patients than hospitals," she said.
One concern is that testing of workers and residents on one day won't detect infections that they suffer the next day. Malcolm said state health officials are conducting a point prevalence study to determine how often they have to retest workers and residents.
Another concern is what happens when universal testing identifies infections in asymptomatic workers who then have to immediately halt care of residents.
Long-term care facilities already had substantial workforce shortages before the pandemic. A reliance on a minority workforce only complicates matters. Malcolm said black Minnesotans make up 18% of the workforce in congregate care facilities but 43% of lab-confirmed COVID-19 cases in these facilities so far.
Malcolm said one option is using COVID-19 funds already approved by the Legislature to offer bonuses to workers who fill in, perhaps for multiple days and weeks rather than just spot shifts. Furloughed hospital workers could be one such source. As of Thursday, $72 million of the $200 million in COVID-19 funds remained available, though the Legislature was weighing additional financial support for the state's pandemic response.
Another option is to use the National Guard to address long-term care facility needs. Malcolm acknowledged the need for training of any fill-in workers who provide care to residents, many of whom have dementia and other age-related health issues.
The state's emergency operations center will be used to help coordinate a response that until now had been centered within the Minnesota Department of Health.
While the risk to long-term care residents was evident from the start, Malcolm acknowledged how quickly it exposed workforce shortages and other vulnerabilities in these facilities.
"In hindsight … I would have seen this coming more at the scale that it's coming earlier," she said. "It has taken us by surprise how many facilities will need this level of enhanced help at the same time."
