The deaths in long-term care facilities that fueled the early stages of the COVID-19 pandemic in Minnesota have dropped tenfold since the state launched an aggressive testing and staffing plan to protect workers and residents.
Gov. Tim Walz and state health officials acknowledged shortcomings in their initial response to COVID-19 outbreaks in these vulnerable facilities — which were exacerbated by a lack of federal emergency support and supplies — but said on Tuesday that the state has learned from those early experiences about how to protect them.
At a peak of the pandemic in mid-May, 23 facilities were reporting new outbreaks every day of at least one case of the infectious disease. Now, that rate is 6 per day. The state lost 137 long-term care residents to COVID-19 deaths in the third week of May, compared with 13 last week.
"The clear majority of nursing homes and assisted living facilities in Minnesota have no current identified COVID cases," said Jan Malcolm, state health commissioner. "These facilities are safer today than they were at the beginning of the pandemic."
The state's "hard won lessons," as Malcolm described them, came at a cost.
Among the 1,548 COVID-19 deaths in Minnesota, 1,189 involved residents of long-term care facilities. That includes one of three deaths reported Tuesday.
The state on Tuesday also reported 352 more lab-confirmed cases — bringing the case count to 47,457 — and that the number of Minnesotans currently hospitalized for COVID-19 had increased to 266.
Walz commended state long-term care facilities for reducing the spread of COVID-19 but said challenges remain for them and the state as a whole. More cases and deaths in this population are likely, he added, given the rising mortality risk of COVID-19 cases with age.
The governor said an announcement would likely be coming Wednesday or Thursday regarding a mask mandate in Minnesota.
If instituted, it would join 28 states and numerous cities and retailers that have made such a move.
Based on the latest data supporting the protective benefits, Walz said, widespread mask use in Minnesota — regardless of a mandate — could lead to the further reopening of business and community activities and the resumption of in-school classes in the fall.
An announcement on school reopening plans will come next week.
Walz said people can already go to cafes, work in most offices, play golf, and watch their kids play sports, and that mask-wearing would get the state to the next phase.
"If we wear masks and social distance, we can do all of those things in addition to getting kids back in school," said Walz, noting that even a hesitant President Donald Trump tweeted this week that mask-wearing was "patriotic."
Asymptomatic spread
Minnesota still has the 18th-highest COVID-19 death rate per 100,000 people among states, according to the U.S. Centers for Disease Control and Prevention's COVID Data Tracker, due largely to the early-spring surge in outbreaks in long-term care facilities.
Wisconsin and Iowa are seeing more rapid growth in COVID-19 cases — and both stayed on New York's travel restriction list on Tuesday even as Minnesota was removed. But their overall COVID-19 death rates remain lower than the rate in Minnesota, where some advocates were loath to celebrate the recent progress as a result.
"The governor didn't have a plan and only got a plan when the number of deaths was huge," said Sen. Karin Housley, the Republican chairwoman of a Senate committee on family and aging. "No one should be patting themselves on the back."
The COVID-19 risk to long-term care residents was apparent at the outset of the pandemic in the U.S., which started in February with an outbreak at a nursing home in Washington state where 35 people died.
Preparations in Minnesota were hindered early by confusion over the amount of personal protective equipment — such as masks and gowns — that would be coming from the federal national stockpile, Malcolm said.
"It wasn't well until late April … that we got a very small allocation," she said. "To our surprise and our deep dismay, we were told that was it and we weren't going to get any more."
State officials consequently conserved supplies for hospitals that anticipated large numbers of cases, despite shortages in long-term care facilities.
Health officials also didn't initially recognize how easily the coronavirus that causes COVID-19 was spread by people before symptoms emerged. Many workers with asymptomatic cases consequently infected residents in their care without knowing it.
Turning point
Michelle Solwold, health care administrator at the Good Samaritan Society in Brainerd, recalled how rapidly the virus spread in her 85-bed facility this spring. After two rounds of testing, the facility discovered infections among 32 residents and 29 workers.
State intervention that brought in a dozen nurses from the Federal Emergency Management Agency kept the facility open, she said.
"We were running truly an ICU in our long-term care unit, and it's because of those FEMA nurses that we survived — that we didn't sink," she said.
Daily state COVID-19 death reports showed a three- to fourfold difference in early May between the high number of deaths in long-term care and the low number in people living in their own homes. That gap closed entirely last week because of declines in long-term care deaths.
Walz's five-point plan in early May to improve safety in long-term care facilities was a turning point, Malcolm said, especially the commitment to conduct universal COVID-19 diagnostic testing of all residents and staff in any facility with a confirmed case.
Medical personnel from the Minnesota National Guard conducted many of the screenings, though that responsibility is now being transferred to other health care providers in the state.
Some large nursing homes were so short on supplies in April that they put out calls for donated masks and converted graduation gowns or rain ponchos to turn them into makeshift protective gear. Some workers stayed home because the lack of staffing and supplies had them fearing for their safety.
State health officials recruited corporate leaders to use their purchasing power and connections to secure more supplies for Minnesota, which was able to divert more equipment to long-term care facilities once the needs in hospitals were better understood.
Malcolm said in the week of June 15-23 alone, the state sent 11,000 gowns, 716,000 gloves, 28,000 faceshields and 57,000 N95 medical-grade masks to long-term care facilities.
Staffing shortages have been addressed with the help of 1,100 health care professionals in Minnesota who volunteered to cover shifts at long-term care facilities where workers were out sick, Malcolm said.
'Come a long way'
Progress in containing the virus in long-term care is evident at Jones-Harrison Residence, a large senior care community in south Minneapolis.
In early June, 18 senior residents at Jones-Harrison were sickened by the virus. As of Tuesday, only two were still quarantined on the facility's COVID-19 wing, and they may be cleared to leave this week, said Chantal Peterson, campus administrator at Jones-Harrison.
"We've come a long way," she said. "But it's going to take constant vigilance to stay in front of this."
After a prolonged lockdown, Jones-Harrison will be joining other facilities across the state in allowing residents to visit indoors with family members and other essential caregivers.
The mood was already festive outdoors on Tuesday afternoon, though, as several families showed up to meet their loved ones amid the gated and flowered patios.
Christie Lord, 71, of Minneapolis, arrived with a package of new socks and a yellow rose for her longtime partner, Pamela Palmer, 71, who lives in the memory care unit.
The first time the couple met like this, after a four-month lockdown, they gazed into each other's eyes for at least 10 minutes before they each teared up and began to talk.
"It was like a miracle, like she had risen from the dead," Lord said.
Such face-to-face meetings have gained new meaning, Lord said, after the "dark days" of the lockdown, when so many people were dying from COVID-19 in senior homes that the couple was unsure they would ever see each other again. Lord said she would drive by the facility and wave at Palmer from her car.
"I feel proud of everyone who fought this virus," she said, "and helped get us through the nightmare."
Staff writer Glenn Howatt contributed to this report.
