After more than 1.4 infections, 12,183 deaths and 60,000 hospitalized the state looks forward to the next phase
Pioneer Press article featuring Elder Voice Family Advocate's Kristine Sundberg.
After two years, a flood of illness and incalculable losses, is the coronavirus pandemic finally over?
No. But that doesn’t mean we are not in a much better place,” said Jan Malcolm, state health commissioner, who has guided Minnesota through the last two years of the pandemic. The state reported its first COVID-19 infection March 6, 2020.
“We have to stay prepared,” Malcolm added. “We should be at a point where COVID doesn’t dominate everything.”
That can already be seen in new guidance from officials doing away with mask and vaccine requirements at bars and restaurants.
While the current picture looks good, Malcolm noted there’s still a lot of risk for people who are vulnerable.
“When we say ‘back to normal,’ that’s not true for everyone,” she said. “We are in a way better place. A lot has changed for the good.”
Here’s a detailed look at how far we’ve come since that first case was diagnosed, what the long-term impact has been and what to expect next.
CASES AND TESTS
Diagnosing coronavirus infections quickly, easily and accurately was one of the first big challenges of the pandemic and it remains an intermittent frustration two years in.
At first, it was nearly impossible to get a test and the initial kits sent to states by the Centers for Disease Control and Prevention didn’t work.
Gov. Tim Walz’s “Minnesota moonshot,” including a partnership with the Mayo Clinic and the University of Minnesota, gave the state strong testing capacity by summer 2020. By that fall, as one of the worst surges in cases of the pandemic was taking hold, a new lab in Oakdale was shipping saliva tests to people’s front doors.
Minnesota has now administered almost 19 million COVID-19 tests, roughly three tests for each of the state’s 5.7 million residents. At its peak, the state was processing more than 60,000 tests per day.
Almost 1.4 million residents have tested positive for COVID-19 — about a quarter of the state’s population. More than 98 percent of them recovered enough they no longer need to be isolated, while 61,000 have gotten sick multiple times.
For much of 2021, getting tested was easy and there were a growing number of options. Then, when the omicron variant hit, cases soared and tests were once again nearly impossible to find.
Early stumbles on testing by the federal government and the relative free-for-all between the states for accurate methods and supplies encouraged unusual players to come to the field.GS Labs was one of them — it was spun off of a testosterone replacement clinic in Omaha, Neb.
If the government hadn’t stumbled, there would be no GS Labs,” said Dr. Darin Jackson, the labs’ medical director. “We filled a void.”
GS Labs provides rapid antigen tests for most people and follows up with genetic tests for symptomatic patients who need them. It has eight locations in the Twin Cities and about 25testing testing sites across the U.S.
Minnesota, like much of the U.S., has experienced an ebb and flow of infections that has been hard to predict. Cases hit the most vulnerable early on, then were widespread when the weather got colder and the delta variant brought months of high case rates.
Finally, the omicron-driven surge hit quickly and drove rates to unprecedented heights. Jackson says his labs were testing 10,000 people a day right around Christmas. That type of sudden and renewed demand is proof that quick, easy and accurate tests will likely be needed for a while.
That’s the million-dollar question,” Jackson said. “I don’t think it will be going away any time soon.”
HOSPITALIZATIONS AND STAFFING
Ensuring everyone with COVID-19 who needed a hospital bed was able to get one was the key medical aim of the state’s early response and it never really changed. But the way those patients were cared for has been dynamic throughout the pandemic.
The early concerns were about space and equipment. Ventilators and protective gear were in short supply. There was talk of triage hospitals in empty buildings or public spaces like the Mall of America.
It never came to that, but hospitals have been full for much of the pandemic with more than 60,000 needing treatment. Once prepared, doctors and nurses were able to handle an influx of cases in the fall of 2020.
Then, vaccines helped lessen the demand until the delta variant began driving up cases again. From summer 2021 until the end of the year, hospitals were hit with an unprecedented number of patients.
“The first six months was running fast,” said Rahul Koranne, president and CEO of the Minnesota Hospital Association. “The last year and a half has been nothing but exhaustion and crisis upon crisis.”
The lasting shortages have been staffing. Thousands of nurses and other care providers have left their jobs during the pandemic because of burnout, fear of infection and exhaustion.
Calli Pettigrew, a nurse at Children’s Hospital in St. Paul, says the pandemic had a catastrophic impact on her and her colleagues. Early on, she was furloughed to help the hospital save money, and when she came back six months later, many of her colleagues had left and there were staffing shortages.
“The past two years has felt like being crushed from all sides,” she said. “It is unsustainable. I’m so tired of being called a hero. I just want to be treated like a human being.”
Pettigrew said systemic reforms to better protect nurses and patients are desperately needed.
“If more nurses decide to leave the bedside, our system will crumble,” she said.
The Minnesota Department of Employment and Economic Development estimates there are 40,000 open medical jobs in the state. Nationally, about one in five medical workers has quit and another one in three is considering it.
To fill the gap, Walz had to call in the Minnesota National Guard, get help from the U.S. Department of Defense and spend $40 million on temporary medical workers.
Nevertheless, hospital capacity remains strained in parts of Minnesota even as COVID-19 cases have fallen. Many are filled with patients who delayed care for other conditions during the pandemic.
About 38 percent of the state’s hospitals still don’t have any available intensive care beds.
Koranne says hospitals and state leaders must do more to address staffing shortages or there could be dire consequences.
“It could mean a Minnesotan shows up in an emergency room and we don’t have the staff to care for them,” he said.
Koranne says the pandemic left the state’s hospitals in dire financial shape. That makes it more challenging for institutions to rebalance how they provide care when they need to respond to COVID-19 outbreaks.
Minnesota’s hospitals went from tight 1.4 percent margins prior to the pandemic to losing more than $3 billion in the early months of the pandemic. “We are really worried about next year,” year,” he said.
From the start, Minnesota’s elderly and vulnerable adults have been hit hardest by the pandemic. More than 81 percent of 12,183 deaths have been people 65 or older and about46 percent of fatalities were residents of nursing homes or long-term care.
DEATHS AND LONG-TERM CARE
The majority of those who died in Minnesota had pre-existing health conditions that put them at higher risk. After vaccines became widely available, health officials say the average age of those who died began to trend younger because of fatalities among the unvaccinated.
But overall the young were least likely to have a fatal outcome with COVID-19. Just 110 Minnesotans under the age of 35 died of COVID-19, less than 1 percent of all the state’s deaths.
Minnesota has a team that investigates every fatality and COVID-19 has to be a cause of death to be included in the state’s tally. In addition to the confirmed COVID-19 deaths, there are 190 others that are suspected to have been caused by the coronavirus, but the person never had a positive test.
For much of the pandemic, Minnesota had one of the nation’s highest rates of deaths in long-term care. At its worst point, there were more than 700 long-term care facilities with cases among residents or staff.
Kristine Sundberg, executive director of Elder Voice Family Advocates, says it was a “travesty” that Minnesota didn’t have a licensure system for assisted living until August 2021. She believes better oversight at the start of the pandemic could have saved lives.
Sundberg noted that isolation was also a killer for many vulnerable patients because it “prevented families from monitoring the care being given.”
In other incidents, people died of outright loneliness. “Social isolation” and “failure to thrive” were listed on several Minnesota death certificates at the height of the pandemic.
Long-term care facilities have defended their actions during the outbreak. The industry has long suffered from staffing shortages and the pandemic created many other unprecedented challenges.
Cases and deaths among long-term care residents dropped dramatically once vaccines became available and facilities had the staff and supplies to control the spread of the virus.
VACCINES AND BOOSTERS
The three vaccines that won emergency approval less than a year into the pandemic were a game changer. Shots from Pfizer and Moderna tapped an emerging technology that uses mRNA genetic material.
“Remarkable,” said Malcolm. “The scientific progress that has been made in two years is nothing short of breathtaking.”
Minnesota administered 5.5 million doses of vaccine in the first six months they were available. By summer 2021, demand waned considerably. A lot of the hesitancy was driven by misinformation being spread on social media about vaccine effectiveness and safety.
Through January, Minnesota spent more than $10 million on vaccine incentives. About 66 percent of the state’s 5.7 million residents have completed their initial series of vaccines.
To encourage more residents to get the jab, Walz offered incentives like cash, event tickets and even opportunities for college scholarships.
Unfortunately, that may not be enough. Research of patients receiving care through veterans hospitals found vaccine protection waned considerably after six months.
To restore protection, boosters are recommended for anyone 12 and older. More than 2.1 million boosters have been administered so far.
Vaccine makers are creating variant-specific versions of their shots in order to try to keep up with the evolving SARS-CoV-2 virus that causes the illness COVID-19. Health experts believe a seasonal shot, much like those already manufactured for influenza, may be needed to keep the coronavirus in check.
VARIANTS BREAKTHROUGHS
The arrival of variants, specifically the delta strain that became dominant last summer, upended the pandemic fight. While some variants were not of consequence, delta and later omicron were much more contagious and vaccines did little to prevent infections.
But health officials say the shots still protect against severe illness and death.
Nonetheless, breakthrough infections climbed dramatically during the delta wave. Omicron drove them even higher.
Since widespread vaccination began in January 2021, there have been more than 367,000 COVID cases in people who were fully vaccinated, roughly 37 percent of the almost 996,000 cases diagnosed during that time.
Of those, 9,836 were hospitalized and 1,777 died.
Furthermore, when the highly-contagious omicron variant hit the state in December and January, the majority of infections, close to 60 percent, were in people who were vaccinated.
Laura Kirk and her family in Southwest Minneapolis were among them. After a Christmas celebration, where everyone who was eligible was vaccinated and most had a booster, 12 of the 16 attendees eventually tested positive. Luckily, no one had a severe illness.
“It made it clear that omicron presented a whole new ballgame,” said Kirk, who is a professor of nursing at the University of Minnesota. “I think our experiences, while it was awful and, sobering, it also demonstrated how truly effective these vaccines are.”
The coronavirus pandemic led to unprecedented restrictions on nearly every aspect of life in order to slow the virus’ spread.
In March 2020, Gov. Walz issued a peacetime state of emergency that was in place for more than a year. It didn’t end until summer 2021 when lawmakers included it in a deal for the current two-year state budget.
Under the emergency, Walz was able to close businesses and schools and require people to stay home except for necessary trips. It was controversial from the start and Minnesota Republican lawmakers tried repeatedly to end it.
Even after the statewide restrictions ended, many local communities and schools kept coronavirus mitigation measures in place.
That lead to ruckuses at school board meetings, like one in the Rosemount-Apple Valley-Eagan district on Feb. 14 where residents chanted for the masks requirement to be lifted and shouted down school board members.
“It has been a challenging two years for everyone,” Superintendent Mary Kreger said at a follow-up meeting Tuesday when the board voted to follow new CDC guidance and end mask requirements. “Understandably, people are exhausted.”
With unprecedented restrictions also came a flood of state and federal aid to offset the impact on the economy. More than $72 billion has come to Minnesota through a series of aid packages since the pandemic began, according to recent testimony by Minnesota Management and Budget officials to the state Senate finance committee.
Much of that, more than $52 billion, was various types of economic assistance sent to workers and businesses through stimulus payments, enhanced unemployment and aid to businesses to keep employees on the payroll. For context, the state’s latest two-year budget is about $52 billion.
More than $7 billion was sent to Minnesota state and local governments in flexible funds that could be used for a variety of programs. Another $3.4 billion was earmarked for education, $4 billion was for human service programs and $1 billion was for housing aid.
LONG-HAULERS AND THE LASTING IMPACT
Minnesota will be dealing with the impact of the pandemic for years, if not decades, to come. One of the most persistent and mysterious impacts is those who were sickened with COVID-19 and never fully recovered.
The so-called “long-haulers,” or those with long COVID, can experience symptoms for months after they normally would have expected to recover. The most common are brain fog, fatigue, shortness of breath, as well as joint and muscle pain.
Dr. Greg Vanichkachorn, director of Mayo Clinic’s COVID-19 Activity Rehabilitation Program, says it’s hard to know how many people have long COVID, but estimates suggest it could be almost 30 percent of those who were infected. Most of those who experience lasting impacts after infection were not seriously ill in the first place.
There are still a lot of questions about what causes long COVID, but some clues are beginning to emerge as the condition is studied at Mayo and elsewhere. How the immune system reacts to a coronavirus infection is a key focus of research.
“We think a lot of the symptoms come from that robust immune inflammatory response,” Vanichkachorn said. “There’s also been some studies showing perhaps pieces of the virus still floating around in the body that could be causing this immune effect.”
The good news is that many long-haulers eventually recover, Vanichkachorn says. But it is important that anyone suffering from prolonged symptoms contact their health care provider.
“The big takeaway is that it’s not rare,” he said. “Outside of acute illness, just helping people survive, the long-COVID scenario is the one I am worried about most.”
As Minnesotans prepare for what they hope will be a new normal in the months ahead, it is clear the state has been dramatically changed by the pandemic. Everything from childcare to schools, shopping to work, housing to health care is different in ways large and small.
Commissioner Malcolm says that’s a good reason not to discount the SARS-CoV-2 virus going forward. New variants are bound to emerge, and some of them may require an aggressive response.
“This virus is unpredictable and still evolving,” Malcolm said. “We have to keep the tools in the toolbox and be ready to use them. This virus has surprised us multiple times and it should keep us humble.”