Coronavirus in one state (142)

The Minnesota Department of Health conducted another of its regularly scheduled press briefings yesterday afternoon (the audio is at the bottom). MDH Commissioner Malcolm noted in her opening summary that trends continue to move in the right direction, but she insists that we remain at “high risk” with the epidemic out of control. This is necessary to justify the incredibly destructive shutdown regime imposed by Governor Walz.

At 8:45 of the audio, Malcolm referred to a recent Journal of the American Medical Association’s research letter. Looking it up to check against her remarks, I found the December 16 JAMA letter “All-Cause Excess Mortality and COVID-19–Related Mortality Among US Adults Aged 25-44 Years, March-July 2020.” The letter purports to identify excess deaths among young adults in the specified time period that are attributable to the epidemic (citations omitted in quote below):

From March 1, 2020, to July 31, 2020, a total of 76,088 all-cause deaths occurred among US adults aged 25 to 44 years, which was 11,899 more than the expected 64,189 deaths. Nationally, excess mortality occurred in every month of the study period and overall in every HHS region. Among adults aged 25 to 44 years, 4535 COVID-19 deaths were recorded, accounting for 38% of the measured excess mortality.

Malcolm mangled the JAMA letter findings in her remarks. She attributed all excess deaths in the age group to the COVID-19 (“we see in the data that COVID-19 is responsible for these excess deaths”). One has to examine closely every relevant assertion of fact she makes. In fact, most of the excess deaths were not ascribed to the disease. The JAMA letter goes on to speculate: “Although the remaining excess deaths are unexplained, inadequate testing in this otherwise healthy demographic likely contributed.”

Even if so, that still leaves a lot of room for excess deaths attributable to other causes. The letter itself adds that “it is possible that simultaneous increases in opioid deaths may have occurred during the pandemic period, making it less clear which of these 2 diseases represents the current leading cause of death among younger adults in areas experiencing COVID-19 surges.”

I asked Kevin Roche for his comments on the JAMA letter in this context. Kevin adds this observation:

The authors examined all cause, opioid and CV-19 deaths among 25 to 44 year-olds from March 1 to July 31. Comparisons were made to 2015 thru 2019. 76,088 deaths occurred in this group, 11,899 more than expected. 4535 were supposedly CV-19 deaths, or only 38%. We know what the rest are due to. The authors make the usual comments about maybe we missed some CV-19 cases, but what is far more likely is that deaths were attributed to CV-19 that had nothing to do with the virus, including accidents and homicides.

In short, nothing that Malcolm says should be taken at face value. Her comments are sloppy at best.

Another case in point: Malcolm also discussed the recession of the current surge of the epidemic in the Upper Midwest. Using a population-adjusted metric, she claimed that since early December case growth has receded faster in Minnesota than in our neighboring states. Asked by Star Tribune reporter Jeremy Olson for the data that substantiates this point, Malcolm whiffed. Also on the call with her was Infectious Disease Division Director Kris Ehresmann. She whiffed too. They had no idea.

If the closure of bars and restaurants is a matter of life and death — if it is necessary to mitigate a true public health emergency — state officials should be calling for the voluntary closure of the bars and restaurants at the tribal casinos and MSP International Airport. What accounts for their silence? MDH evaded a straightforward answer the first time I asked, advising me of the limits of Governor Walz’s jurisdiction. I submitted a follow-up question to MDH a week ago asking them why they haven’t sought voluntary compliance with the governor’s shutdown regime. MDH will provide a response some time, but as of this morning they are taking the silent approach with me as well.