Coronavirus in one state (144)

The Minnesota Department of Health favored me with the courtesy of a reply to my six pending questions submitted on December 15 (1-3 below) and December 21 (4-6 below). I asked questions 2, 3, and 6 at the suggestion of Kevin Roche. Check Healthy Skeptic for comments Kevin may have on these responses. I asked question 5 at the request of Center of the American Experiment’s John Phelan. John will comment on the response later this morning at the American Experiment site. I comment briefly on the response to question 1 immediately following the response below:

1. Question: I asked you three weeks ago how you have asked the tribal casinos to conform to the governor’s current shutdown order (E.O. 20-99, effective as of the time of this question, and the currently effective E.O 20-103) and what the responses were. You told me that the state has no regulatory role with respect to tribal casinos. I know that. But you have presented the governor’s current shutdown order as a matter of life or death that is sufficient to justify the infliction of great harm on many businesses throughout the state. The casinos voluntarily complied with the shutdown order this past March. Please explain to me why you haven’t asked them to comply voluntarily with the terms of the current shutdown order.

Response: Tribes are sovereign nations. So as a general approach, MDH works with them in a collaborative way providing them data, advice and guidance about COVID-19 that is befitting that relationship. A key component of the relationship is respect for Minnesota tribes as sovereign nations ultimately responsible for the operations and safety of their casinos during the pandemic. If you have questions about specific tribes or casinos and how decisions were made, we would refer you to those tribes for further information.

Please attend to the sickening nonresponse and the lack of media interest on this point. Walz danced around this issue in his patented style in response to one question posed to him and noted in part 140 of this series. The authorities will not provide a straightforward answer to this question. Although they have shut down indoor service at bars and restaurants throughout the state on the bald assertion that they pose a life and death health hazard, they decline to ask tribal casinos to conform voluntarily with Governor Walz’s lockdown regime. The lack of candor is telling. Something doesn’t compute. I trust that the intelligent reader can figure it out for himself.

2. Question: You have repeatedly implied and stated that the incubation period for manifestation of the disease is two to four weeks, the time it would take to see the effect of mitigation actions, when the research shows that the average time between exposure and development of symptoms is a week or less, and that it is extremely rare for symptoms to appear more than ten days after exposure. Shouldn’t the effectiveness of mitigation measures be evident in case counts within a week?

Response: Absolutely not. The effectiveness of mitigation measures cannot be measured within a week. The time it takes to see the effect of mitigation measures and the incubation period for a single case of COVID-19 are two very different things. You are correct that the average time between exposure and development of symptoms is about 7 days, but we know there are still many cases that do not show symptoms until Day 10, 12 or 14. Cases do not become part of our reports or data on the exact day they develop symptoms. It may take several days after someone develops symptoms for them to see a health care provider or for them to get tested. It may take another couple days for that positive result to be reported and for the case to be confirmed through case investigation and to be reported by us as a case. So we’re already beyond the one week time frame you describe. More importantly, however, in considering mitigation measures and looking at their impact, we must look beyond the Week 1 primary case, so to speak. In fact, cases occurring in a particular week were already infected the week prior. That is, that exposure has already occurred and mitigation is not a time machine – we can’t go back and un-expose someone, which would be the only way to see effects in one week. Therefore, when actions are taken, they have no impact on the cases already infected and currently incubating. The goal of these mitigation efforts is to decrease the next round of spread (secondary cases) and the next round of spread (tertiary cases) and so on and so on. Which is why the impact of mitigation efforts takes weeks to see in the data.

3. Question: You have been telling us for several months that a new release of Minnesota model 3.0 was imminent. Versions 1.0 and 2.0 appear to have been wildly inaccurate. Why hasn’t model 3.0 been released consistent with your repeated assertions?

Response: We have worked on the model through summer and fall and anticipate releasing information in the most appropriate context and in a way that balances all the high-priority issues being considered right now with vaccine release.

4. Question: (This is for Director Ehresmann): Referring to your recently published CDC analysis of Minnesota cases related to the Sturgis rally (citation here), please provide your estimate, if any, of how many Minnesotans attended the 10-day rally that drew a crowd of some 400,000 this past summer.

Response: We have not estimated how many Minnesotans attended the Sturgis rally. Such an estimate was not relevant to or needed for our study of Minnesota cases connected with the rally. Our study simply described the chain of transmission that occurred in MN from this particular event and highlighted the far-reaching effects that gatherings in one area can have on another. Eighty-six Minnesota COVID-19 cases (51 primary, 35 secondary or tertiary) were associated with the South Dakota motorcycle rally; approximately one third of counties in Minnesota reported at least one case epidemiologically linked to this event. The South Dakota tourism bureau would likely have estimates on the number of attendees from each state.

5. Question: Please provide the questionnaire or outline used by staff to interview subjects for the purpose of COVID-19 contact tracing.

Response: We have not routinely provided the specific interview questions to reporters because the questions can change, depending on the course of the pandemic. However the interview forms follow a standard outline based on best practices and MN law. The outline of the interview is: 1) Tennessen (privacy) statement), 2) demographic information, 3) living setting, 4) illness history, underlying health conditions, 5) potential exposures during the incubation period, 6) infectious period/release from isolation, 7) assess contacts/potential exposures, 8) exposure notification app information, 9) need for essential services, 10) prevention messages, 11) additional demographics and isolation address.

6. Question: In light of the World Health Organization release last week (citation here) warning about the use of PCR test results with high cycle numbers, will you provide information on the cycle numbers associated with the PCR tests used in state labs (assuming you know what cycle numbers are used by various labs across the state as a threshold for positivity — please state if you do not)?

Response: The WHO release seems to address improper analysis of RT-PCR. Any reputable, regulated laboratory should be following the Instructions For Use (IFU) for their test platform exactly to ensure a positive result is not because of background. We do not have the Ct values of other labs around the state. The assay that the Minnesota Public Health Laboratory (PHL) uses has a cut off of 40 Ct. There are many different platforms used and all of them will have different Ct cut off values, they typically range from 35-45. Since the design of each assay is different, Ct values are not comparable across platforms. Many platforms do not even report the Ct value, so laboratories are unable to even report one.

Yesterday’s MDH press briefing (audio below) was the last of the week. The questions focused in a mostly unenlightening fashion on the distribution of vaccines and the occurrence of vaccinations in the state.

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