Coronavirus in one state (150)

The past three Minnesota Department of Health press briefings have been devoted to the rollout of the COVID-19 vaccine in Minnesota. They carry on in the disingenuous spirit to which we have grown accustomed but otherwise are lacking in general interest. Barring unforeseen circumstances I will cut back this series to installments in which I can report my own exchanges with the department (my own, that is, with a little help from Kevin Roche).

In part 149 of this series question number 1 was submitted by a reader. MDH responded in characteristic fashion. The reader writes with an update:

I was not surprised by the tortured doublespeak that MDH used in responding to the question. I did, however, get a little entertainment value out of the fact that they were so confident of their original answer that they felt a need to clarify it with even more tortured doublespeak [in an update] after you posted. I also thought Darwin Akbar’s translation of their response in the comments section was right on point.

We cannot explain it and we don’t know how it happened. Yes, that virus sure is tricky, but under Governor Waltzes-with-Idiots, we’ve got it on the run.

Your continued efforts to draw attention to the emperor’s wardrobe are appreciated, at least by me.

I am sad to report that my father did not remain asymptomatic. The virus caused mild respiratory symptoms which have subsided, but he continues to decline in health due to extreme chronic fatigue, a sharp decline in cognitive abilities, and the accumulative effects of isolation since March 2020.

He is now under hospice care and the sad reality is that he will soon end up as a statistic on the weekly MDH report. His fate and the fate of 3,790 (and counting) LTC residents is a tragedy.

Here are the questions submitted on January 11 along with the department’s responses:

1. Question: Looking at per capita death rates, it appears that Minnesota has fallen behind Sweden and, on a population/age adjusted basis, Florida as well. Would you please explain how you hold to the view that the edicts restricting schools and businesses have been necessary to prevent spread of COVID-19 given that neither Sweden nor Florida has imposed such restrictions?

Answer: It’s not clear to us from your question what source or sources you are using or exactly which statistics you are citing so that makes commenting difficult. However, here’s what we can say: Comparing rates from one state to another or a state to a country is perilous, as it often leads to an apples to oranges comparison. States or countries may define COVID deaths somewhat differently or calculate death rates differently. And data displayed or available on websites may not be comparable, depending on reporting systems. The Florida Department of Health website displaying their mortality data clearly cautions that they display data based on date of death and they have significant reporting delays, so data displayed for the last two weeks are significantly delayed and are updated frequently. This is true for Sweden, too. The data sources and dates should be similar and you should be looking at data from at least two weeks ago.

More importantly however, per capita death rates were not and should not be the sole factor in making decisions on whether certain restrictions or mitigation measures are needed or were justified. One also needs to look at the trends in positivity rate (percent of residents who test positive), hospitalization rates, hospital and ICU bed capacity trends, as well as what is known about how the virus spreads, the kinds of environments most likely to lead to greater spread (and what happens if you have more people in those environments) and so on. The governor’s executive orders are based on such factors and indicators as these and others – a constellation of things – aimed at achieving a set of outcomes specific for Minnesota, not related to what other jurisdictions are doing or ordering to prevent the spread of COVID and protect their citizens. In MN, through the actions we have taken, we have managed, so far, to avoid the kinds of surges in cases that have overwhelmed hospitals and ICUs in other locations.

2. Question: The CDC recently published a study regarding antigen test use in campus environments. In the study antigen tests and PCR tests on the same samples were compared and positive tests were cultured. Antigen tests had very high levels of both false negatives and false positives. In addition, over half the positive results from both antigen and PCR tests did not culture viable virus. If you are familiar with this study, please state why you continue to rely on antigen tests and whether you might reassess how you determine a positive test result from either kind of test.

Answer: It’s not clear from your question which study you are referring to, however, if it is this one, there was actually a really low false positive rate (1.3%).

Regardless, it’s important to note that antigen tests are one tool and are to be used in conjunction with other testing and mitigation efforts. Because of the known limitations with antigen tests, positives are considered probable (our website clearly states that) and, per CDC guidelines, confirmatory testing is recommended in many scenarios.

Viral culture is not a sensitive diagnostic tool because there are many variables as to why a virus will or will not grow in culture. It’s common that samples taken from a person with a presumed high-viral load will not be culture positive. That does not mean they are not infected and not capable of spreading it to others.

Antigen tests are useful because they have a quick turn-around time. With the quick result, a facility can determine quickly if it may be having an outbreak, rather than waiting days for a PCR result. For a symptomatic individual, having the knowledge that they are positive a few days earlier than another test allows them to notify their contacts sooner and hopefully prevent them from spreading COVID, and may avail them of the opportunity to use certain therapeutics, such as monoclonal antibodies, that are very time-limited.

3. Question: Insofar as some two-thirds of deaths attributed to COVID-19 have taken place among residents of long-term care facilities, shouldn’t they be the first in line to receive the vaccine before younger health care workers? Please explain.

Answer: There are many people deserving of vaccination and preventing further deaths is certainly one of the goals of vaccination. With limited vaccine supply right now, we have had to take a phased approach to vaccination and prioritize certain groups based on their risk of being exposed as well as their degree of vulnerability to becoming infected or developing complications from the virus. We have been following federal guidelines for priority groups, so the first phase of vaccination has focused on health care workers and people living in long-term care facilities. They are receiving vaccinations right now. Our long-term care facilities have been severely impacted during the pandemic and many of our most vulnerable citizens, and health care workers, are considered higher risk because of more possible exposures. We also want to protect our health care workforce because they are vital to caring for people who are sick with COVID-19 or any other illnesses or conditions.

The department held press briefings on January 12, January 14, and January 19.
All the relevant numbers have continued to decline and the most recent wave of the epidemic has receded in the Upper Midwest.