Minnesota health officials discuss pandemic, take listener questions

After a few days of a testing slowdown in Minnesota since Labor Day, data released Friday included nearly 20,000 tests. In addition, there was only moderate new case growth, with 484 infections reported.

On Monday, MPR News Host Kerri Miller talked with Health Commissioner Jan Malcolm and the state’s infectious disease director, Kris Ehresmann, about COVID-19 testing, the spread of infection in the state and the return of children and adults to school this fall.

Guests:

• Jan Malcolm is the commissioner of the Minnesota Department of Health.

• Kris Ehresmann is the director of the Infectious Disease Epidemiology, Prevention and Control Division at the Minnesota Department of Health.

The following is a transcript of selected segments of the show, edited for clarity. To listen to the full conversation you can use the audio player above.

I'm gonna ask you something that came in via Twitter that I think represents some of the anxiety that Minnesotans are feeling here. As we go back indoors and the weather cools down, Mallory asks, “Will we shut things down again, if necessary? With schools back in session and winter coming? I'm very worried.” Do you see that as any kind of a possibility? Or would it be very difficult to go back to those lockdown circumstances?

Jan Malcolm: Boy it's a great question, and I do think it would be difficult to go back to where we were in March. In March, this was brand new. We all had lots of questions. There was a higher degree of fear just over the unknown. I think there was more public support for taking very widespread and pretty dramatic actions just to sort of get a handle on things. Now that we know as much more as we do about COVID-19, and some of what we know has changed, obviously. And, that's important to note too, but I think the public now expects us to take more measured and precise actions to try to manage where the risk is the highest.

So I think those widespread actions would be difficult, especially at the state level. But you've heard many wise people call for more of a national strategy around that and that might actually be necessary and be more successful if it was done at the nationwide level. But we certainly always have our eyes on these things. And the governor has said many times, he will do what he feels is necessary to keep a handle on this pandemic.

Kris, I hear the commissioner acknowledging that while — and we hope this isn't the case — but if the numbers are telling us that a lockdown would be the most effective way to handle this, public sentiment about it, and public pressure would make that very difficult. Is that also where you see that we are?

Kris Ehresmann: We've definitely shifted in terms of the public's perception of this pandemic. And not just their perception, but their patience with it, if you will. When the decision was made for a "shelter in place" order in March, the public went along with it, and it really felt like we were kind of all on the same page. Things have really shifted in terms of where people are at. It doesn't feel quite as united as it did at that time. I think that we're at a different place. Now, that's not to say that from the epidemiologic standpoint — my job within the department and our team's job — is to provide the epidemiologic data that we're seeing that are necessary for making decisions. And so we will continue to do that, regardless of kind of what the public opinion is.

Caller question: Do I have to wear a mask when I'm six foot distancing? And if I do, why?

Ehresmann: Well, certainly when you're in a public space, and you're, you know, indoors and moving through an environment, you're wearing the mask to protect the people around you. So just as we've said all along, but I think people sometimes get confused. Your mask is not to protect you, but it's to protect the people around you because sometimes people think, “well, I don't care, I'm not worried about this.” It's not for you. It's for the people around you.

The times in which we would say that you wouldn't need to wear a mask is if you're getting together with someone, you are outside, you're seated and distant from people. So you've ensured that six-foot of distancing, then, you know, you can certainly take your mask off. But I think when you are indoors, that airflow is such that, you know, masking is the right thing to do. And again, it's not for your sake, it's for the people around you.

Commissioner, I think this is another good moment to say that this has been a learning curve, not just for those of us who aren't in public health, but even for those who are in public health. I still hear from people saying, "What gives? At the beginning of this we heard not to wear masks," I just think we need to repeat again that we have been learning about this virus transmission, as we go. Can you add some context to that?

Malcolm: That is absolutely true. And the public is right to say that the messages have shifted as we've learned more and as situations have changed. Part of the reason that you heard — even federal leaders saying early on — “you don't need to wear a mask,” is because there was such great concern for the shortage of the availability of masks, and the need to really conserve that equipment for health care workers and the like. And the fact that we just didn't have great information on the utility of masks.

As [Ehresmann] said, the primary purpose is to protect others. As we've learned more about the virus itself, how large the droplets are, how long they can maintain in the air and so forth. The evidence for masking has become even more strong. And now there's some evidence also that suggests that there may be some benefit to the person wearing the mask as well. So all of that continues to evolve as more data comes in, and that does lead us to, to update and change the guidance and change the recommendation. So we really do appreciate and need people's patience with the fact that the information continues to evolve. And that our job, as Kris said so well earlier, is to just give people the best information we know, with the most current information we have.

Commissioner, if you had to identify the areas that you're most concerned about right now for transmission of the virus in Minnesota, would you say it is colleges and it is congregate care centers? Or are there other places that you're really worried about?

Malcolm: Yeah, I think definitely we're seeing you know, we just with the return of cooler weather, everybody going back inside. The strong desire to still continue to be in relationship with each other and to be together. It is certainly some of those very specific environments: schools, colleges, congregate settings — whether those are congregate care settings or congregate living settings — or close-quarters work settings. But we also have seen a fair number of outbreaks associated with just social gatherings. And that's a message that we've been trying to send as well. Just because we're gathering with family and friends, doesn't make that by definition less risky than with a bunch of strangers.

On Friday, the United States reported almost 1,000 deaths from COVID-19. And that's been happening every day. For months, Canada reported zero. Why are people still dying in the United States? And Canada seems to have, you know, gotten this number down to zero?

Malcolm: It is easy to some degree, when you just keep hearing these numbers day after day after day to think “Well, this is kind of what it is, and this would come to expect it or accept it at some level.”

But it doesn’t have to be that way. There are a significant number of these cases and deaths, you know, could be prevented if we were adhering more closely to those recommendations that are meant to keep us all safer. And Kris said something important at the beginning of the call, just the fact that people are weary of this, they have perhaps become desensitized to the risks, or minimizing the risks to themselves may not be thinking fully about the risks to others.

And so we see, you know, kind of more concerned about the negative consequences of doing all these protective behaviors, the restrictions on our fun and on our freedom, and our ability to do what we want to do. And we see that really playing out in the choices that people are making, unfortunately.

So we just have to keep reinforcing that message, while fully acknowledging the disruption, the negative impacts of these restrictions. They are there for a reason. And we are not finished with the risk that this virus is posing to our communities, and our loved ones and to ourselves.

One of the things we've learned is that even though the statistics are quite clear that younger people and people without underlying health conditions are less likely to have a severe illness. We're learning a whole lot about the potential for long term very serious health consequences even among people who may not feel or think that they are at much risk.

Kris, I was looking at some research... People who were infected and sickened early on, and months later, They don't feel like they're back to 100 percent months after that. What are you seeing that concerns you both about the long term effects of having had an infection — again, even if at the time you didn't feel like you had a very serious case?

Well, as the commissioner indicated, you know, we're continually learning about this disease. It's really only been eight or nine months that we've known about COVID. And so it's hard to talk completely about long term consequences because we haven't had a very long time to be dealing with things.

But what we're hearing and what we're seeing is that individuals who have had COVID and may have had what wasn't perceived as a severe case, are continuing to have lingering effects. There's also been research that's been done that looked at individuals who, again had mild cases or perhaps asymptomatic cases that suggest that they may have had cardiac damage. So what we're learning is that the initial symptoms and the initial presentation of this disease does not necessarily constitute the full effect that it has on a person's body.

The sheer fact that we've had mild cases, that when re-evaluated — and this is being done at the national level with studies — that have identified cardiac damage, well, that's something that's really significant. And I think sometimes, that our younger residents just aren't thinking of those things. They're really feeling invincible, and it's a wonderful time of life, to feel invincible. But in this case, this virus may not be cooperating with that.

Listen to the full conversation using the audio player above.

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