Gov. Tim Walz plans to continue his ban on indoor service at bars and restaurants and is expected to announce Wednesday afternoon whether he will extend other restrictions on public life after his four-week lockdown measures expire Friday.
The governor first implemented limits on bars, restaurants, gyms and social gatherings in mid-November as hospitals stood on the brink of being overwhelmed with COVID-19 patients. The moves drew criticism from some who argued the public health rules wouldn’t help, or were too tough on certain businesses like fitness centers or activities such as youth sports.
Lawmakers approved $216 million on Monday to help struggling businesses, but it took weeks for the politically divided Legislature to act on the relief package.
Walz spokesman Teddy Tschann said the continued stop to indoor dining is meant to “protect health care capacity” and serve as a sacrifice to keep elementary schools open and bridge the gap until COVID-19 vaccines are more widely available. The restrictions will last “through the holiday season,” Tschann said.
But the extension of at least some of Walz’s limits raises a larger question: Have the lockdown measures to this point actually worked?
A ‘favorable’ trend
In mid-November, COVID-19 was surging in Minnesota. The state reported 423 deaths in October and 553 deaths through Nov. 18, the date Walz announced the four-week restrictions.
That was a sharp uptick from the 219 deaths reported in September. Cases in the state shot up in October and November, and so did hospitalizations. There were 366 people hospitalized in intensive care with COVID-19 on Nov. 18 compared to 136 a month earlier.
The day after Walz announced new rules to stop in-house service at bars and restaurants and ban most gatherings, hospital officials begged Minnesotans to wear masks, distance from each other and forgo Thanksgiving celebrations with people outside of their households. Staffing shortages were severe as hospitalizations rose.
“If I could get down on my knees and you could still see me above the podium I would do so,” said Dr. Penny Wheeler, the CEO of Allina Health, at a news conference. “We need your help, terribly.”
Cases, deaths and hospitalizations continued to increase for a time after the lockdown measures. The state reported a record 101 deaths on Nov. 27 and 9,022 cases on Nov. 28.
Yet since those high-water marks in late November, daily new cases have been declining. The seven-day average positive case rate, which lags by a week, has slipped from a peak of 15.5 percent to 10.9 percent in the most recent data. Single-day positivity rates this week have hovered closer to 7 percent. (Officials say a rate above 5 percent signals widespread transmission.)
Dr. Nasia Safdar, a professor at the University of Wisconsin and Medical Director of Infection Control at UW Hospitals and Clinics, said “the trend is favorable, that the positivity is low.”
Dr. Dimitri Drekonja, a professor at the University of Minnesota’s Division of Infectious Diseases and International Medicine, said daily new case totals weren’t reflective of the severity of the pandemic earlier in the year because testing was so limited. But with testing widely available, the daily cases can better measure the outbreak. “We’ve seen a pretty clear curve where it peaked, it plateaued and the tests are going down and I don’t think they’re going down because people are choosing to not be tested and can’t get a test,” Drekonja said.
He added that on weekly calls with other infectious disease clinicians, many have reported fewer patients with the virus whose cases aren’t severe enough to be hospitalized.
The number of people hospitalized with COVID-19 has dipped slightly, too. The latest data from the Minnesota Department of Health shows there are 300 people in the ICU with COVID-19 and 1,009 people hospitalized but not in intensive care.
One key metric that hasn’t declined: deaths. The state has reported 890 deaths through 15 days in December, which is more than the 688 deaths recorded in the final 15 days of November.
Drekonja said hospitalizations and deaths follow after infections, meaning there is a lag period between when a person becomes sick and when they are hospitalized or die. The high death rates are still being driven in part by the higher case rates before the recent decline, Drekonja said.
State health officials told reporters this week the rate at which cases are growing has declined and celebrated the dip in hospitalizations, though MDH commissioner Jan Malcolm said Minnesota is “still in a very precarious state” with high rates of infection.
What’s responsible for the decline in cases?
Safdar and Drekonja said it’s impossible to say whether Walz’s restrictions alone or in part blunted what had been a startling increase in cases and deaths. That would take sophisticated research and analysis. It’s possible not every restriction is effective or helpful, and people could be staying home for other reasons, such as the dire warnings from health professionals.
But given that COVID-19 is transmitted through “shared air,” and passed more easily between people when they’re indoors, stopping Minnesotans from congregating in bars and restaurants and other similar places “makes inherent biologic sense,” Drekonja said.
“I definitely think it’s been helpful and I think it’s been working,” he said.
Safdar said there is little doubt in the minds of public health workers that restrictions work, though she noted they’re hard to sustain over time as people grow weary of isolation. But lockdown measures that can be enforced — such as closing bars and restaurants — combined with changes in behavior sparked by pleas from public officials and medical professionals, can lead to a reduction in severity of a pandemic.
Drekonja said there is anecdotal evidence, or “quasi-experimental evidence,” such as cell phone data tracking compliance with lockdown measures, that suggest areas with restrictions on public life see quicker reversions back to lower case rates.
Safdar said counties have implemented their own restrictions in Wisconsin since courts limited the governor’s power to institute statewide rules. Places that better adhered to the Wisconsin mask mandates and created other rules, “generally have more favorable outcomes,” she said, even if the exact cause of those outcomes can’t be determined.
Malcolm told reporters Monday it’s still early to assess the full impact of the stay-home measures but said “we certainly noted that the downturn in case growth has coincided pretty nicely with the pause.”
MDH infectious disease director Kris Ehresmann said the state was still recording lagging cases tied to bars and restaurants for a time during the lockdown, but the agency has caught up with those cases.
MDH spokesman John Schadl said the state has found no case data on outbreaks tied to weddings or big events during the four-week break, even though weddings, but not receptions, have been allowed to continue. Weddings and particularly wedding receptions had been a large source of outbreaks.
Republican legislators have argued gyms and fitness centers can be operated safely. The state collected limited data on COVID-19 spread at health clubs prior to the lockdown, but the Pioneer Press reported there were outbreaks with connections to dozens of such businesses. Safdar said “the literature supports the fact that gyms can often be a hotspot for infections” because people are breathing heavily in relatively small spaces that commonly have poor ventilation. Some of those problems can be mitigated, though, she said.
Schadl said it’s hard to tell if there have been fewer cases tied to small gatherings, such as family get-togethers, because the events are hard to pinpoint in the huge volume of case investigations. But the agency says the overall decrease in cases suggests people are gathering less, whether in businesses like bars or in each other’s homes, Schadl said.
“This shows the significance of the activities that were paused in that they were, at least collectively, contributing significantly to transmission,” he said. “This is consistent with what we know about transmission and the types of activities that we know are risky.”
Where Minnesota goes from here
Walz hasn’t announced publicly how he will handle gyms, movie theaters and activities like youth sports going forward, though MPR reported the governor will allow fitness centers to open with more safety restrictions and let children practice sports starting Jan. 4 but not play games.
Drekonja said he would tell Walz that going forward, the state should “try to cautiously open” but be “really wary of indoor places where you would share air.” That includes bars and restaurants, but also things like high school sports where people compete indoors in close contact.
Safdar said Walz is juggling economic and other concerns in tandem with the “pretty draconian” health rules. “But from the public health perspective, the approach that is currently being taken is an effective one to stop the spread.”
“It’s clearly and understandably not popular but it does work as I think Minnesota is starting to see,” she said.