Big Books & Bold Ideas with Kerri Miller

MN top health officials on what’s behind the Midwest COVID-19 surge

Two women sit at a table and speak.
Minnesota Department of Health Commissioner Jan Malcolm, right, speaks at a press conference alongside state infectious disease director Kris Ehresmann in St. Paul on March 20.
Evan Frost | MPR News File

The number of COVID-19 cases in the U.S. is climbing toward a third peak. This time, the Midwest is driving the surge. 

In Wisconsin, hospitals are at or near capacity following a tripling of coronavirus patients in the last month. North Dakota and South Dakota showed the highest number of cases per capita in the country based on the most recent seven-day average. 

Minnesota set its own record for new cases on Friday, and hospitalizations and deaths in the state continue to rise. And Friday's record increase was followed by case counts topping 1,700 both Saturday and Sunday.

Given recent trends, a leading coronavirus modeling group projected more than 170,000 people could die from COVID-19 nationally between now and Feb. 1. How and why has the virus taken hold again in the Midwest?

Each Monday at 9 a.m., MPR News host Kerri Miller delves into pandemic science and trends and takes listener questions. This week, she talked to two top Minnesota public health officials — Health Commissioner Jan Malcolm and state infectious disease director Kris Ehresmann — about the current surge and what’s driving it and look ahead to how a vaccine might be distributed in the state. 

Use the audio player above to listen to the full program or read the edited transcript below.

What’s driving the recent case surges in Minnesota, Upper Midwest?

Malcolm: The disease is really very prevalent all over our state. And what's driving the transmission is lots and lots of small things really different from spring and even the summer peak, where it was more identifiable to certain settings — large workplaces, long-term care facilities, etc.

Now what seems to be happening is — it's the smaller social interactions that people are having the parties [and] the get-togethers, going to an event here or there. It's just the relaxation of our guard as people have understandably gotten weary of this.

Ehresmann: Anytime people are gathering together in groups, particularly large groups, we see the potential for transmission. And rather than, say this was because of a big event, a large rally or a large event, what we're seeing is it's multiple smaller events [such as] going out for happy hour after work with your coworkers or getting together with a bunch of friends that you haven't seen for a while. In reality, all of those different interactions can lead to transmission.

The point is that, in the spring, we were seeing things associated with congregate care with manufacturing, and large workplaces, things like that. Now, it's really more person to person or smaller groups.

I don't want to discount the role that large groups play, but we're also seeing that interaction between people, groups getting together — that is the challenge.

Listener question: If I get tested and the result comes negative before Thanksgiving, can I go to a family gathering? — Deb from Duluth

Ehresmann: The challenge with testing is that it is good for the day that you're tested. So you could test negative on Sunday, and then turn out to be infectious on Tuesday, and go to your gathering on Thursday and unwittingly infect someone. So that is the challenge with testing.

If you test positive, you've got the disease and you take action accordingly. But when you test negative, it's not like a magic thing that gives you protection or license going forward. I think if you want to be able to see family in a safe way, we're going to basically sequester ourselves for a 14-day incubation period, and then you'd know that you had no exposures.

Health Department last week made a chance to its COVID-19 data. What should Minnesotans know about the change and how should they understand it?

Malcolm: We started reporting results from antigen tests in addition to the PCR test. Antigen tests have the value of producing more rapid results and being easier to administer in a physician office.

But the data are still emerging on — under what circumstances antigen tests are reliable, and when they aren't. So we do report them separately [from] the PCR tests, which are still kind of considered the “gold standard,” but we expect antigen tests are going to become more and more widely used. So we felt it was important to start counting the results from those tests as well.

We follow up on that just the same way we do a PCR test. So if somebody tests positive with an antigen test, we advise all the same precautions: quarantining for 14 days; isolating if you've had an exposure; isolating if you are the case.

Listener question: When will we have fast, accurate COVID-19 testing? — Alex via Twitter

Ehresmann: We have so much more testing than we did early in the pandemic. And there's been a huge push to make testing available to all Minnesotans. What we're finding, which is really challenging, is that while on the whole, the turnaround time is really good, there are the occasional situations in which it's not. And sometimes, I think for the people who find themselves waiting for those test results, that's all that matters. And that's what causes a great deal of frustration.

But in general, we had over 44,000 tests run last week when we had the high number of cases. So we know that that testing is being done but unfortunately, sometimes when we have a slow turnaround, it's just for the wrong person in the wrong situation.

[Minnesotans have] more testing being brought on board. There's the nasal swab which can be used for molecular testing or PCR testing. The nasal swab can also be used for antigen testing — it's used in individuals who have symptoms, and about five to seven days after their exposure, and that can be a really accurate test. And then the saliva testing that's now available and offered by the state is also PCR testing, even though the specimen is saliva. So there are a number of different options.

What is Minnesota’s COVID vaccine distribution plan?

Malcolm: I think we should feel good in Minnesota. Kris and her team have a lot of experience with with vaccination and campaigns to get vaccine distributed appropriately and quickly and safely.

So we've got a strong system on which to build — this is going to be complicated in the scale of it. And the just the different vaccines, probably with different requirements, it's going to make it more challenging.

Really good education, really good partnership with our health care providers with pharmacies is going to be essential so that the people actually administering the vaccine can help the folks receiving the vaccine to really understand what's going on.

Vaccines are just going to be such a critical tool to getting people back to work, back into the classroom. So we are highly motivated to get people the information that they need to get these vaccines just as soon as possible.

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