Starting Monday, anyone exhibiting COVID-19 symptoms may be tested at Hutchinson Health. That’s a significant change as tests were previously only available for prioritized health care workers, inpatients, skilled nursing and congregate living staff and emergency response personnel.
As part of an increase in COVID-19 testing throughout the HealthPartners network, a drive-up testing site is set up at Hutchinson Health. But people can’t just show up to be tested, they’ll first have to make an appointment by calling the clinic at 320-234-3290, according to Laura Templin-Howk, Hutchinson Health’s lab manager.
“The Hutchinson phone line will go through some partial screening and then forward them to a central hub phone line with HealthPartners, and HealthPartners will go through the screening questions and get them on the schedule,” Templin-Howk said.
The appointment is required to make sure the hospital has the patient’s information and supplies ready to make the test collection process quick and avoid bottlenecks. During the phone call, patients will be asked about their symptoms. The common COVID-19 symptoms include fever, a new cough, shortness of breath, a sudden loss of taste and smell, and a sore throat. Patients can decide if they want to have a rapid strep test done as well.
Based on symptom severity and risk factors, patients will either be referred for an in-person visit and testing at a HealthPartners respiratory center, referred to a clinician for additional evaluation, or scheduled to a drive-up testing location.
The hospital started taking appointments for drive-up testing Monday morning, and according to Templin-Howk can schedule as quickly as two hours in advance. Tests were scheduled every 10 minutes at first, and then ramped up to every five minutes. The collection process itself takes less than a minute. If there are families with multiple people experiencing symptoms, they will all be able to have samples collected at the same time.
What to expect
After making an appointment, patients will start at the Plaza 15 lot and make their way through the drive-up line to the intake tent. This is where they will confirm their appointment, and a bag with testing equipment will be placed on their windshield. They’ll also receive information about how to sign up for a MyChart account to receive their results quicker.
After the intake tent, patients will pull into the collection tent where there will be two people, one person collecting samples and an assistant to bag the samples and send them off to the lab.
“It’s a nasal swab, but it’s a deep nasal swab,” Templin-Howk said about the collection process. “It’s pretty far into the nose. It doesn’t hurt but it’s not comfortable, I’ll put it that way.”
While rapid strep tests are performed at Hutchinson Health, COVID-19 tests are sent into HealthPartners for testing, and results usually take 48-72 hours to receive. HealthPartners has performed more than 6,000 tests since mid-March and currently has the capability to do 300 tests per day. On May 13, that will expand to 2,000 tests per day throughout its network. Any test that is collected that exceeds HealthPartners’ capability is sent to Quest, a reference lab.
“HealthPartners has put in a lot of effort to make sure the test actually happens,” Templin-Howk said. “That’s the hard part. People are under the misconception that just because they got swabbed they’ll get those results and they’ll get it timely, and that’s not necessarily the case.”
Those who test positive will be contacted by a central nurse line. The nurse line will give patients further instructions about what to do if they are in a high risk category versus if they are not.
No antibody tests yet
Templin-Howk stressed that this is what is known as a PCR test, which tells if a patient is currently infected. That is different from the antibody test, which is a blood test. Hutchinson Health is not doing antibody tests yet but anticipates having them available in a couple weeks.
“That antibody test only tells you if you’ve been exposed (to coronavirus),” Templin-Howk said, “but it does not tell you if you have immunity. There is a lot of misconception out there right now about the value of that antibody test.”
Templin-Howk was not certain what to expect as far as long waits for the tests, but she said there has been a lot of interest and other facilities have seen longer lines.
“Some of the other HealthPartners sites opened (Friday) and they were slow in the morning,” she said, “and their volumes doubled in the afternoon.”
Do you know where your next meal is coming from?
Many people don't and the numbers are staggering: 10,000 cars waited for food at a San Antonio Food Bank distribution point. The line was a 1/2-mile long in both directions at the Second Harvest Food Bank in Anaheim, California. People lined up three hours before food distribution in Des Moines, Iowa, and Feeding South Florida has seen a 600-percent jump in those asking for food.
The list of those needing food support during the COVID-19 pandemic stretches from coast to coast and goes on and on.
Remarkably, the opposite is happening in McLeod and Meeker counties. According to Lennie Albers, executive director of the food shelves in Hutchinson and Glencoe, usage is down.
“We are down 25 percent for the month of April compared to last year,” she said. “That is overall, both sites are pretty comparable. We're down 21.5 percent in Glencoe and 25.7 in Hutchinson, with an average of about 23.4 percent overall.”
Jamie Revermann, executive director of the Meeker Area Food Shelf, has observed a decrease, too. So far, she said the Litchfield and Dassel sites are down a little bit from when the pandemic first started in March. Revermann believes the reasons are due to unemployment being good, schools getting meals out to students and the stimulus checks.
“Our numbers have been down a little bit because programs have been so reactive in getting people the funds they need right now,” she said.
“People are in a little better spot,” she said. “The longer we go, we expect to see more people.”
Although numbers are down, Albers said those using the shelves now range from new people they've never met before to clients they haven't seen in a long time. Regulars, she guessed, were sheltered a little bit more in place and were not coming in as often.
McLeod and Meeker counties aren't alone in seeing a decrease in usage. Albers participates in a weekly Thursday Zoom virtual meeting with Hunger Solutions, Second Harvest, food shelves and feeding programs throughout the state.
“Up until (April 23), neighboring counties Kandiyohi, Sibley, southwest Carver, Meeker were all experiencing the same trend,” she said. “Usage was down. (On April 30) they said it was something that was recognized across the state. We all were seeing it and feeling it. I got an email from Good in the 'Hood, they do a lot of great things in the metro area, they have seen a 300 percent increase in requests for food. It depends on where you are and how COVID is affecting your community and your direct distribution. I was curious looking across the state. It's talked about. Not everyone is swamped at this moment. We're preparing to be swamped. We're all preparing to be swamped. It's a ways out. We're just riding the wave.”
"COVID-19 hasn't affected the outskirts," she said." That is still to come. The metro is the hardest hit. They are reacting to that as it's coming. Fortunately, we have a little bit of time to plan.”
During the stay-at-home order, food shelves in Hutchinson and Glencoe have put their grocery list online, so clients can fill it out in advance. They are also offering proxy pickup, which means a client can have someone else pick up their groceries.
"We have a great partnership with social services and public health," Albers said. "They have volunteered to deliver food. The client fills out the grocery list and returns it to us and we fulfill it at the food shelf."
Meeker Area Food Shelf launched a mobile site in December serving clients in Cosmos.
"We have clients who pre-order food and we bring it to their homes," Revermann said. "We chose Cosmos because there wasn't a grocery store in that town. Since the pandemic, we've extended to all of Meeker County. We had started it specifically in Cosmos and now we've opened it to anyone."
Now Revermann said they are working on outreach to get the word out about the mobile site to social workers and churches.
"We want to let people know if they need food and are homebound, we can get food to them," she said. "Due to the pandemic, people want to stay home, and we're figuring out how to do that and serve people and keep them safe."
PLANNING FOR MORE
Revermann has worked at the food shelf for more than three years. During her first year, she saw a 50 percent jump in usage, which is a big increase for them.
"We serve 200-250 families a month between the two sites," she said. "We serve about 20 in Cosmos, and I don't have the number for the expanded service to Meeker County. It has continued to go up specifically during the summer months since kids are home from school."
While food shelf usage is down now, Revermann expects that to change.
"When school lunches are no longer happening and the extra money in unemployment is done in July, we're expecting to see a huge increase," she said.
In preparation for an uptick in usage, Albers said they're stockpiling emergency food boxes of canned goods.
“We hope we can unpack those and put them on the shelf,” she said. “If things change, we have to change the way we distribute. We're trying to anticipate different scenarios. It's really hard. We don't know when or what. We're really trying to think through all that.”
Thanks to the Minnesota Food Share March Campaign, which was extended through April, local food shelves are ready to meet the needs of residents.
"We're in a good spot to do more," Albers said. "The local response has been fabulous. If people missed it or didn't know about it, there are ways to give on our website and we're still accepting food."
“Our community has been really great in supporting us financially,” Revermann said. “We've seen less in the amount of food donated. During the March drive we focus on churches, and with them being closed, we didn't see as much food come through the door. We're trying our best to serve people as safely as possible. If you know someone who is homebound and needs food, let us know and we'll create a plan to get it to them.”
It seems like just yesterday, and it seems like forever ago.
In fact, it was Saturday morning, March 28, when Minnesotans were officially “ordered to stay at home” by decree of Gov. Tim Walz.
The unprecedented stripping of liberties would have seemed unimaginable — except that it was happening, or about to happen, across America and all over the world, in societies free and not.
It was, of course, the best defense that public health officials had to offer against the novel coronavirus, which had just begun to surge in America but had killed only five people in Minnesota at the time.
Sunday marked the 37th day of Minnesota under the closest thing we’ve experienced to a “lockdown.” It was to be the last. But on Thursday, Walz extended the order an additional two weeks, until May 18. He also allowed most closed retailers to open for delivery and curbside pickup, and he pledged to soon relax restrictions on non-lifesaving medical procedures.
His argument for extending the stay-at-home order is basically this: We still don’t know enough about the state’s outbreak — except that it’s still growing — and it’s too risky to loosen things up any further. It’s a rationale supported by some and criticized by others, with some Republicans being the most vocal critics.
So, let’s take stock. What did those 37 days get us?
Obviously, a smashed economy is one result of the restrictions. Nearly 594,000 Minnesotans filed unemployment claims by the end of April. But many economists believe the effect of an unchecked pandemic would have been equally as bad, if not worse, and many agree that the economy can’t recover until the virus is under control.
In the fight against the virus, we gained a lot. But there are some notable things we still don’t have.
Here are some important concepts, based on interviews with health and hospital officials and state and public health data.
The “shutdown” of vast swaths of the economy and social interactions acted like a sudden drop in temperature under the laws of thermodynamics: Everything slowed down. The soup of society no longer mixed as it had, and the spread of the virus was significantly slowed.
Moreover, Minnesotans appeared to have heeded the stay-at-home order more closely than other Americans and more than many forecasters expected. The result: Not only did we buy time by pushing the curve out, we appear to have flattened the curve, creating a slower spread than most, if not all, states — at least for a while.
To be clear, it still spread, but the factor of its exponential growth — the speed at which a contagion spreads — was lowered, so it spread slower. From a mathematical standpoint, the fact that Minnesota nearly froze in place when the number of cases was still relatively low meant that the raw number of new infections daily was far less than if we were farther along.
Still, it exacted a toll, especially in places where strict isolation isn’t possible.
More than 75 percent of the state’s 395 deaths as of Saturday have been residents of long-term care facilities — places like nursing homes where strict measures were put in place before the outbreak to try to keep the virus from getting in.
And in the meat processing industry — where workers continued to slice and package pork and poultry shoulder to shoulder in assembly-line fashion — outbreaks have forced the shutdown of major plants.
Walz’s justification for his initial stay-in-place order — which was to last two weeks — was to buy time to prepare. What did we get for that time?
For several years, and in late March, the combined number of intensive-care beds at Minnesota hospitals hovered around 1,200. ICU beds — and ventilators to aid in breathing — are crucial to reduce the death toll of the virus, which usually kills by causing the lungs to fail.
The big fear — a fear ultimately realized in Italy and Spain and nearly so in New York City — was that a wave of seriously ill patients needing ICU care would exceed the number of beds, forcing a rationing of care and leading to avoidable deaths. At the time, an epidemiological model by the University of Minnesota School of Public Health projected a peak ICU demand of between 2,000 and 4,800 beds. That model is expected to be revised within a week or so, and officials have suggested they expect the projected peak demand to be on the lower end, if that.
As of this weekend, the state has 1,244 ICU beds. However, within 24 hours that number can jump to 2,044. Within three days: 2,588. Meanwhile, 2,844 ventilators can be on hand for the surge. Additionally, state emergency management officials, working out of the state’s Emergency Operations Center in St. Paul in conjunction with hospital coalitions, have established plans for hundreds of beds for non-COVID patients, should they be needed.
Personal protective equipment — N95-grade respirators, surgical masks, surgical gloves, gowns and face shields — were in a precarious state in late March, here and across the country.
The pandemic preparedness plans of Minnesota, like those of every state, had always banked on a national stockpile filling in any gaps. But those plans, in hindsight, failed to grasp two possibilities that both became reality: First, that the national stockpile would be understocked and the federal government would defer the task of acquiring supplies to the states, and second, that the demand would be not isolated to hot spots but nearly nationwide, as the virus had spread silently for the month of February.
Hospitals urged Walz to ban non-lifesaving procedures so they could conserve their supplies, and he agreed.
But the state itself had no stockpile, and that wouldn’t stand, state and hospital officials said.
In the past five weeks, that’s changed. As of Saturday, the state had 345,000 N95 respirators, 2 million surgical masks, 7.3 million gloves, 49,000 gowns, and 152,000 face shields. That’s on top of significant supplies that hospitals have obtained.
Add up the ICU capacity and the PPE supplies, and Walz has all but declared victory in the preparation for the coming peak.
“When we hit our peak — and it’s still projected to be about a month away — if you need an ICU bed and you need a ventilator, you will get it in Minnesota,” Walz said last week.
Testing was a mess in late March in Minnesota, as it was in much of the country. Tests were being rationed for those seen as in most need, but even those people weren’t always getting them. There was no national plan for how to surmount a lack of ingredients — ranging from chemicals to supplies — and coordination between providers, suppliers and the need.
The result was that no one had a clear picture of who had the virus and where it was spreading. “Stay home if you’re sick” was the best policy anyone could muster, and it led statisticians to conclude that for every test-confirmed case in Minnesota, there were likely 100 others who had the virus.
In the week leading up to the March 28 stay-at-home order, Minnesota averaged 1,720 tests per day, according to data compiled by the Pioneer Press. Last week, the average had jumped to 3,006 and appears to be on track to reach 5,000 diagnostic tests per day soon.
That increase — and its trajectory toward 10,000 tests daily — is the result of a partnership between the state, the Mayo Clinic and the University of Minnesota to achieve what Walz described as a “Minnesota moonshot” of testing capacity. In short, the idea was for Minnesota to figure out the testing problem on its own.
In one respect, it has been a success. However, for the larger goal — test everyone with symptoms — the state appears to be a ways off, and leading public health experts across the country have said the U.S. needs to increase its testing capacity by orders of magnitude.
For example, as of Saturday, there were 3,436 confirmed active cases of coronavirus. By the 100-factor, that would mean more than 343,000 people currently have it in the state. But fewer than 80,000 tests have been performed in Minnesota since testing began, and many people, such as health care workers, will require regular testing to ensure they don’t spread it themselves.
When Walz extended the stay-at-home order the first time — from an expiration of April 10 to May 4 — he said a key goal was to buy time to increase testing capacity.
So file testing capacity under something we got for the five weeks, but also something we didn’t get enough of.
Testing alone isn’t worth much if you can’t track down and isolate those infected — and their contacts — to stop the chain of transmission and quash outbreaks.
That’s where contact tracing comes in. The state estimated it would need 750 contact tracers — people interviewing patients — to be able to get a handle on the situation. There were still less than 100 at the time Walz extended the order.
While that number increases by a dozen or so weekly, 750 is nowhere in sight. It’s unclear if the state’s plan to reassign state employees will suffice.
“We’re becoming more challenged on that,” said Kris Ehresmann, head of the Department of Health’s epidemiology division.
For example, workers being interviewed in the outbreak at the JBS pork plant in Worthington speak 58 different languages. Finding translators became a stumbling block, and as a result, not all people with positive test results could be interviewed within 24 hours — a crucial step to contain a virus that spreads so quickly.
It’s hard to recall how different it all felt on March 28 than it does now.
Let’s jump back in time. On March 28:
Walz actually announced the stay-at-home order March 25.
At that time, most scientific data on the virus was based on information out of China, and in hindsight, the medical knowledge was full of holes. Doctors hadn’t yet discovered how the virus attacks other organs, and it was only last week that the CDC updated its list of symptoms, acknowledging that patients can become dangerously ill without developing the trademark dry cough.
Perhaps the biggest blind spot, however, was the virus’s greatest weapon: asymptomatic spread. We now know that you can get the virus and be contagious for up to 48 hours before any onset of symptoms. “Stay home if you’re sick” isn’t much of a defense against that.
Health Commissioner Jan Malcolm on Friday mused on the speed of knowledge gained since Walz initially shut things down. “It’s kind of amazing to remind ourselves, but we’re talking about a six-week span of time since we saw the first confirmed case in long-term care. We didn’t know at that time about the role of asymptomatic spread,” she said.
WHAT WE DIDN’T GET: IMMUNITY
In some ways, nothing has changed: There’s no vaccine, and we’re a population that’s essentially just as vulnerable as we were.
When our outbreak started, Minnesota was a land of 10,000 lakes and nearly 5.7 million people — all of whom were ripe for the virus to sicken, or at least use to spread.
By the 100-fold estimate of confirmed-to-actual infections, some 573,000 Minnesotans have had the virus. Might sound like a lot, but it’s not. Assuming all those people are now immune — an assumption that is hardly proven — that’s a 10 percent immunity rate. That’s far short of the estimated 67 percent minimum needed for herd immunity — which doesn’t stop a pandemic but merely puts it on a trajectory toward stopping.
So, five weeks later, even with those assumptions and estimates, there remain more than 5.1 million Minnesotans just as ripe for the virus as they were March 28.