SUMMARY • • • • • • • • • MINNESOTA STATE REPORT 11.08.2020 Issue 21 Minnesota is seeing a continued dramatic rise in cases and test positivity that will continue to lead to increasing hospitalizations and deaths; additional mitigation strategies are needed. The rise in test positivity, hospitalizations, and deaths confirm increasing disease activity. Minnesota is in the red zone for cases, indicating 101 or more new cases per 100,000 population, with the 10th highest rate in the country. Minnesota is in the red zone for test positivity, indicating a rate at or above 10.1%, with the 12th highest rate in the country. Minnesota has seen an increase in new cases and an increase in test positivity. Hospitalizations continue to rise and exceeded 1,000 new hospitalizations, by far the highest at any time in the pandemic. Viral transmission is intense throughout the state with the highest incidence rates in multiple counties in the western half of the state; counties in western Minnesota also have larger increases in cases, higher test positivity rate, and increases in test positivity. The following three counties had the highest number of new cases over the last 3 weeks: 1. Hennepin County, 2. Ramsey County, and 3. Anoka County. These counties in the Minneapolis CBSA represent 33.3% of new cases in Minnesota, but the greatest growth in cases is outside of the Twin Cities area. 100% of all counties in Minnesota have moderate or high levels of community transmission (yellow, orange, or red zones), with 87% having high levels of community transmission (red zone). During the week of Oct 26 - Nov 1, 20% of nursing homes had at least one new resident COVID-19 case, 44% had at least one new staff COVID-19 case, and 6% had at least one new resident COVID-19 death. Minnesota had 440 new cases per 100,000 population, compared to a national average of 209 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 8 to support operations activities from FEMA; 21 to support medical activities from ASPR; and 1 to support operations activities from USCG. Between Oct 31 - Nov 6, on average, 146 patients with confirmed COVID-19 and 96 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Minnesota. An average of greater than 95% of hospitals reported either new confirmed or new suspected COVID patients each day during this period. RECOMMENDATIONS • • • • • • • • • • • We share the strong concern of Minnesota leaders that the current situation is worsening dramatically and that additional measures are needed to limit further cases and avoid increases in hospitalizations and deaths. The Governor’s continued personal guidance on these measures is critical and is commended. Minnesota has had considerable success in limiting morbidity and mortality using the adaptive adjustment of mitigation measures in response to changes in incidence. Additional measures should be taken, including augmented communications to reinforce messaging around social gatherings and a new asymptomatic surveillance approach to limit community spread. Maximizing control of transmission will allow for greater resumption of business activity in addition to limiting cases, hospitalizations, and deaths. The silent community spread that precedes and continues throughout surges can only be identified and interrupted through proactive and increased testing and surveillance, as universities have done with frequent (weekly) required testing. This approach can be adapted to communities/counties in the orange or red zone with proactive weekly testing of groups from the community (teachers, community college students, county workers, staff in crowded or congregate settings, all hospital personnel, large private sector employers). These cases should be triangulated with cases among long-term care facility (LTCF) staff to identify geographic areas with high numbers of asymptomatic and pre-symptomatic cases, which should then trigger widespread proactive testing and isolation of positive cases among 18-40 year-old community members. These efforts to identify and reduce asymptomatic transmission should run concurrently with testing of symptomatic persons and contact tracing of cases. Expanded, strategic use of point-of-care antigen tests with immediate results will be critical to expanding this model into the community; these tests should be used among all individuals independent of symptoms in orange and red counties. Requiring use only in symptomatic individuals is preventing adequate testing and control of the pandemic. Antigen tests perform well in the highly infectious window and will be effective in identification of asymptomatic and presymptomatic infectious cases. • Antigen tests do not perform well after 8-10 days post infection when nucleic acid cycle times are greater than 30. • All antigen results must be reported with both the number of positive results and total tests conducted; positives must be reported as COVID cases. Proactive testing must be part of mitigation efforts inclusive of mask wearing, physical distancing, hand hygiene, and immediate isolation, contact tracing, and quarantine. All red and orange counties must begin proactive testing of 18-40 year-old community members. Mitigation measures to limit transmission in personal gatherings need continued strengthening. This needs communication from state and community leaders of a clear and shared message asking Minnesotans to wear masks, physically distance, and avoid gatherings in both public and private spaces, especially indoors. Hospital personnel are frequently trusted in the community and have been successfully recruited to amplify these messages locally. Ensure all K-12 schools are following CDC guidelines, including mask wearing, and utilize the Abbot BinaxNOW tests to routinely test all teachers as another indicator of the degree of community spread to further increase mitigation efforts. Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus. Encourage institutions of higher education to test their student body before they leave campus for Thanksgiving break to mitigate exposure to family and community. Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 COVID-19 Issue 21 MINNESOTA STATE REPORT 11.08.2020 STATE STATE, % CHANGE FROM PREVIOUS WEEK FEMA/HHS REGION UNITED STATES NEW COVID-19 CASES (RATE PER 100,000) 24,842 (440) +59% 207,351 (395) 687,656 (209) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 14.3% +4.5%* 11.4% 8.4% 238,862** (4,235**) +0%** 1,857,759** (3,536**) 7,362,570** (2,243**) COVID-19 DEATHS (RATE PER 100,000) 154 (2.7) +24% 1,493 (2.8) 6,542 (2.0) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE 20% +5%* 19% 15% SNFs WITH ≥1 NEW STAFF COVID-19 CASE 44% +4%* 39% 29% SNFs WITH ≥1 NEW RESIDENT COVID-19 DEATH 6% +1%* 7% 5% TOTAL VIRAL (RT-PCR) LAB TESTS (TESTS PER 100,000) * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 11/6/2020; previous week is 10/24 - 10/30. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 11/4/2020. Previous week is 10/22 - 10/28. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Data is through 11/1/2020, previous week is 10/19-10/25. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. COVID-19 Issue 21 MINNESOTA TESTING NEW CASES STATE REPORT 11.08.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (10/17 - 11/6) DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 11/6/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 11/4/2020. COVID-19 Issue 21 MINNESOTA STATE REPORT 11.08.2020 HOSPITAL PPE SUPPLIES HOSPITAL ADMISSIONS 130 hospitals are expected to report in Minnesota DATA SOURCES – Additional data details available under METHODS Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. PPE: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. Values presented show the latest reports from hospitals in the week ending 11/4/2020. COVID-19 Issue 21 MINNESOTA STATE REPORT 11.08.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LOCALITIES IN RED ZONE LOCALITIES IN ORANGE ZONE LOCALITIES IN YELLOW ZONE 25 ▲ (+13) 1 COUNTIES Minneapolis-St. Paul-Bloomington St. Cloud Duluth Rochester Brainerd Fargo Grand Forks Mankato Willmar Fergus Falls Winona Faribault-Northfield 76 ▲ (+38) 8 Austin ▼ (-3) 0 ▼ (-13) 3 N/A ▼ (-20) ▼ (-10) Change from previous week’s alerts: ▲ Increase Hennepin Ramsey Anoka Dakota Washington Stearns St. Louis Wright Scott Clay Olmsted Sherburne Chippewa Mower Renville Lake Stevens Lac qui Parle Koochiching Traverse Fillmore Cook Lake of the Woods ■ Stable ▼ Decrease All Red CBSAs: Minneapolis-St. Paul-Bloomington, St. Cloud, Duluth, Rochester, Brainerd, Fargo, Grand Forks, Mankato, Willmar, Fergus Falls, Winona, Faribault-Northfield, Alexandria, Red Wing, Worthington, Bemidji, Grand Rapids, Marshall, Owatonna, Albert Lea, New Ulm, Hutchinson, La CrosseOnalaska, Fairmont, Wahpeton All Red Counties: Hennepin, Ramsey, Anoka, Dakota, Washington, Stearns, St. Louis, Wright, Scott, Clay, Olmsted, Sherburne, Crow Wing, Chisago, Polk, Kandiyohi, Benton, Morrison, Otter Tail, Carver, Winona, Todd, Rice, Douglas, Blue Earth, Goodhue, Nobles, Beltrami, Becker, Carlton, Itasca, Isanti, Mille Lacs, Roseau, Cass, Hubbard, Lyon, Steele, Nicollet, Pine, Freeborn, Brown, Wabasha, Wadena, Le Sueur, McLeod, Meeker, Marshall, Aitkin, Houston, Redwood, Rock, Dodge, Clearwater, Martin, Yellow Medicine, Pennington, Norman, Murray, Swift, Waseca, Kanabec, Pipestone, Faribault, Cottonwood, Pope, Sibley, Jackson, Big Stone, Kittson, Lincoln, Wilkin, Mahnomen, Watonwan, Red Lake, Grant * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 11/6/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 11/4/2020. COVID-19 Issue 21 TOTAL DAILY CASES Top 12 counties based on number of new cases in the last 3 weeks DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 11/6/2020. Last 3 weeks is 10/17 - 11/6. COVID-19 Issue 21 MINNESOTA STATE REPORT 11.08.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY NEW CASES PER 100,000 VIRAL (RT-PCR) LABORATORY TEST POSITIVITY WEEKLY CHANGE IN NEW CASES PER 100,000 WEEKLY CHANGE IN VIRAL (RT-PCR) LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 11/6/2020. Previous week is 10/24 - 10/30. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 11/4/2020. Previous week is 10/22 - 10/28. COVID-19 Issue 21 National Picture NEW CASES PER 100,000 NATIONAL RANKING OF NEW CASES PER 100,000 National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State ND SD WI IA WY NE MT IL UT MN KS ID AK IN CO MO RI NM MI AR KY OK OH NV TN CT National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State MS TX WV NC FL AZ AL NJ PA MA SC DE MD GA VA WA OR LA DC CA NY NH ME HI VT NEW CASES PER 100,000 IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: County-level data from USAFacts through 11/6/2020. The week one month before is 10/3 - 10/9; the week two months before is 9/5 - 9/11; the week three months before is 8/8 - 8/14. COVID-19 Issue 21 National Picture VIRAL (RT-PCR) LAB TEST POSITIVITY NATIONAL RANKING OF TEST POSITIVITY National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State MT ID SD IA KS NE ND MO UT WI OK MN NV NM IN IL TN TX CO MS AL MI WY KY AK SC National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State AR VA AZ GA OH NC PA FL OR NJ CT WV MD WA LA DE RI NH CA HI ME NY DC MA VT VIRAL (RT-PCR) LAB TEST POSITIVITY IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Testing: Combination of CELR (COVID-19 Electronic Lab Reporting) state health department-reported data and HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 11/4/2020. Tthe week one month before is 10/1 - 10/7; the week two months before is 9/3 - 9/9; the week three months before is 8/6 - 8/12. COVID-19 Issue 21 National Picture NEW DEATHS PER 100,000 NATIONAL RANKING OF NEW DEATHS PER 100,000 National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State ND SD AR MT WI KS IN NM IA MO WY MS ID TN IL NE MN OK AZ AL NC TX WV NV MI RI National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State SC GA MA LA OH CO NY CT KY UT PA FL DE OR WA MD NJ DC CA VA NH AK ME HI VT NEW DEATHS PER 100,000 IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Deaths: County-level data from USAFacts through 11/6/2020. The week one month before is 10/3 - 10/9; the week two months before is 9/5 - 9/11; the week three months before is 8/8 - 8/14. COVID-19 Issue 21 METHODS STATE REPORT 11.08.2020 COLOR THRESHOLDS: Results for each indicator should be taken in context of the findings for related indicators (e.g., changes in case incidence and testing volume). Values are rounded before color classification. Dark Green Light Green Yellow Orange Red ≤4 5–9 10 – 50 51 – 100 ≥101 Percent change in new cases per 100,000 population ≤-26% -25% – -11% -10% – 0% 1% – 10% ≥11% Diagnostic test result positivity rate ≤2.9% 3.0% – 4.9% 5.0% – 7.9% 8.0% – 10.0% ≥10.1% Change in test positivity ≤-2.1% -2.0% – -0.6% -0.5% – 0.0% 0.1% – 0.5% ≥0.6% Total diagnostic tests resulted per 100,000 population per week ≥2001 1001 – 2000 750 – 1000 500 – 749 ≤499 Percent change in tests per 100,000 population ≥26% 11% – 25% 1% – 10% -10% – 0% ≤-11% 0.1 – 1.0 1.1 – 2.0 ≥2.1 -10% – 0% 1% – 10% ≥11% Metric New cases per 100,000 population per week 0.0 COVID-19 deaths per 100,000 population per week Percent change in deaths per 100,000 population ≤-26% -25% – -11% Skilled Nursing Facilities with at least one resident COVID-19 case, death 0% 1% – 5% ≥6% Change in SNFs with at least one resident COVID-19 case, death ≤-2% -1% – 1% ≥2% DATA NOTES • • • • • • • Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. It is critical that states provide as up-to-date data as possible. Cases and deaths: County-level data from USAFacts as of 22:13 EST on 11/08/2020. State values are calculated by aggregating county-level data from USAFacts; therefore, values may not match those reported directly by the state. Data are reviewed on a daily basis against internal and verified external sources and, if needed, adjusted. Last week data are from 10/31 to 11/6; previous week data are from 10/24 to 10/30; the week one month before data are from 10/3 to 10/9. Testing: The data presented represent viral COVID-19 laboratory diagnostic and screening test (reverse transcription polymerase chain reaction, RT-PCR) results—not individual people—and exclude antibody and antigen tests, unless stated otherwise. CELR (COVID-19 Electronic Lab Reporting) state health department-reported data are used to describe county-level viral COVID-19 laboratory test (RT-PCR) result totals when information is available on patients’ county of residence or healthcare providers’ practice location. HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) are used otherwise. Some states did not report on certain days, which may affect the total number of tests resulted and positivity rate values. Because the data are deidentified, total viral (RT-PCR) laboratory tests are the number of tests performed, not the number of individuals tested. Viral (RT-PCR) laboratory test positivity rate is the number of positive tests divided by the number of tests performed and resulted. Resulted tests are assigned to a timeframe based on this hierarchy of test-related dates: 1. test date; 2. result date; 3. specimen received date; 4. specimen collection date. Resulted tests are assigned to a county based on a hierarchy of test-related locations: 1. patient residency; 2. provider facility location; 3. ordering facility location; 4. performing organization location. States may calculate test positivity other using other methods. Last week data are from 10/29 to 11/4; previous week data are from 10/22 to 10/28; the week one month before data are from 10/1 to 10/7. HHS Protect data is recent as of 11:59 EST on 11/08/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EST on 11/07/2020. Hospitalizations: Unified hospitalization dataset in HHS Protect. This figure may differ from state data due to differences in hospital lists and reporting between federal and state systems. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. The data presented represents raw data provided; we are working diligently with state liaisons to improve reporting consistency. Data is recent as of 22:28 EST on 11/08/2020. Hospital PPE: Unified hospitalization dataset in HHS Protect. This figure may differ from state data due to differences in hospital lists and reporting between federal and state systems. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. Data is recent as of 17:24 EST on 11/07/2020. Skilled Nursing Facilities: National Healthcare Safety Network (NHSN). Data report resident and staff cases independently. Quality checks are performed on data submitted to the NHSN. Data that fail these quality checks or appear inconsistent with surveillance protocols may be excluded from analyses. Data presented in this report are more recent than data publicly posted by CMS. Last week is 10/26-11/1, previous week is 10/19-10/25. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. County and Metro Area Color Categorizations • Red Zone: Those core-based statistical areas (CBSAs) and counties that during the last week reported both new cases at or above 101 per 100,000 population, and a lab test positivity result at or above 10.1%. • Orange Zone: Those CBSAs and counties that during the last week reported both new cases between 51–100 per 100,000 population, and a lab test positivity result between 8.0–10.0%, or one of those two conditions and one condition qualifying as being in the “Red Zone.” • Yellow Zone: Those CBSAs and counties that during the last week reported both new cases between 10–50 per 100,000 population, and a lab test positivity result between 5.0–7.9%, or one of those two conditions and one condition qualifying as being in the “Orange Zone” or “Red Zone.”