Minnesota, we have a problem revisited
I was very pleased to see that my recent Star Tribune op — Minnesota, we have a problem — generated not one but two day’s worth of replies. Sadly, many…
After Minnesota Governor Tim Walz first declared a peacetime emergency on March 13 and signed his sweeping state shutdown order on March 25, we both started paying close attention to developments related to the COVID-19 epidemic in Minnesota. As we followed the news daily on Power Line (powerlineblog.com, where Scott regularly contributes) and on Healthy Skeptic (healthy-skeptic.com, where Kevin writes), we hoped that our focus on Minnesota might help illustrate more significant phenomena occurring across the country concerning the epidemic. Combining our interests in politics, public policy, media, and the health care industry, we seek to do the same here, with a longer look back. We hope to clarify a few of the big-picture conclusions that have emerged from the data and yet remain obscured in the public relations of the responsible public officers and the mostly-sycophantic press coverage of their efforts.
Before looking back, we would like to highlight 10 conclusions.
(1) It became apparent early on that the epidemic presented a risk of fatality to elderly nursing-home residents with serious medical conditions. They represent some 80 percent of all Minnesota COVID-19 fatalities and have done so since the start of the epidemic. Yet Walz’s administration sent recovering coronavirus patients from hospitals to nursing homes, which exacerbated an already bad situation.
(2) Others who died with serious medical conditions outside long-term care facilities account for almost all the rest of the fatalities. Those with serious underlying medical conditions—both in and out of congregate living settings—account for roughly 98 percent of all deaths attributed to the disease. By our calculation, these conditions affect approximately 15 percent of Minnesotans.
(3) The median age of all decedents is approximately 83. The disease presents almost no risk of death to the relatively young and the relatively healthy. As we write, only two persons under the age of 30 and 10 under the age of 40 have died of the disease in Minnesota.
(4) If those with serious medical conditions were warned of the risk and encouraged to act appropriately, the rest of the state could be set free to go about its business.
(5) Walz has rejected this option, asserting that the disease places everyone at significant risk. This statement is false, based on the data from Minnesota and across the country, and based on the risk relative to many other causes of death.
(6) Most Minnesotans who contract the virus are asymptomatic or have mild illness. Testing of the exposed population at the Worthington meatpacking plant showed that 90 percent of employees who tested positive were asymptomatic.
(7) Although it gets lost in the torrent of words in his public comments, Walz has asserted that the measures he has taken only delay the inevitable. According to former state epidemiologist Michael Osterholm, whom Walz has advertised among his brain trust, the virus will infect some 60-70 percent of Minnesotans. The virus will continue to spread until a critical mass—that 60-70 percent—reaches immunity. Epidemiologists debate what level of infection is needed to achieve population immunity, but whatever the level, we have only delayed the inevitable, at great cost.
(8) Walz imposed his statewide shutdown on the assumption that 74,000 Minnesotans would die of COVID-19 without it. He based this assertion on a “Minnesota Model” that was allegedly customized to fit Minnesota data. He should have regarded the model—at best, an extreme outlier in its predictions—as highly suspect and discarded it as a ground for any serious action. Despite having been revised twice, the model continues to be grossly inaccurate in its projections. Estimates produced by any version of the model are not even close to the actual numbers.
(9) The Governor’s shutdown led to the loss of 800,000 jobs in Minnesota, seriously damaged our health care system and harmed the health of many of our residents. With no basis in science or data, children have been held out of school and activities. Minorities and low-income persons have been especially hard-hit, with frustration resulting from the shutdown contributing to the rioting and looting following George Floyd’s death.
(10) The print and broadcast media in Minnesota have failed in their essential obligation to challenge government assertions on behalf of the public and to ensure the presentation of accurate and complete data.
Governor Walz announced his sweeping executive order on March 25, four days after Minnesota recorded its first death attributed to the virus. While the future course of the epidemic was uncertain, it was already apparent that the greatest risk was among the elderly. But Walz chose to set forth an apocalyptic vision of doom.
“To battle COVID,” he vowed, “we’re going to make sure that we reduce the impact, especially deaths of our neighbors.” Walz touted his reliance on “the best data possible” as projected by a tailor-made model produced by experts at the University of Minnesota and the Minnesota Department of Health. “We’re using the best scientific data,” Walz assured Minnesotans, and then issued a warning based on the model. “If we just let this thing run its course and did nothing,” Walz asserted, “upwards of 74,000 Minnesotans could be killed by this.” And Walz emphasized that all age groups are at risk: “Here in Minnesota, our cases range from six months to 94 years.”
We’ve all heard about “flattening the curve.” It’s become a cliché. According to Walz, however, it was already too late to flatten the curve in Minnesota. The best we could do was “move the infection rate out, slow it down, and buy time” to build up the availability of intensive care units and hospital capacity. According to Walz, only 235 intensive care units were available in the state. “Buying time” became a recurring theme of the shutdown. Walz said he needed two weeks. (As we write this article in late June, let it be noted, we are still “buying time,” and we will be paying for it for a long time to come.)
“So the attempt here is to strike a proper balance of making sure our economy can function, we protect the most vulnerable, (and) we slow the rate (of infection) to buy us time to build our capacity to deal with this,” Walz said.
Walz’s speech implied that we needed to “buy time” to ward off the huge human toll he depicted. The Minnesota Model said so. Reading Walz’s speech closely, one might reasonably have wondered what “buying time” would buy us, whether the time we were paying for was a good deal, or whether it would buy us anything good at all. Holding out the prospect of 74,000 deaths without the “significant mitigation” imposed by the terms of his executive order, Walz left us hanging. How many lives would be saved by buying time? Walz didn’t say exactly or explain how he arrived at a given number. The infection rate might be slowed, but that meant only that the progress of the disease would be spread out over time. Walz’s own charts showed no practical effect. Most of us would be exposed to the virus. How many lives were to be saved by slowing it down? Walz didn’t say.
The Minnesota Model touted by Walz quickly proved to be a farcical embarrassment. As we write, the authorities have attributed nearly 1,400 deathsto COVID-19 in Minnesota. We will undoubtedly exceed this number by the time this article reaches print. There is nevertheless no conceivable set of circumstances in which the projection of 74,000 deaths was reasonable, and that should have been clear when Walz asserted it.
The following week it was reported by Jeremy Olson in the Star Tribune that with “significant mitigation,” the model projected 50,000 deaths. “Buying time” over two weeks or longer was projected to save 24,000 lives by freeing up intensive care units and hospital capacity. Walz somehow omitted this refinement, perhaps in the interest of plausibility.
The model, it turns out, was the product of a weekend’s work of back-of-the-envelope calculations by young research assistants working for the University of Minnesota School of Public Health. The School of Public Health posted an April 6 profile of the assistants crowing about their work: “I don’t think a lot of researchers get to work on something over the weekend and have public figures talk about it and make decisions based on it three days later.”
After the absurdity of the model projections became glaringly apparent, Health Commissioner Jan Malcolm offered this explanation: “(The model numbers) are not about specific point-intime estimates. They are about directional changes.” No one has explained how a number (e.g., 74,000 deaths) can be anything other than a number.
Walz has never acknowledged that he may have placed undue reliance on the Minnesota Model to shut down the state following his speech. With hindsight, it is undeniable that reliance on the model was misplaced. Walz, however, has never been called to account for this shortcoming by the media. On the contrary, the Star Tribune, for example, supported the Walz administration’s after-the-fact explanation that the data produced by the Minnesota Model were not to be taken literally, but rather taken figuratively to point the way.
If the Minnesota Model pointed the way, however, it pointed in the wrong direction.
One concern expressed by experts in the early stages of the epidemic—and supposedly validated by the model—was that the health care resources to treat all potential cases of serious illness would prove inadequate. There were worries in particular about shortages of personal protective equipment, ICU beds, and ventilators. Walz predicated his March 25 shutdown order on an anticipated lack of hospital capacity and ICU availability. Yet even at the time of the shutdown order it was apparent that there was enormous flexibility in making ICU beds and ventilators available for patients who needed them (as in hard-hit New York City).
We saw this in Minnesota as well, as somehow between the initial and second versions of the Minnesota Model, the state’s estimated ICU capacity grew by over 10 times.
And ventilator need was substantially overestimated due to changes in care guidelines resulting from ventilator use actually worsening the condition of many patients.
It is highly unlikely that Minnesota ever was or ever will be in any real danger of insufficient treatment resources. The third and most recent iteration of the model adds yet another mystery to the mix, as it has 70 percent of elderly patients dying at home, thus never needing hospitalization (apparently based on the Minnesota data). Given the heavy skewing of serious illness toward the elderly, how would anyone therefore expect that hospitals might be overwhelmed?
Hospitals went begging for patients, and the asserted 235 available ICU rooms quickly morphed into more than 2,000—yet the shutdown continued for months. We won’t try to work out the math underlying the alleged 24,000 lives saved by the shutdown through the freeing up of hospital capacity because it was never more than a nightmarish fantasy.
Public policy is the realm of costs and benefits of government actions. Tradeoffs are the name of the game. Yet recently disclosed documents show that Walz issued his drastic shutdown order before he had received any assessment of its economic consequences. The Department of Employment and Economic Development delivered its initial report on economic impacts to Walz on April 3. Unlike the COVID model, this projection was eerily accurate. DEED said that Walz’s shutdown could cost 805,656 Minnesotans their jobs, almost exactly equal to the current total of new jobless claims. Yet this sobering forecast apparently had no impact, as Walz repeatedly extended his shutdown order.
One perverse cost of the shutdown quickly became obvious.
To take just one prominent example: On April 10, the Mayo Clinic announced a seriesof cost-cutting measures to address a projected $3 billion loss in 2020, half of it due tothe effects of the shutdown. Mayo announced furloughs and pay cuts affecting a thirdof its workforce, some 20,000 employees. The shutdown inflicted enormous damageto hospitals and health care systems across the state.
In addition, Walz has yet to acknowledge the health problems that his shutdown created. These problems derive from canceled appointments, missed vaccinations for children, increased mental health issues, increased drug and alcohol addiction, and other recognized consequences of unemployment.
The economic damage done by the shutdown announced in Walz’s March 25 order is shocking. Around 800,000 Minnesotans have filed unemployment claims. They represent the job losses and small-business closures that have yet to be fully accounted for. Consumer spending, the true engine of the economy, has been eviscerated.
Walz asserted that consumers wouldn’t return to business-as-usual as long as they feared contracting COVID-19, yet he used his daily press briefings to stoke their fears. He seems to have been waging a campaign of fear to support the merits of his shutdown orders. Consumers are indeed fearful. Their fear should be assuaged with accurate information, and they should be trusted to manage their behavior appropriately when armed with the facts.
The crisis located in the nursing homes and congregate care settings was evident from the early days of the epidemic in Minnesota. Beginning at about two-thirds, the share of all such deaths attributed to the disease rose steadily to 80 percent by mid-April. On April 27, before the media took notice of the issue, we asked Commissioner Malcolm: “Referring to the 286 total deaths to date, (we note that) every decedent under age 70 has died in long-term care or a similar setting. The youngest person to die outside long-term care was in his 70s. Why is it necessary to close the schools and shut down the state to protect the atrisk population?”
Malcolm responded through Department of Health press officer Doug Schultz: “We have had deaths in people younger than 70 and certainly many cases in all age groups. It is necessary to take the community mitigation measures we have because all Minnesotans are at risk from COVID-19, as none of us has immunity. Some people, like those in long-term care and those with underlying health conditions, are far more at risk than others. But if we didn’t reduce transmission in the community as we have with the stay-at-home order, we would see far more disease circulating and many times more serious cases that would quickly overwhelm our health care system….”
When the issue of nursing home fatalities became impossible to ignore, the Walz administration promulgated a “5-point battle plan” to address it. Acknowledging the focus of the crisis in long-term care facilities, Commissioner Malcolm announced the “battle plan” on May 7. She summarized the plan in 15 PowerPoint slides. One can only wonder why it came so late.
On May 19, well after deaths in long-term care had come to dominatethe fatality data in Minnesota, Chris Serres reported in the Star Tribune that the Minnesota Department of Health had evacuated COVID-19 patients from hospitals to nursing homes early in the epidemic. “Minnesota hospitals have since discharged dozens of infected patients to nursing homes, including facilities that have undergone large and deadly outbreaks of the disease, state records show.” While the Walz administration has somehow escaped criticism in the local media, Minnesota’s nursing home crisis has become a national disgrace.
Neither Walz nor Commissioner Malcolm responded to our request for an interview in connection with this article. Three months after Walz began issuing shutdown orders, it seems clear that they went much too far, failed to protect Minnesota’s most vulnerable citizens, did vast and needless damage to the state’s economy, and were at all times unsupported by the data. It is not apparent that Walz has sought advice beyond a small circle of supposed experts or his own partisan colleagues. The lack of a critical press has served him especially poorly in this respect.
Minnesotans often feel a keen rivalry with Wisconsin, a state with similar population size, composition and density. On May 13, that state voided its shutdown order. There was no uptick in cases or deaths. In fact, throughout the epidemic, Wisconsin has had fewer cases and
deaths, including fewer deaths among long-term care residents, while conducting the same number of tests. Wisconsin demonstrates the lack of necessity for extreme shutdowns, and the ability to trust citizens to make their own decisions on their risk and how to protect themselves. Walz suggested that the science of the epidemic was somehow different in Wisconsin and has refused to relinquish his dictatorial emergency powers and show trust in Minnesotans.
But it isn’t just Wisconsin—Minnesota has performed poorly in comparison with all five Upper Midwestern states. The Walz administration has managed to achieve both the highest rate of jobless claims and the highest COVID-19 death rate of any Upper Midwestern state.
Early on in the course of the epidemic and more so with each passing week, it became apparent that there is little risk of serious illness or death to the vast majority of Minnesotans from COVID-19. By contrast, there is a significant risk to the infirm elderly and others with serious medical conditions. The protection of those living in congregate care settings should not be difficult.
We agree with Walz in one respect. The best course is one that has certainty in ending the epidemic, which is letting the virus burn itself out by infection of a critical mass of the population, while protecting the high-risk population. As Walz acknowledged at the outset, this is a concession to the inevitable. The course he has chosen only protracts the process and aggravates the adverse consequences.
The spread of the virus leads to asymptomatic or mild illness in over 95 percent of the population. Achieving population immunity will reduce transmission and protect all remaining uninfected persons, including the vulnerable elderly. That is the course on which we should have embarked and can still elect. It gets us to safety in a reasonable time, with far less economic devastation, adverse health effects, and other harms. And we need to reopen our economy as quickly as possible if we will have any reasonable hope of reversing the considerable damage that has already been done.