Minnesota elective surgeries, care to resume next week

Hospital leaders hailed Tuesday's announcement by Gov. Tim Walz to lift a suspension of elective surgeries, even as they faced their busiest day yet in the COVID-19 pandemic and anticipate a surge of more patients soon.

While the suspension preserved masks and other supplies for caregivers treating COVID-19 patients, it has allowed other medical problems to fester in patients whose heart conditions have worsened and whose cancers have gone unscreened.

"There's confusion that stems from the word elective — that this is similar to having your nails done or something," said Dr. Emily Chapman, chief medical officer for Children's Minnesota. "We are deferring cases that would perhaps not be considered emergencies, but are necessary."

Walz on Tuesday ordered that hospitals, surgery centers and clinics — including dental and veterinary clinics — could resume elective procedures next week if they put social distancing plans in place to protect workers and patients.

The governor called it a "calculated risk," but said gains in medical supplies such as N95 masks should allow Minnesota hospitals to treat COVID-19 while caring for patients with untreated diseases, chronic illnesses and pain.

"This … strikes the proper balance between holding COVID flat, moving things out, but also recognizing that quality of life is impacted" when other care is delayed, he said.

The move came despite a record high of 434 Minnesotans being hospitalized Tuesday for COVID-19, including 182 in intensive care. The state also on Tuesday reported 27 COVID-19 deaths, raising the state total to 455.

When including patients who don't have COVID-19, 972 of the state's available 1,244 ICU hospital beds were occupied — though another 1,338 beds could be readied within 72 hours.

Concerns remain over supplies of masks and personal protective equipment (PPE). The state's reserve inventory includes 5 million regular face masks that are weeks overdue for delivery, and 1.5 million N95s with a delivery status that is listed on the state COVID-19 website as "unclear."

Roughly 344,000 N95s are actually in the state's reserves, though, and hospitals have devised ways to reuse some and also use older supplies beyond their expiration dates.

"Until they're in your warehouse, there is a little bit of a concern," Walz acknowledged, but he expressed confidence in the team of state leaders and executives from Ecolab, Target and other companies that are managing procurement.

Nurses "are frustrated and disappointed with today's decision," according to a statement from the Minnesota Nurses Association. The union worried that elective procedures could add confusion about when and where nurses could use N95s vs. standard masks and put them at risk.

"Continuing this crisis standard of PPE use while adding nonessential surgeries will result in needless infection and death of patients and workers," the union said.

Diagnostic testing has been prioritized for health care workers, to ensure they aren't carrying the virus to their patients, and testing has identified 1,088 who have been infected during the pandemic.

Testing identified 99 health care workers who were likely infected on the job, though investigations can't rule out other sources of transmission, said Kris Ehresmann, state infectious disease director.

Walz said some providers might not have the supplies to resume normal activities right away next week, and the Minnesota Medical Association said doctors will be ready to scale back elective procedures again if PPE supplies dwindle.

"Minnesota's physicians recognize the dynamic situation associated with the COVID-19 pandemic and are prepared to monitor and adjust, as needed," said Dr. Keith Stelter, MMA president.

HealthPartners is using a variety of measures, including ultraviolet light, to sanitize and reuse N95 masks at Regions Hospital in St. Paul and Methodist Hospital in St. Louis Park.

The health system needs to provide elective procedures now or some stable patients will become emergencies anyway, said Dr. Mark Sannes, HealthPartners senior medical director. "These are things that really can't wait any longer."

Tuesday's news was a "huge relief" to Jay Jackson, whose 8-year-old son, Wes, needs follow-up orthopedic surgery this summer to remove plates in his lower extremities. A pre-surgery appointment was one of more than 10,000 canceled by Gillette Children's Specialty Healthcare in St. Paul.

"He's got a growing body and he's got these plates," said the St. Paul dad. "If you don't get that surgery done in time, the bones end up sort of growing around the plates … [and] you have to have a much more extensive surgery."

Hospital leaders have a much better sense than a month ago about how rapidly PPE is used in this pandemic, and that should help them manage supplies and foresee shortages, said Jan Malcolm, state health commissioner.

Minnesota's COVID-19 case count reached 7,851 on Tuesday, but has only doubled in eight days — despite concerns that it might double every day or two at this phase of the pandemic, she added. "They are very moderate [increases] for where we are in the progression of the pandemic, and they are well within the ranges we have projected."

One-fourth of the 617 newly reported cases on Tuesday occurred in five counties where food processing plants have outbreaks. Lab-confirmed cases reached 1,069 and there has been one COVID-19 death in Nobles County, where an outbreak forced the closure of the JBS pork plant in Worthington. Cases reached 815 and there have been two COVID-19 deaths in Stearns County, where two food processing plants reported multiple lab-confirmed infections. Only Hennepin County has a higher case count in Minnesota, with 2,519.

Increased diagnostic testing for COVID-19 is one reason Walz is granting more exemptions under the statewide stay-at-home order, which lasts until May 18. Due to a technical glitch, the state on Tuesday reported only 2,068 diagnostic tests, but Malcolm said the actual number was higher.

Hennepin Healthcare on Tuesday announced it is focusing more of its capacity of 1,000 diagnostic tests per day to identify and limit outbreaks in long-term care facilities and group homes and shelters.

The Minneapolis-based provider hadn't publicly disclosed its capacity when it started testing in March, due to concerns about the global shortage of testing supplies, but is in a strong position to address this problem, said Dr. Glen Hansen, director of Hennepin Healthcare's molecular diagnostic lab.

Minnesota's COVID-19 deaths include 368 people who had been living in long-term care facilities. More than nine in 10 COVID-19 deaths in the state have involved residents of these facilities, or people with underlying health conditions such as asthma, diabetes, compromised immune systems, and diseases of the heart, kidney or lungs.

Hansen said more aggressive identification of these outbreaks and then testing of at-risk residents — even before they show symptoms — could reduce the spread to other vulnerable individuals.

"We're trying to figure out where the virus is, where it's gone and, more importantly," he said, "where it might be going."

Staff writer Chris Snowbeck contributed to this story.