Minneapolis Hospitals Brace for COVID-19 Surge Following Protests

Clinicians in Minneapolis are anxiously awaiting what the next few weeks will bring, given the large protests against systemic racism and police brutality that began not long after the state’s reopening, during which distancing and mask-wearing were often spotty.
The city is where a white police officer was captured on video May 25 kneeling on the neck of a black man, George Floyd, for nearly 9 minutes and killing him. Thousands of people have filled the streets in Minneapolis and other cities across the U.S. in protest.

“We are already on the verge in terms of staffing and space,” said Caitlin Eccles-Radtke, MD, an infectious disease physician at Hennepin County Medical Center in Minneapolis. “We are getting closer and closer to being overly full.”
Eccles-Radtke said hospitalists were already expecting things to pick up right around now, two weeks after the state’s stay-at-home orders were lifted on May 18. Her facility has already been “busy and stressful” and additional units have already been converted into COVID-19 ICUs.
“Knowing how this spreads and how many people have been out all hours on multiple days and nights, I’d be remiss to say nothing would happen,” she told MedPage Today. “The question is the increase in volume: will it be manageable? We are not sure yet but we are quite nervous.”
Reopening and the protests are occurring against a backdrop of a rising infection rate in the state, according to Ryan Demmer, PhD, MPH, an epidemiologist and community health expert at the University of Minnesota. The state has recently had about 600 to 1,000 new infections and about 30 deaths per day, he said.

Local models predicted a peak in early- to mid-June, Demmer said, but that was before the economy started reopening and before the protests occurred.
“Given what we know about this virus, at the top of the list of things you don’t want right now are large public gatherings,” Demmer told MedPage Today. “You have people from Minneapolis and other areas coming together with good potential for spread. Then they go back to their communities and perpetuate the spread further. That’s a real concern.”
Hospitals in Minneapolis haven’t exceeded surge capacity, Demmer said, given the time bought by stay-at-home orders that allowed them to convert regular beds to ICU beds.
Tim Sielaff, MD, PhD, chief medical officer of Allina Health, which operates Abbott Northwestern Hospital in Minneapolis, said in a statement that the hospital “hasn’t hit surge capacity so [it] won’t be making any other adjustments.”

“Allina Health has been actively preparing for a surge in COVID-19 patients for the last few months,” Sielaff said in the statement. “Our careful planning and preparation is not in response to the recent protests, but as part of our system-wide response to the COVID-19 pandemic.”
But Eccles-Radtke cautioned that ICUs in Minneapolis “are pretty full. There’s not a lot of extra capacity in the Twin Cities right now, which is why this is scary if things blow up.”
She noted that Minneapolis and St. Paul have been reporting hospital capacity so that paramedics can route patients appropriately, not overwhelming any single hospital.
Demmer agreed that “if things start to ramp up, there are scenarios projected where we could run out of space in the hospitals.”
Eccles-Radtke and her crisis response team have also asked city and state officials for modeling data to help predict what a resultant surge may look like, based on the number of people that were out at the protests, what percentage were wearing masks, and other factors.

Many protesters did appear to be wearing masks, Eccles-Radtke and Demmer said, and the fact that the protests were outdoors allowed participants to physically distance from each other.
Still, not all were wearing masks, Eccles-Radtke said, and there was “yelling, there was spit, aerosols, droplets. These people were in close proximity. It’s a big worry.”
The fact that the majority were younger and therefore at lower risk of being severely ill and dying from COVID-19 was a positive — but “younger people can be asymptomatic carriers,” she warned. “What happens in 2 or 3 weeks to mom or grandma, we don’t know.”
Demmer said people have a false sense of security because of the disease’s high rate of asymptomatic transmission. “You don’t know if you’ve come into contact with someone who’s infected…. If just one infected person shows up to the protest, it could become a super-spreader event.”

Infections among healthcare workers who attended the protests are also a concern, particularly among those who work at nursing homes, which have been hard-hit by COVID-19, Eccles-Radtke said.
She recommends that anyone who attends the protest should quarantine themselves for two weeks.
A spokesperson for the Minnesota Department of Public Health told MedPage Today that the state is developing plans to provide testing in both Minneapolis and St. Paul to people involved in the protests. The plans are still being formulated, so no other details are yet available, the spokesperson said.
Andrea Westby, MD, an expert in community health at the University of Minnesota, said she’s particularly concerned because many African Americans attended the protests and this group has been particularly hard-hit by the virus.
“I respect peoples’ rights to choose justice and accountability over COVID,” Westby said. “We need to do the best we can to minimize damage.”
https://www.medpagetoday.com/infectiousdisease/covid19/86829