Presentation to the Senate Finance and Policy Committee - Minnesota State Senate
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Presentation to the
Senate Finance and Policy Committee
2/10/21 1
Respiratory Disease
• COVID-19 is a respiratory disease.
• The spread of COVID-19 from person to
person is mainly through exposure to
infectious respiratory droplets (including
large and small droplets and particles)
which generally occurs when a person is
within 6 feet of another.
• Virus from the nose and throat is
carried in droplets from the mouth or
nose when an infected person speaks,
Photo credit: James Gathany, CDC, PHIL coughs, sings or sneezes.
2/10/21 2
COVID 19: A Serious Disease
“Corona Virus Hijacks the Body from Head to • ACE-2 receptors on many tissues
Toe, Perplexing Doctors” The Wall Street • Loss of taste and/or smell
Journal, 5/7/2020
• Respiratory failure
• Encephalitis
• Cardiac disease and heart attacks
• Kidney disease
• COVID Toes
• Large vessel strokes in people ages 30-40 years old,
particularly males
• Kawasaki-like disease in children, a multi-system
inflammatory disease with vasculitis
2/10/21 3
Variants of Concern
• B.1.1.7 (Variant first identified in UK)
• Increased contagiousness; binds more tightly to ACE2 receptor
• Possible increase in severity
• Spread rapidly in the UK and caused surges; now identified in >60 countries
• Rapidly pushes out other strains
• In US, >900 cases in 34 states (extensive under-identification due to limited
whole-genome sequencing; 18 cases identified in MN)
• Models predict it will be dominant strain in US in March
• Although original B.1.1.7 variant responsive to vaccine, some B.1.1.7 variants
identified that have E484K mutation which may evade immunity from prior
infection with standard strain; vaccine effectiveness may be decreased with
these
2/10/21 4
Variants of Concern (cont.)
B.1351 (Variant first identified in South Africa)
• Thought to have increased contagiousness
• Has E484K mutation (associated with evading immunity)
• Reinfections in people who had common strain of virus in South Africa identified
• Decreased vaccine effectiveness a concern
• 9 cases in US identified from 3 states
2/10/21 5
Variants of Concern (cont.)
• P.1. First identified in Brazil
• Thought to have increased contagiousness
• Has E484K mutation (associated with evading immunity)
• Reinfections in people who had common strain of virus in Brazil identified
• Studies not yet done, but likely decreased vaccine effectiveness
• 3 cases in US (2 in MN) identified from 2 states
2/10/21 6
Controlling spread of Variants
• With increased contagiousness, mitigation measures all that more important.
• Critical to mask--wear masks appropriately and consistently
• Social distancing, limited interactions outside of household, handwashing
• Monitor for symptoms, exposures and get tested
• Limit travel (many of MN variant cases associated with international and domestic travel)
• Get vaccinated when it is your turn
• Need to remain vigilant so that variants do not gain a foothold in MN
2/10/21 7
COVID-19 By the Numbers: Minnesota
140
120
100
Daily New Cases per 100,000
80
60 New cases per 100,000 people
Case Rate
40
20
0
4/1/2020 5/1/2020 6/1/2020 7/1/2020 8/1/2020 9/1/2020 10/1/2020 11/1/2020 12/1/2020 1/1/2021
Source: MDH COVID-19 Case Data, current as of 1/19/21
2/10/21 8
COVID-19 By the Numbers: Minnesota
140 300
120
250
Hospital, ICU and Deaths (7-day rolling average)
100
Daily New Cases per 100,000
200
80 Hospital
Admissions
150
60
Case Rate 100
40
50
20
0 0
4/1/2020 5/1/2020 6/1/2020 7/1/2020 8/1/2020 9/1/2020 10/1/2020 11/1/2020 12/1/2020 1/1/2021
Source: MDH COVID-19 Case Data, current as of 1/19/21
2/10/21 9
COVID-19 By the Numbers: Minnesota
140 300
120
250
Hospital, ICU and Deaths (7-day rolling average)
100
Daily New Cases per 100,000
200
80 Hospital
Admissions
150
60
Case Rate 100
40
50
20
ICU Admissions
0 0
4/1/2020 5/1/2020 6/1/2020 7/1/2020 8/1/2020 9/1/2020 10/1/2020 11/1/2020 12/1/2020 1/1/2021
Source: MDH COVID-19 Case Data, current as of 1/19/21
2/10/21 10COVID-19 By the Numbers: Minnesota
140 300
120
250
Hospital, ICU and Deaths (7-day rolling average)
100
Daily New Cases per 100,000
200
80 Hospital
Admissions
150
60
Case Rate 100
40
Deaths
50
20
ICU Admissions
0 0
4/1/2020 5/1/2020 6/1/2020 7/1/2020 8/1/2020 9/1/2020 10/1/2020 11/1/2020 12/1/2020 1/1/2021
Source: MDH COVID-19 Case Data, current as of 1/19/21
2/10/21 11Minnesota Compared to our Neighbors: Cases 2/10/21 12
Minnesota Compared to our Neighbors: Deaths 2/10/21 13
Transition to Exponential Growth Happens
with Little Warning
Daily New Cases per 100,000
130
Restaurants open/Phase 3
June 10: 6.7
Sept 17: 15.9
Oct 5: 20.8
Oct 20 : 30.6
120
110
Phase 3 opened
100
with case rate @ 6.7
90
80 Up to 20
70 within 3
Reached 15 mid-September weeks
60
50
40
Most the summer small changes between 8 to 12,
30
and then once hit 15 never came back down Exponential
20
10
growth started 2
0
weeks later.
2/10/21 14Consequences Rise with Case Rates
Weekly New ICU Weekly Health Weekly Health Weekly
Weekly New
Daily Case rate Average Weekly Stays Deaths
Admissions Care Workers - Care Workers -
per 100,000 Daily Cases Cases (15.7% of (1.5% of
(4.9% of cases)
admissions)
Acute Care Congregate Care cases)
10 550 3,850 190 30 200 140 60
Current 15 800 5,600 280 40 290 210 80
20 1,100 7,700 380 60 400 290 110
30 1,700 11,900 590 90 630 450 170
40 2,200 15,400 760 120 810 580 220
50 2,800 19,600 970 150 1,030 730 290
60 3,300 23,100 1,140 180 1,210 860 340
75 4,100 28,700 1,420 220 1,510 1,070 420
100 5,500 38,500 1,900 300 2,020 1,440 560
150 8,300 58,100 2,870 450 3,050 2,170 850
Updated 1/19; Admissions and deaths based on specimen dates 11/15 to 12/15; health care workers based on MMWR week 51.
2/10/21 15Case Rates by County ▪ Metro counties ≤ 15/10,000, except Scott county (17.1) ▪ Counties with highest rates all in Greater MN ▪ 1/3 of counties > 15/10,000 2/10/21 16
MN Face Covering Requirements 2/10/21 17
The Protective Benefit
When Everyone Wears Masks
• Primarily intended to reduce the
emission of virus laden droplets.
• Especially relevant for people who
are asymptomatic, infected, but who
may not know they are infected.
• Help reduce exposure by the wearer
to droplets from an infected person.
Community benefit for SARS-CoV-2 control is due to the combination of these effects.
2/10/21 18Face Covering Best Practices
A face covering should fit
snugly over the nose
and mouth.
Face coverings are not a
substitute for social
distancing.
2/10/21 19Face Covering Best Practices • Use breathable fabric that is tightly woven • Use at least two or three layers • May use a mask with inner filter pockets • Avoid masks with valves 2/10/21 20
CDC Brief on Face Coverings
Over 25 new studies done in 2020
conclude the effectiveness of masking.
COVID-19: Considerations for Wearing Masks | CDC
• Experimental and epidemiological data support community masking to
reduce spread
• Encourages adoption of universal masking policies in combination with
interventions like social distancing, hand hygiene, and adequate
ventilation
2/10/21 21Research Highlights on
Effectiveness of Face Coverings
Setting Exposure of Effect Setting Exposure of Effect
Interest Interest
USS Theodore face coverings service members who wore Kansas counties state mask mandate COVID-19 incidence
Roosevelt aircraft during an outbreak face coverings had lower during summer surge with option for counties decreased in 24 counties with
carrier infection rate than those who to opt-out in Kansas mask mandates after July 3,
did not (55.8% versus 80.8%) but continued to increase in
81 counties without
mask mandates
Hair salons in two masked hair stylists none of the 139 clients Tennessee counties mask requirements areas with mask requirements
Missouri infected with COVID-19 developed symptoms with 67 had a slower growth rate in
exposed 139 clients, testing negative for SARS- hospitalizations for COVID-19
all masked CoV-2 (without controlling for cases)
than those without
mask requirements
Boston health institution of universal significantly lower rate of
care settings surgical masking with SARS-CoV-2 positivity among States in the U.S. mask mandates in 15 reduction in COVID-19
provision in hospitals health care workers states and Washington, transmission
after masking DC over summer rates in states mandating face
mask use in public compared to
those without mandates
Arizona during mask mandates, limiting transmission rates were up by Germany regional mandates for face masks reduced the number
summer surge large crowds, social 151% prior to these measures mandatory mask wearing of new COVID-19 infections 45%
distancing and then stabilized and in public transport (between 15% and 75%) over a
decreased by 75% with and shops period of 20 days after the
continued application mandates
Source: Gandhi
2/10/21M, Marr LC. Uniting Infectious Disease and Physical Science Principles on the Importance of Face Masks for COVID-19. Med (N Y). 2021 Jan 15;2(1):29-32. doi:22
10.1016/j.medj.2020.12.008. Epub 2020 Dec 16. PMID: 33521753; PMCID: PMC7833696.Face Covering as a Community Mitigation Measure Multiple studies conducted a variety of different ways have shown universal face masking is correlated with reduced COVID-19 incidence in multiple countries around the world, and in multiple states in the United States One study published this week looked at U.S. states categorized as “early” (pre-June 12), “late”, and “never” mask requirement adopters; when controlling for age, poverty, and race the researchers found strong protective effect (i.e. fewer COVID-19 cases) for “early” vs. “never” adopters, and a smaller protective effect for “late” vs. “never” adopters 2/10/21 23
Mask Wearing - Effect Study led by Mayo Clinic Division of Engineering Collector and a Diffuser 2/10/21 24
Face Covering Requirement:
Key Mitigation Strategy
Executive Order 20-81 – Effective July 25, 2020
• People in Minnesota are required to wear a face covering
in all indoor businesses and public indoor spaces, unless
alone
• Workers are required to wear a face covering when
working outdoors in situations where social distancing
cannot be maintained
2/10/21 25State by State: Mask Mandate
Regulated
Not Regulated
County Specific
2/10/21 26Minnesotans Wear Face Coverings
June 1, 2020 January 15, 2021
47% 77%
39% Increase
2/10/21 Source: COVID-19 (healthdata.org) 27Youth Sports and Face Coverings 2/10/21 28
CDC Youth Sport Masking Recommendation
Require consistent and correct use of masks –
make sure staff, athletes, and spectators are
covering their noses and mouths. Higher-intensity Sports
Provide everyone with information before the People who are engaged in high-
sporting event – intensity activities, like running,
may not be able to wear a mask if
proper use, removal and washing of masks it causes difficulty breathing.
Limit high-intensity sports when
Consider having additional masks on hand in indoors.
case player forgets one or needs to replace a
moist mask with a dry one.
Source: Considerations for Youth Sports | CDC
2/10/21 29American Academy of Pediatrics
Recommendations on Youth Sports Masking
“Indoor sports bear a greater risk of transmission of SARS-CoV-2,
and certain sports (e.g., ice hockey) carry higher relative risk.
If indoor sports take place, proper use of a cloth face covering
for all indoor sports training and competition is strongly recommended.”
“Cloth face coverings have been shown to decrease transmission rates of SARS-CoV 2;
therefore, the AAP encourages that athletes wear them at all times
for group training, competition, and on the sidelines.”
Source: COVID-19 Interim Guidance: Return to Sports (aap.org)
2/10/21 30COVID-19 Transmission Risks and Sports Sports and gyms, fitness centers, and similar facilities are activities and settings in which people engage in activities that pose a substantial risk of transmission of COVID-19 • People are in close proximity to one another from different households • Time spent together - duration of practice, game or class • Activities involve exertion and heavy breathing • Indoor environments 2/10/21 31
MN Sports: Goal of Face Coverings Reduce transmission in the team during practices and/or competitions. Keep students in school AND our kids safer when they return to play. Minimize the transmission path to the greater community and economy 2/10/21 32
Sports Outbreak Data 2/10/21 33
Sports: COVID-19 Outbreaks and Mitigation
Outbreak Exposure of Effect Setting Intervention Effect
Interest
Ice hockey in Finland transmission of COVID-19 1 asymptomatic player US high school athletes face coverings during sports Covid-19 incidence decreased
without masking infected 48 other players and by 21-64% among
led to quarantine of 6 teams1 participants in indoor sports
(basketball, volleyball,
football, cheer/dance)5
Ice hockey in Florida transmission of COVID-19 1 presymptomatic player US National Football League intensive mitigation measures no additional spread occurred
without masking infected 14 of 22 other players (including strict mask use) after implementation of
during a single game2 after 21 of 41 cases linked to mitigation measures6
a single club, including
unmasked meetings
Ice hockey in Canada transmission of COVID-19 1 asymptomatic player Strenuous exercise in healthy exercise capacity and CO2 No significant difference in
during inconsistent mask infected 88 others after a volunteers levels while masked capacity or CO2 levels while
wearing single practice3 wearing surgical mask,
though N95 use associated
with increase in CO27
Football in Italy a Champions League football nearly 10,000 people in 2 US Major League Baseball intensive mitigation measures no secondary spread to two
match in Feb 2020 as a countries infected; may have including frequent testing, opposing teams following an
superspreader event been the origin of COVID-19 quarantine, and mask outbreak of 20 cases in
outbreak in Italy4 wearing another team8
1. Kuitunen et al, 2021. 5. Watson et al, 2021.
2. Atrubin et al, 2020. 6. Mack et al, 2021.
3. 2/10/21
CBC News, Ottawa, Dec 2020. https://www.cbc.ca/news/canada/ottawa/ottawa-hockey-covid-19-sports-outbreak-1.5849017 7. Epstein et al, 2021. 34
4. Yahoo News, California, May 2020. https://news.yahoo.com/game-zero-soccer-game-attended-182603718.html 8. Murray et al, 2020.Minnesota Sports Face Covering Requirement
Executive Order 21-01
Face coverings must be worn
in accordance with applicable
guidance for youth sports
available on the
Stay Safe Minnesota website
(https://staysafe.mn.gov).
2/10/21 35MDH Sports Face Covering Alternatives If a sport requires a helmet and that interferes with wearing a face covering safely or effectively, athletes may consider alternatives to face coverings that are specifically designed by helmet manufacturers (i.e., a full-face shield). 2/10/21 36
State by State: Youth Sports Masking
Mask Required
No Mask Required
County Specific
2/10/21 37Medical Exemption Considerations and Findings The American College of Allergy, Asthma and Immunology Finding: there is no evidence that wearing a face covering makes asthma worse. The MN Chapter of the American Academy of Pediatrics Finding: the situations and conditions that pose an actual obstacle to wearing a face covering are limited. 2/10/21 38
Face Coverings and CO2 CDC: Face coverings do not raise the carbon dioxide (CO2) levels in the air that the mask wearer breathes - CO2 can escape through the sides of face coverings and is small enough to pass easily through face coverings. 2/10/21 39
Injuries Related to Face Coverings?
MDH and Minnesota youth sports are aware of
anecdotal reports of injuries potentially related to
face coverings and youth sports
MDH also connects with these organizations and
the national AAP about potential injury reports
To date, two reports of concussions were
reported, but no medical confirmation was
received
MDH encourages injury reports to be sent to MDH
or youth sports organizations for further review Twin Cities, Pioneer Press, January 4, 2021
2/10/21 40Thank you
Daniel Huff, MDH Assistant Commissioner
2/10/21 41You can also read
