The elderly Ramsey County resident who is Minnesota’s first COVID-19 case came into contact with very few people while sick, greatly reducing the threat of infection to others, state health officials said Saturday.
But 42 Minnesotans who aren’t even in the state may face a stronger risk of infection. They’re among 3,500 passengers who remain in quarantine on the Grand Princess cruise ship off the coast of California.
That announcement that Minnesota’s first patient poses a very low risk to others came after an unusually swift investigation into the patient’s contact history. Most such inquiries take days, with dozens of public health workers scrambling to interview hundreds of people in an attempt to outrace the spread of infection. Friday’s contact investigation wrapped up in a couple of hours.
At least in this case, the threat of the novel coronavirus spreading from the individual to the community at large appears low, said Kris Ehresmann, infectious disease director for the Minnesota Department of Health, in a media briefing on Saturday. The patient is recovering at home under strict isolation protocols not to leave the house or interact closely with others.
“From an epidemiological standpoint,” Ehresmann said, “it is about as good as you could ask for.”
State health officials are readying for much more extensive contact investigations due to the rapid spread of the virus, which emerged in Wuhan, China, in December and has now caused more than 102,000 illnesses and 3,400 deaths worldwide. The U.S. count includes 340 illnesses and 14 deaths.
A $25 million state budget request is expected to receive legislative approval Monday, and will allow the Health Department to repurpose grant-funded infectious disease specialists in areas such as HIV and foodborne illnesses to help out with investigations of future positive cases of COVID-19.
“We had epidemiologists standing by who came in [Friday] because you just don’t know if the person is going to say, ‘You know, I was at the Mall of America,’ or whatever,” Ehresmann said. “We absolutely did not have that situation. The person handled everything so perfectly.”
The first Minnesota case involved someone who is older than 65 who had been on the Grand Princess last month for a voyage between California and Mexico. After COVID-19 cases had been discovered among passengers on that ship, the Minnesota Department of Health reached out this week to 26 passengers who had disembarked from that cruise on Feb. 21 and returned to Minnesota.
Only two people had symptoms, and the other traveler tested negative. The other 24 travelers are now beyond the 14-day incubation period in which they would have suffered symptoms if they had been infected on the cruise.
However, 42 Minnesotans are among the 3,500 passengers from a subsequent Grand Princess cruise to Hawaii who are now quarantined off the California coast.
The fact that Minnesota’s first case was linked to outstate travel is significant and allows the Health Department to continue its containment strategy of limiting the introduction of the virus into Minnesota, Ehresmann said. “Once you get to the point where you have people who are positive and you cannot identify a link back [to the sources of their infections], then that’s a concern, because that is indicating that this is just spreading in our community indiscriminately.”
While the person in the Minnesota case became sick Feb. 25, the investigation determined that the individual hadn’t been within 6 feet of anyone for more than 10 minutes since returning home from the cruise, health officials said.
The distance is roughly the zone in which someone could come in contact with droplets if another person coughed or sneezed. The coronavirus that causes COVID-19 illness also does not hang as long in the air as the measles virus, so health officials believe that transmission requires sustained contact between people.
Minnesota’s first case also reacted appropriately after state health officials reached out on Thursday. The individual called ahead for testing at an M Health Fairview facility on Friday and showed up wearing a mask to protect the health care workers and other patients.
“The health care worker was masked and the patient was masked so there was very low risk,” Ehresmann said.
The state Health Department frequently conducts contact investigations to contain outbreaks, though they often receive little attention. Epidemiologists often trace contacts of individuals in the state with tuberculosis, for example.
The state Health Department was lauded for its efforts in 2017 to limit the spread of measles from one child in a child care facility to no more than 75 patients.
“[Parents had] brought the child to a football game and they had gone to the mall,” Ehresmann recalled. “There were multiple exposures with large groups of people. That’s the kind of thing that we’re preparing for now.”
Each patient infects 2.2
While other coronaviruses cause common colds, this new version is concerning because nobody has immunity to it. The virus, known officially as SARS-CoV-2, appears about as infectious as severe seasonal strains of influenza. Studies estimate one COVID-19 patient is likely to spread the virus to 2.2 others.
Given the rapid spread of this coronavirus from China to multiple countries, including the U.S., Ehresmann said it is likely to pass from person to person in Minnesota at some point despite containment efforts. The state’s public health lab tested at least another 11 samples from suspect patients in Minnesota Saturday, though the results weren’t immediately available.
Even so, containment efforts serve a vital role in at least slowing down the spread, Ehresmann said, and preventing or reducing a spike in cases that could overwhelm the state’s hospitals and health care capacity.
“Our goal,” she said, “is to slow everything down and make it manageable both for the health care system as well as for our infrastructure.”
The ability of containment efforts to limit outbreaks is dependent on infected people agreeing to isolation, and others at risk agreeing to quarantines. Ehresmann said the state health commissioner has the ability to gain court-ordered quarantines, but that hasn’t been needed so far in her career. People in this outbreak appear to be complying with state recommendations to prepare for quarantines that could last up to two weeks — based on the number of shoppers who have wiped retail store shelves of toiler paper and bulked up on medicine, canned goods and bottled water.
“People might chafe a bit,” Ehresmann said, “but they recognize what needs to be done.”