A former administrator for the Centers for Medicare and Medicaid Services says he has advised Minnesota Gov. Tim Walz to shut down bars and other indoor services to prevent further spread of COVID-19.
Andy Slavitt, who worked under President Barack Obama from 2015-17 and is a fundraiser for the Minnesota DFL, has sparked debate with a series of tweets posted to his 500,000-plus Twitter following on Sunday.
"I spoke to Governor Walz and Commissioner Jan Malcolm today and called for closing all of the bars to indoor service across the state of Minnesota," Slavitt began.
He wrote that "as challenging as this is to bar owners & patrons, this isn't even close to a difficult recommendation to make at this time," noting that bars have been COVID-19 hot spots that "represent the clearest discernible difference in accelerating case growth."
"When they are open, spread increases. When they close, they go down. This is not a secret," Slavitt continued. "And as new data confirms, what starts in bars ends up in assisted living soon enough."
The past week in Minnesota saw cases grow, including more than 1,500 new cases reported over the weekend. But high numbers of cases can be the result of more testing, so the key metric to consider is the positive test rate. Minnesota's positive test rate is also rising, just on Sunday joining 34 other states that have a 7-day rolling average above the World Health Organization's (WHO) 5 percent threshold.
The WHO says that a 14-day positive test rate of below 5 percent is the key to keeping businesses open. Minnesota's 7-day rolling average, as of Sunday, was 5.11 percent, according to Johns Hopkins University. Here's how Minnesota's daily positive tests rates for last week skipped up and down.
- Monday: 7.6%
- Tuesday: 10.2%
- Wednesday: 5.9%
- Thursday: 4.6%
- Friday: 2.96%
- Saturday: 5.00%
- Sunday: 5.5%
While the number of cases has been rising particularly among the younger population, the rising case counts have yet to lead to a spike in hospitalizations and deaths, though this metric tends to lag a few weeks behind rising cases.
As of Friday, Minnesota hospitals had an ICU bed maximum capacity of 2,198. Of those, 1,071 were in use, and as of Saturday there were 123 COVID-19 patients occupying ICU beds.
Walz has previously said he was open to reimposing restrictions on dine-in services if it led to a subsequent spike in cases. While the positive case rate has risen in recent weeks, Minnesota is not yet seeing the surge that is currently impacting southern states.
Furthermore, with the virus predominantly affecting younger people, who are more likely to survive a bout of COVID-19, there hasn't yet been a corresponding rise in the state's death rate.
Minnesota bars, restaurants fighting for survival
Minnesota's bars and restaurants were ordered to close for approximately three months, and have only been allowed to serve customers inside at no greater than 50 percent capacity since June 10.
Slavitt said he thinks patios should be allowed to stay open, but that dine-in service should shutter again. This would likely be devastating to an already beleaguered industry.
The weight of the economic slowdowns related to the pandemic has resulted in dozens of bars and restaurants permanently closing, though since indoor service was allowed to reopen there have been at least six instances of outbreaks linked to specific bars: two in Minneapolis, two in Mankato, and one each in Rochester and St. Cloud.
Others have faced temporary re-closings since June 10 after employees tested positive for the virus. The Freehouse in Minneapolis, for example, has already closed for deep cleaning and sanitizing twice in the past couple of weeks.
"We hope to open later this week for curbside and patio dining," The Freehouse announced Sunday, noting that a professional deep cleaning will take place Monday. "In the meantime, we will be evaluating hours, seating configurations and operations to make sure that The Freehouse is a safe and controlled environment for all."
Meanwhile, Gov. Walz said last week that a decision for the possibility of a mandatory mask policy could come very soon. The Minnesota Medical Association is among those calling for the mask requirement. Slavitt doesn't think masks are enough.
"For all the conversation around masks, with bars open, masks simply won’t matter enough. Bars are one of the few places where strangers congregate inside, in close quarters, with music & noise, speaking loudly. Also, drunk," he wrote.
When Gov. Walz issued a stay-at-home order in March, he did so in an effort to buy healthcare workers time they needed to add hospital capacity for patients who become critically ill, while also stockpiling personal protective equipment.
Numerous states seeing significant COVID-19 growth
Minnesota was among the last states to reopen partially after the stay-at-home order, but many states that reopened earlier have since seen explosive case growth.
On Sunday, Florida set a national single-day record with more than 15,300 new cases, which broke New York's previous record of 12,274 set in April.
Per the New York Times: "The states seeing the record increases were often among those where officials had delayed implementing stay-at-home orders in the spring and moved quickly to ease the restrictions they did put in place."
In Florida, disease transmission has quickly pushed hospital capacity and put a strain on healthcare workers. The New York Times reports that 43 intensive care units in 21 Florida counties have reached capacity.
A similar strain is being felt in Texas, where the number of COVID-19 patients hospitalized has gone from 2,008 on June 11 to 10,400 on July 12, according to CBS News. That includes just 977 available ICU beds.
When states reopened only to dial back with closures
Here's a look at the phased reopening/closing of bars and restaurants has evolved in three of the states currently seeing robust disease circulation.
Florida: Limited reopening of businesses and beaches began the first 10 days of May. Restaurants and gyms May 18, with bars following June 5. Bars were ordered to close again on June 26, while restaurants and gyms in the state's most populous county (Miami-Dade) were ordered to close again on July 6.
Texas: The first phase of the reopening plan began May 1. Between May 8-18, gyms, salons and barbers began to open, followed by bars on May 22. On June 12, restaurants were allowed to open at 75 percent capacity. Bars were then re-closed June 26.
Arizona: Dine-in service at restaurants resumed May 11, with gyms and pools following two days later. Bars re-closed for at least a month on June 29, prompting more than two-dozen bar owners to sue the governor.
Texas began seeing daily positive test rates balloon about one month after its bars reopened (May 22), and the upward trend has continued since approximately June 21, per Johns Hopkins University.
It took nearly a month for Minnesota to begin seeing more robust case growth couple with higher positive test rates, though there's only one week of data to support such a possible trend going forward.
In Florida, bars reopened June 5. The positive test rates remained fairly idle (around 4-5 percent) for about a week before that rate began rising into the teens the last 10 days or June, and it has remained elevated in the upper teens since then.
Airborne transmission indoors
Last week, the WHO said it "cannot rule out" the potential of airborne transmission of the virus, especially in indoor settings like bars, restaurants, choir practices and fitness sessions.
It led to the WHO urging people to "avoid crowded places, close-contact settings and confined and enclosed spaces with poor ventilation."
Airborne transmission means the smaller droplets that leave a person's nose or mouth may hover in the air for some time and remain contagious, though it remains more likely to spread the virus through larger droplets from sneezing and coughing, the WHO said.