ST. PAUL -- Earlier this week, four of Minnesota's largest health systems — Allina Health, HealthPartners, M Health Fairview, and Mayo Clinic — all announced they would postpone non-essential services until further notice. The moves came in anticipation of their need to focus all available resources on the rapidly evolving coronavirus pandemic, one that many believe will severely test the load limits of the state's hospital system in coming weeks.

On Thursday, March 19, Gov. Tim Walz ordered every other provider in the state to do the same.

The governor's emergency order requires "all non-essential or elective surgeries and procedures, including non-emergent or elective dental care, that utilize PPE or ventilators, must be postponed indefinitely." The order goes into effect at 5 p.m. on Monday, March 23, and comes two days after the Minnesota Hospital Association requested the action in a letter to the governor.

In asking for the directive, the MHA cited "an expected surge of COVID-19 patients," coupled with a need "to protect patients and our workforce, preserve critically short supplies of personal protective equipment, and preserve inpatient bed capacity and other equipment for critically ill patients."

It seeks to put every possible glove, mask, bed and ventilator in the state health system to use in fighting coronavirus.

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The Walz order describes the clinical care now prohibited as "a surgery or procedure that can be delayed without undue risk to the current or future health of a patient." The mandate likely means the end for the time being of most orthopedic, cataract, cardiac, bariatric, cosmetic and interventional radiology procedures within the state — a veritable short list of the most widely-utilized services within the health care system today.

The directive also marks a new stage in what has been depicted as an approaching crisis of capacity in the state healthcare system. As the first use of the emergency powers available to the governor to impose central control on both public and private health care resources, it focuses all providers on a dual mission going forward: emergencies and coronavirus care only.

It was welcomed by MHA on Thursday.

“We thank the governor for following the recommendations from the CDC and professional medical organizations and applying this policy across the state,” said Dr. Rahul Koranne, president and CEO, Minnesota Hospital Association, in a statement. “While this is a difficult decision for the hospital and health system community, it is the right thing to do in order to protect our patients and preserve supplies, equipment and staffing for the most urgent and time-sensitive patient needs.”

"That's all intended to slow down the use of personal protective equipment so that it can be redirected to the areas where it's needed the most," said Minnesota Department of Health infectious disease specialist Kris Ehresmann at a daily press briefing.

Health officials said on Thursday that state tested 405 Minnesotans for coronavirus on Wednesday, adding 12 new cases and raising the statewide confirmed case count to 89.

The state added four cases in Hennepin County, one in Rice County, one in Carver County, three in Anoka County, one in Martin County, one in Mower County, and one in Clay County, the latter briefly misreported by state health officials as Wadena County and marking the first appearance of the virus in the northland.

According to a statement from Clay County Public Health, the case from northern Minnesota was a male between 18 and 24 who had been diagnosed in a healthcare facility and who had recently travelled internationally.

All were recovering in isolation at home.

State health officials on Thursday broke down the testing source of the positive cases for the first time. Of the 89 positive findings so far, 67 have been determined at the state health lab, 14 by Mayo Clinic, 1 by Arup Laboratories, 2 by Labcorp and 2 from out of state providers.

While health officials believe community transmission is occuring widely throughout the state at this time, it has only been confirmed in Hennepin, Dakota, Ramsey and Martin counties. "We really believe there is widespread community transmission of COVID-19 throughout the state," said Ehresmann. "The 89 cases represent the tip of the iceberg."

Ehresmann sought to reduce panic about coronavirus in some quarters, while also taking note of an undue lack of concern in others.

"While we want people to take this seriously," she said, "the vast majority of COVID-19 cases are mild. We are concerned about people's mental health. On the other end, we are hearing about people who don't feel this is a real problem. We'd like to get those individuals to recognize that we all need to be taking this seriously and to follow the guidelines."

The state has now tested 3,038 people. It is only testing healthcare workers, the hospitalized and persons in long term care. The health department advises all persons who develop respiratory symptoms and a fever, if they are able to manage their symptoms at home, to self-isolate for 14 days, or three days after the end of their fever, whichever is longest. It has stressed that there is no treatment value to gaining a positive diagnosis for its own sake.

Family members of those who isolate are advised to isolate for even longer -- two weeks from the start of the patient's isolation.

The CDC COVID-19 symptom checklist is here.

MDH COVID-19 hotline: (651) 201-3920. 2,300 calls yesterday

Business impacts hotline: (651) 297-1304 or (800) 657-3504.

School and childcare hotline: (651) 297-1304 or (800) 657-3504.

MDH COVID-19 website: Coronavirus Disease (COVID-19) website.

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