ROCHESTER — A recent Mayo Clinic study finds that Minnesota’s death rate increased by 17% in 2020. Predictably, COVID-19 was a major contributor to mortality, but deaths of despair also grew during the first year of the pandemic.

The study, published Monday in BMC Public Health, used death certificate data provided through the Rochester Epidemiology Project and compared the 89,910 deaths recorded in 2018 and 2019 to the 52,030 deaths in 2020.

“One out of every 10 deaths in the state was due to COVID,” said Dr. Rozalina McCoy, an endocrinologist, associate professor of medicine at Mayo Clinic and the study’s lead author. “That’s a lot. It’s one of the major leading causes of death.”

While COVID-19 played a big role in that 17% increase in mortality across the state, McCoy’s team found that “deaths of despair” also increased in 2020. For this category, the researchers looked at overdoses and accidental poisonings, assault by firearms, malnutrition, alcoholic liver disease, and other chronic liver diseases.

McCoy said the term “deaths of despair” encompasses deaths related to social issues and was first used to describe deaths associated with the opioid epidemic and suicide. The research team added firearm and malnutrition deaths into this category.

“We still think that it reflects the underlying principle of death of despair, the collapse of the social fabric of our society, with people being stressed and isolated from each other,” McCoy said.

Malnutrition deaths, examined within the study for the first time by McCoy and her team, are among the striking statistics in the report. They found a 48% increase in malnutrition deaths in 2020, and the most affected group of people were older women in rural areas who lived alone.

“Churches and social groups either went virtual or closed, and for many older people, being virtual is just as good as closed, that they couldn’t access them,” McCoy said. “You have older people living in rural areas becoming isolated and not getting enough food and really struggling, and I think that’s kind of where we see the malnutrition.”

Deaths from accidental poisonings also jumped up by 49%. Causes of death in this category include opioids, other drugs and non-drug poisonings such as carbon monoxide. Teens, young adults and people of color saw the greatest increases in poisoning and overdose deaths during 2020.

“Opioids, in general, are the majority of overdose deaths, but they changed from 55.6% before the pandemic to now 63.3% in 2020,” McCoy said.

Researchers also found a 68% increase in firearm deaths and a 25% increase for liver disease-related deaths in 2020. For firearms, more men died than women, but the proportion of women killed by firearms grew.

“My main concern is whether these are domestic violence-related deaths,” McCoy said. “There’s no way to know with this data, and I think that it’s going to be very important to get a sense about what happened with domestic violence.”

There are two silver linings within the report. The first is that McCoy’s team didn’t find an increase in deaths by suicide, which are often under the deaths of despair umbrella. McCoy said her hypothesis, which hasn’t been tested with the data available yet, is that with stay-at-home guidance, more people weren’t alone when they experienced a mental health crisis.

“When everybody was stuck at home, for those people who were having thoughts of suicide of self-harm, because they were not alone, they were able to get through this crisis,” McCoy said.

The other silver lining is that the research doesn’t show a rise in deaths that would be connected to delays in screenings and other health care while COVID ravaged hospitals. The research team expected to see some additional deaths from cancer, heart attacks and strokes during this time period, but that didn’t play out in the data.

“There was so much concern that people are forgoing needed medical care, and as a result of not seeking the care that they need — either because they’re afraid to go to the hospital or the hospitals are full from COVID — there was a concern that people aren’t getting the care they need and are dying as a result,” she said.

A big takeaway from this study, according to McCoy, is how community (and a lack of it) is an important aspect for people’s health. This information could inform future public health precautions if, or when, the state faces another pandemic.

“Hindsight is always 20/20, or not even, because we still don’t know what would have been the best way to deal with the pandemic,” McCoy said. “All we know is what we see now in the rearview mirror, and I think the way we shut down with no lifeline for many people, that resulted in death that potentially could have been avoided.”

In the future, the research team will evaluate Minnesota’s deaths in 2021 and 2022 to look at excess mortality over the course of the pandemic.

Recent reports that Department of Energy and FBI officials think the COVID-19 pandemic originated with a so-called lab leak appear to have provided all the “evidence” many require. As a scientist who has led or contributed to several peer-reviewed studies that tell a very different story, I’ve looked on with amazement at the growing divide between what the science shows and what much of the public — and a minority of the intelligence community — believe. But I’ve also watched with understanding for those who still suspect a lab leak because I started there myself.

The nucleus of all lab leak conjectures — they are not a single hypothesis but a wide range of sometimes mutually exclusive speculations — was famously captured by the comedian Jon Stewart. “Oh, my God, there’s a novel respiratory coronavirus overtaking Wuhan, China — what do we do?” Stewart said during a June 2021 appearance on “The Late Show With Stephen Colbert.” “Oh, you know who we could ask: the Wuhan Novel Respiratory Coronavirus Lab. The disease is the same name as the lab!”

Stewart didn’t have the name right, but he was referring to the work of the Chinese scientist Shi Zhengli, whose lab at the Wuhan Institute of Virology does indeed study SARS-related coronaviruses from horseshoe bats, the ultimate reservoir of both the original SARS virus and SARS-CoV-2, the virus that causes COVID-19.

The month before Stewart’s tirade, Science published a letter by me and several other scientists arguing that lab leak hypotheses must not be prematurely dismissed. The letter dramatically shifted the debate about where COVID came from; two weeks later, the Biden administration announced a 90-day intelligence community review of the pandemic’s origins.

While the intelligence community did its work, I set about my own. Though I considered a lab leak plausible, I nevertheless thought a zoonotic origin — a jump from animal to human — to be considerably more likely. Around the same time, the likelihood of a natural origin was bolstered by a paper from scientists in China and Britain proving that live specimens of mammal species previously found to harbor SARS viruses had been sold at markets in Wuhan just before the onset of the pandemic.

A scientist’s job is to kick the tires of a hypothesis — to try to falsify it. I tabled all my other research to try to falsify the hypothesis that the pandemic began at one of those markets, the Huanan Seafood Wholesale Market, where many of the earliest known COVID patients worked.

First I investigated the possibility that Shi’s lab had possessed a virus close enough to SARS-CoV-2 to be its progenitor. Shi had collected what was at the time the closest known relative of the pandemic virus, known as RaTG13, from a mine in Yunnan province.

I asked Nature to request that Shi publish several SARS-related coronavirus sequences that had been reported in the journal. Within days, she provided them. The result: no smoking gun; they were all much more distantly related to SARS-CoV-2 than RaTG13.

Next I set out to answer another key question: Were so many of the earliest known COVID cases linked to the Huanan market simply because that was where people were searching for them? It had been suggested that the market was the first place where cases were detected because China was focused on markets with live animal sales such as those where SARS appears to have emerged.

This turned out to be dead wrong. No such surveillance of live animal markets occurred in Wuhan prior to the pandemic. Astute doctors recognized the new viral pneumonia before an epidemiological link to the Huanan market emerged. Before that association was made, more than half the early cases diagnosed had a clear link to the market — a huge share for a workplace with about 1,500 employees in a sprawling city of 11 million. Also, both of the earliest two lineages of SARS-CoV-2, designated A and B, appeared to be geographically linked to the market, as I wrote in Science in November 2021.

But would mapping the residences of the earliest known patients cast doubt on the hypothesis that the market was the epicenter of the pandemic? I found a way to identify most of these locations by overlaying different low-resolution maps from a World Health Organization report. I then teamed up with Kristian Andersen of the Scripps Research Institute, who was leading an independent study of spatial patterns within the Huanan market, and we assembled a large, international team of experts.

We found that the earliest known COVID cases lived much closer to and more centered around the Huanan market than could be explained by chance. Crucially, this was true even of patients who reported that they hadn’t worked at the market, shopped there or knowingly been in contact with anyone who did.

A more scattered distribution of early cases throughout the city would have suggested that the virus was already widespread in December. But the pattern clearly showed that it was only then beginning to bleed into the community surrounding the market and didn’t spread more widely across the city until later.

Our analyses linked the market not only with lineage B, which had already been found there, but also with lineage A, which had not. Just before we first reported these findings in February 2022, George Gao and his colleagues reported that lineage A was indeed present at the Huanan market before it was closed. This shows that the Huanan market wasn’t simply the site of a “superspreader event,” which would have amplified only a single lineage.

Within the market, meanwhile, the surfaces of stalls that sold live mammals or meat were more likely to have tested positive for SARS-CoV-2 just after the site was closed. One stall riddled with positive samples from surfaces associated with animal sales, including a metal cage, had been visited years earlier by my co-author Eddie Holmes of the University of Sydney, who had photographed raccoon dogs there. The same species was among the market animals that tested positive for the SARS virus in 2003.

A highly technical companion study led by UC San Diego’s Jonathan Pekar and Joel Wertheim, along with UCLA’s Marc Suchard, Andersen and me, drew on over 700 of the earliest SARS-CoV-2 genome sequences. The evolutionary trees of these sequences, combined with epidemiological information, shows that the ancestors of lineages A and B almost certainly jumped into the human population separately. We also found that the establishment of these two lineages probably involved about five jumps into individual humans, most of which fizzled out before taking hold. “Molecular clock” analyses indicate that the lineages shared common ancestors that existed around mid-December 2019, corroborating the epidemiological and geographic evidence that the outbreak was largely restricted to the neighborhoods around the Huanan market at that point.

The two studies, which were published in Science following peer review last July, provide overwhelming, unrefuted scientific evidence that the virus that causes COVID emerged at least twice at the Huanan market, likely between mid-November and early December of 2019. And while it may strike some as odd that the virus jumped twice in the same market, research on mink farms and the pet trade shows that when SARS-CoV-2-infected animals are in close contact with humans over a prolonged period, multiple interspecies jumps are inevitable.

And as we showed using cellphone-based mobility data, the Huanan market is an exceedingly unlikely location for the world’s first large cluster of COVID cases unless it was also where the virus emerged. There are hundreds if not thousands of other places where hypothetical lab leak cases could have initiated human-to-human transmission — bars, restaurants, schools, shopping malls — some with a hundred times the traffic of the Huanan market. Even one such event at Huanan is deeply improbable; fold in the strong evidence for two lineages emerging at the market, and the link to the wildlife trade is unavoidable.

Remarkably, some recent reporting suggests that the Energy Department’s new “low confidence” lab leak conclusion may point to an entirely different lab near the Huanan market, the Wuhan Center for Disease Control and Prevention, which would directly contradict all the speculation surrounding the Wuhan Institute of Virology.

There is now a large body of peer-reviewed scientific research consistent with a zoonotic origin of this pandemic. However, there is no credible, peer-reviewed research pointing to a lab leak. Had the evidence gone in the other direction, I’d be reporting that. But it hasn’t.

The “evidence” in favor of a lab leak consists fundamentally of discredited talking points. The lack of a positive sample from an animal sold at the Huanan market, for example, supposedly undercuts the market-origin hypothesis. But not a single relevant live animal was tested there before the market was closed.

Lab leak proponents cling to the contention that the presence of a lab that studies viruses and the emergence of a coronavirus pandemic in the same city can’t possibly be coincidental. But my colleagues and I showed in 2021 that this virus wasn’t going to emerge just anywhere in China: It took a city. Simulations indicate that when a virus with the properties of SARS-CoV-2 jumps into a human in a sparsely populated rural area, it will fail to cause an outbreak 99% of the time. But take that same virus into a huge city like Wuhan, and about a third of animal-to-human transmissions will result in an epidemic.

We should instead be asking: What is the chance that a big Chinese city like Wuhan would have a lab doing the kind of research that has come under suspicion? The answer is, the vast majority of the biggest cities in China have labs involved in such research. If COVID had emerged in, say, Beijing, there would be no fewer than four such labs facing suspicion.

I remain open to any and all evidence supporting a laboratory origin of the pandemic. So far, we have no such evidence.

Michael Worobey is a professor and the head of the department of ecology and evolutionary biology at the University of Arizona. He wrote this piece for the Los Angeles Times.

All Minnesota students will be eligible for free school meals, no matter their family income, under a bill that has passed both chambers of the Minnesota Legislature.

The Senate on Tuesday approved the DFL-led legislation, which will cost the state roughly $200 million a year. House lawmakers approved similar language last month and will have to agree to the Senate’s version before sending it along to Gov. Tim Walz, who on Tuesday said he’ll be “proud to sign it into law.”

Sen. Heather Gustafson, DFL-Vadnais Heights, said the bill will ensure children from low-income families can eat at school, even if their parents don’t complete forms showing they’re eligible. And even families that can afford to pay for meals could “use the break,” she said, calculating the savings in her district at $1,872 a year a family with two students.

“Look at it like a lunchbox tax cut; it gives money back to families,” she said.

The Senate vote was 38-26 as Republicans Jim Abeler, Julia Coleman, Zach Duckworth and Karin Housley joined all DFL lawmakers voting yes.

The difference between the House and Senate bills concerns compensatory revenue – money that school districts get from the state each year based on their number of students who qualify for free or reduced-price meals because of their low family income.

It is expected that fewer families will complete meal-subsidy forms once they’re no longer needed to qualify for free school meals. The Senate’s version of the bill says that for the 2024-25 school year only, school districts will get at least as much compensatory revenue from the state as they did in 2023-24.

Meanwhile, lawmakers are considering other legislation that seeks a more permanent change in the way Minnesota calculates how much extra money schools should get to address needs related to high concentrations of poverty.

“I think it’s extremely shortsighted to not have that important piece figured out” before passing universal school meals, said Sen. Carla Nelson, R-Rochester.

Other Republican opponents said the bill will mostly benefit middle- and high-income families, that school district leaders don’t consider it a priority, and that the program will feel like a burden in years when the state is not sitting on an unprecedented budget surplus.

“We have so many more needs,” said Sen. Jason Rarick, R-Pine City, who suggested spending the money on literacy programs instead.

Duckworth, the assistant minority leader, co-sponsored the bill but called it premature. He said the Legislature first should have agreed on spending targets for the entire education budget, but the Senate on Tuesday rejected his motion to table the bill.

Ultimately, Duckworth voted for it, saying it would do more good than harm.

Abeler agreed.

“There are some very real needs out there that this will help to address. Some might say that it helps a few who may not need the help, but actually I’m OK with that. There are a lot of pressures on a lot of families that this will take a load off,” he said.

The law would require public and private schools that participate in the National School Lunch Program to offer one free breakfast and one lunch to students each day, with the state and federal governments reimbursing their costs.

California and Maine already make school meals free to all students, and a recently passed ballot measure in Colorado will cover costs for schools that choose to participate. Three other states temporarily are providing free school meals, and many other state legislatures have had universal-meal bills introduced.