Some downward trends mean good news. But does that mean the pandemic is over?

A child gets a vaccine from a nurse with another child next to him.
Ten-yearold Joseph Percy gets his COVID-19 vaccine from nurse Kamiel Houston as his 5-year-old cousin Jacqueline watches at Cityview Community School in Minneapolis on Nov. 4.
Evan Frost | MPR News 2021

“The pandemic is over.” President Biden made the statement in an interview that aired last Sunday on 60 Minutes. He went on to say, “We still have a problem with COVID, we’re still doing a lot of work on it. But the pandemic is over.” 

The White House later clarified that Mr. Biden was talking about the disease’s “pandemic phase” and emphasized the importance of getting one of the new bivalent booster shots to minimize personal risks.  

Regardless of the precise meaning of the word pandemic, what are the latest COVID-19 data showing us about the current state of COVID-19 in Minnesota? 

We also look at a couple of mortality metrics that show a shift in the virus’s impact in recent months, though we’ll leave it for you to judge whether that means the pandemic is over.  

Deaths look to be declining again, but recent declines in cases, hospitalizations level off   

After several weeks of declining cases, official case counts ticked up slightly in most regions of the state. Southeastern and southwestern Minnesota were the exception. This could be a validation of the uptick in COVID levels found in Metro wastewater last week. But as detailed later, those went back to declining, so it will be interesting to see if reported cases follow suit as well next week. 

Recent trend in COVID-19 case rates, by region in MN 9-23-22
COVID-19 cases have leveled off or gone up somewhat throughout the state according to latest Minnesota Department of Health data.
David H. Montgomery | MPR News

While hospitalizations didn't increase overall, their decline plateaued over the past week. 

New ICU and non-ICU hospitalizations in MN 2022 Sept 23
Daily hospital admissions due COVID-19.
David H. Montgomery | MPR News

Deaths reached a relative peak for the past six months in late August. Mortality data from recent weeks is still incomplete, but so far deaths are not looking as high as they were in late August. 

Trend in COVID-19 deaths in Minnesota 9-23-2022
Daily deaths from COVID-19 according to Minnesota Department of Health.
David H. Montgomery | MPR News

Wastewater: Good news from all around the state 

Last week the Metropolitan Council and University of Minnesota’s Genomic Center reported an uptick in COVID-19 levels measured at the Metro Wastewater Treatment Plant and said that “we are beginning to see BA.2.75 at levels around one to two percent in Metro influent.” Sounded ominous.  

Now, for the week ending Sept. 19, they are reporting a 29 percent decrease in COVID levels. They also note: “We are intermittently seeing BA.2.75 at levels around one percent in Metro influent.” An increase in either of these numbers for a second consecutive week could have been troubling.  

As it stands, levels now look like they are continuing the slow downward trend dating back to July. That’s reassuring even though they remain higher than last September when the state was entering COVID-19’s delta surge. 

COVID load in Twin Cities metro wastewater 9-23-22
Latest weekly readings show declining COVID-19 levels detected in Twin Cities wastewater.
David H. Montgomery | MPR News

The latest data out of the University of Minnesota’s Wastewater SARS-CoV2 Surveillance Study is showing good news again this week. The project, which tracks data from seven regions through Sept. 11, shows both monthly and weekly declines in all regions, with only one exception: a tiny, one percent increase in North East Minnesota. 

Few areas of risk on the CDC map again this week 

Southwestern Minnesota’s Lincoln County, population 5,567, is the only orange county on the Centers for Disease Control and Prevention’s “Community Level” COVID-19 risk assessment map released yesterday. Only 13 counties are yellow, down from 24 last week. Orange signifies high COVID risk, where residents should wear masks in public indoor settings according to CDC guidance, and yellow signifies medium risk. 

The remaining 73, which include the state’s major population centers, are a more spring-like green, indicating lower risk.  

However, fifty-five of the state’s counties have weekly COVID-19 case rates that exceed 100 per 100,000, which is the CDC’s threshold for high transmission. Five counties have rates at or above 200 cases per 100,000 for the week ending Sept. 21: Carlton, Koochiching, Lincoln, Polk, and Traverse.  

A closer look at COVID-19 death rates in light of claims that the pandemic is over  

One way to evaluate claims that a pandemic is over is to take a careful look at trends in deaths: if COVID-19 is still causing or contributing to a lot of deaths, it might be hard to claim an end to the pandemic.  

As noted in the most recent update to our Color of Coronavirus project, COVID-19 deaths trended up nationwide May through July. COVID-19 was still causing over 400 deaths per day in July nationwide.

That alone, however, might not settle the debate. What if COVID is no longer the primary cause of all these deaths, but more of a contributing factor, among other causes? And how does this relate to overall deaths?

If the overall death rate is lower, it might be possible that COVID’s supposed contributions to all these deaths was not really leading to a difference in the overall death rate. Some researchers theorize, for example, that doctors are simply coding deaths as COVID-related if the patient tested positive for the virus, even if they couldn’t be sure how much the virus contributed to the person’s death.  

While we do not claim to settle this debate, we look this week at a couple of datasets that offer some evidence of a decline of COVID’s impact.  

In recent months, COVID cited less as a primary cause of death  

Infectious disease expert Dr. Shira Doron told NPR last week that more than 70 percent of the COVID hospitalizations at her hospital recently are people who come in for something else and test positive for the virus.  

Just how much COVID may contribute to a death is ultimately a judgement call for the person who certifies a death. If COVID is thought to be the primary reason for a death, it’s listed as the underlying cause. If it’s thought by the certifier (often a doctor) to be one of several reasons for a death, it’s listed as a contributing factor, or one of multiple causes.  

This difference is recorded in publicly available death data, and we’ve used it this week to analyze the percent of all COVID-related deaths where COVID is the primary cause versus a contributing factor.  

Proportion of COVID deaths in US that list COVID as primary factor
CDC data shows changing proportion of COVID-related deaths are primarily caused by the COVID-19.
Elisabeth Gawthrop | APM Research Lab

The share of COVID-related deaths that are primarily due to COVID dropped significantly this spring. For much of the pandemic, COVID was listed as the underlying, or primary, cause of death in 85 to 95 percent of deaths where COVID was listed as a cause of any kind. But while Dr. Doron may be right about the COVID status of patients in her hospital, even in recent months COVID is still listed as the primary cause of death for about 65 percent of COVID-related deaths.  

Excess deaths are lower, but still notable   

If one is skeptical about the coding of deaths as COVID-related, a more straightforward metric is simply the total number of deaths from all causes. If COVID deaths, even deaths where COVID is one of many contributing factors, are resulting in a higher-than-normal overall number of deaths, that is obviously still a problem. 

Deaths have a seasonal pattern – more people tend to die in winter – but are fairly consistent year-to-year. So the total number of deaths in a given week or month can be compared to the number of deaths that would normally be expected in that time period. Any number above the expectation is called ‘excess deaths’. The CDC explains more about this here, which is also where we downloaded the data for this section.

We cannot assume that all excess deaths are directly COVID deaths, but many are likely at least indirectly related to the pandemic. Other causes could include failure to get adequate healthcare for other conditions due to pandemic issues or fear, or stress from the mental health toll of the pandemic.  

US excess mortality since 2018
Excess mortality shows impact of pandemic regardless of how deaths are coded for COVID-19.
Elisabeth Gawthrop | APM Research Lab

For the nation as a whole, we’re seeing a sustained period of more moderate excess deaths, compared to periods of more ups-and-downs in the past. In March 2021 and March 2022, deaths fell below the ‘expected deaths’ threshold for a couple of months, and then rose somewhat but stayed closer to the expected deaths than during the height of the waves. In 2021, however, deaths began to rise again in August. So far, we have not seen the same rebound.  

minnesota excess mortality since 2018
Minnesota has seen less excess mortality lately compared to the national average.
Elisabeth Gawthrop | APM Research Lab

Looking at the same metric for Minnesota shows a couple of things. First, there have been fewer weeks with excess deaths above the expected threshold in the pandemic overall compared to the national data. And second, deaths have stayed below the expected threshold for most of this year following the early 2022 omicron wave. Since mid-February, deaths have exceeded the upper bound of expected deaths in just five weeks. Again, we can hope for even less, but it remains to be seen if the seasonal cycle of increasing COVID hospitalizations and deaths in the fall repeats itself this year.  

Neither the recent continued rate of over 400 deaths per day, nor the lower proportions of deaths being coded with COVID as the primary cause, nor the decreasing prevalence of excess deaths fully settles the question of whether the pandemic is over. But hopefully the data do provide you with a more informed picture of where we are as a nation and as a state. As we move into an uncertain fall and winter season, epidemiologist Michael Osterholm’s saying “we may be done with the pandemic, but that doesn’t mean the pandemic is done with us” seems apt.   

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