Minnesota has avoided a fall COVID surge, but the flu and RSV remain

People wear masks as they walk through the Mall of America
People wear masks as they walk through the Mall of America on June 10 in Bloomington, Minn.
Stephen Maturen | Getty Images 2020

With COVID-19 cases, hospitalizations and deaths largely flat again in this week’s data — and with the weather clearly telling us that we have now entered winter — we can safely say that Minnesota has avoided the fall surge that the state experienced in the two previous years.  

Still, the state is far from avoiding a surge in all respiratory illnesses. The Minnesota Department of Health is reporting 243 influenza hospitalizations and 195 school outbreaks in the last week. Both are way higher than the near zero levels reported for this time over the past four to five influenza seasons, meaning that for this year, the surge in cases is starting much earlier than in past years.  

In the same report MDH indicates that there have been around 180 hospitalizations in each of the last three weeks for respiratory syncytial virus (RSV), about two-thirds of which are babies. 

So, how do we keep ourselves safe over Thanksgiving gatherings? In the Center for Infectious Disease Research and Policy’s latest podcast epidemiologist Michael Osterholm suggests:  

  • Make sure you are up to date with both COVID-19 and flu vaccines. He noted that the latest reports seem to be showing that the new bivalent COVID booster is effective, even against some newer strains. 

  • Wear an N-95 mask in public settings. 

  • Monitor health before getting together and avoid gathering if you have been exposed within the past few days or if you are having symptoms.  

  • Test for COVID-19 immediately before gathering (incidentally, the state is once again offering four free COVID-19 tests, and ordering online only takes two minutes).  

  • If you do end up with COVID, inquire about getting treated with Paxlovid as soon as possible —even if your symptoms are mild. New research suggests that in addition to reducing risks of hospitalization and death, Paxlovid seems to reduce the risk of long COVID. 

Now on to the latest data... 

Cases and hospitalizations remain relatively low, but uptick in ICU admissions and deaths 

The number of officially reported COVID-19 cases remains on the lower plateau established back in October. The most recent complete seven-day average of newly identified cases, from Nov. 10, is 737 cases statewide. While COVID-19 testing regimes have definitely changed over time, the seven-day average on the same date in 2020 was 6,827 and in 2021 was 4,088. 

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COVID deaths in Minnesota
The number of daily COVID-19 deaths in Oct. and Nov. 2022 (green line) is well below the numbers reported at the same time in in both 2020 (yellow line) and 2021(blue line).
David H. Montgomery | MPR News

The number of new daily hospital admissions due to COVID-19 bounces around a bit more than cases, but overall remains lower than the summer months. Since September the state has averaged 64 admissions per day, compared with about 90 per day June through August of this year.  

COVID-19 hospital admissions are a more comparable metric than cases over the course of the pandemic, but they show a similar pattern: hospitalizations are now much lower than we saw in the two previous falls, and do not appear to be rising. For example, the seven-day average number of hospital admissions on Nov. 10 stands at 65 per day. On the same date in 2020, the average was 211, and in 2021 it was 147. 

The footnote on this seemingly good news appears in the graphs below. When we break out admissions to ICU beds, we do see another uptick at the end of the most recent week. Since this is not coinciding with an uptick in non-ICU hospitalizations it may just be a blip — but we will certainly keep our eyes on this trend. 

COVID Hospitalizations in MN
The number of new daily COVID-19 hospitalizations in Nov. 2022 (green line) is well below the numbers reported in Nov. 2020 (yellow line) and 2021 (blue line).
David H. Montgomery | MPR News

The Department of Health is reporting 13,610 lives lost in Minnesota to COVID-19, including 2,744 so far this year. Cause-of-death data takes longer to process, so the latest firm data that we have dates to late October. At that time, we did see an uptick in average deaths from COVID-19 per day to 8.1., up from 5.6 during the first three weeks of October.  

Similar to the more recent uptick in ICU admissions noted above, the uptick in deaths does not appear to be correlated to a sustained change in hospitalizations, so further increases would be surprising. Still, we will continue to watch these data. 

While every death is a tragedy to the friends and family of those we lose, as a state we can take some comfort in the fact that our COVID-19 death rate is now much lower than was the case at this time for the two previous years of the pandemic. In late October of both 2020 and 2021 we were averaging nearly 20 COVID-19 deaths per day, over double the number we are now experiencing. 

COVID deaths in Minnesota
The number of daily COVID-19 deaths in Oct. and Nov. 2022 (green line) is well below the numbers reported at the same time in in both 2020 (yellow line) and 2021(blue line).
David H. Montgomery | MPR News

Wastewater: increases in northern and central Minnesota and decrease in southeastern corner of the state; not much change according to latest Metro data 

The most recent wastewater analysis in the state, from the Metropolitan Council and the University of Minnesota’s Genomic Center, shows a seven percent decrease in viral load entering the Twin Cities Metro Plant for the week ending Nov. 14 as compared with the previous week. According to the Metropolitan Council, “the weekly average load over the past nine weeks (Sept. 13 to Nov. 14) has not varied much, remaining within 20 percent of the average value for the period.”   

COVID load in Twin Cities metro wastewater
COVID load in Twin Cities wastewater went up slightly but not much overall change over the last nine weeks according to the Metropolitan Council.
David Montgomery

In terms of COVID variants, the Metropolitan Council reports “BA.5 constituted 91 percent of the viral RNA entering Metro, and BA.4 and BA.2 represented two percent and seven percent respectively, of the total viral RNA load.” In an email communication with the Metropolitan Council, they note that “many of the mutations we monitor occur in more than one of the current circulating sub-lineages, so they do not uniquely identify individual sub-lineages” and so “right now, we can’t quantify individual BA.5 sub-lineages using our targeted mutation approach.” 

The Minnesota Department of Health, however, notes that “for the most recent two-week period (Oct. 23 through Nov. 6), we are finally starting to see a rise in BQ.1 and BQ.1 sub-lineages that the rest of the country has already experienced. Though BA.5 continues to be identified in the majority of cases, BQ.1 and its sub-lineages increased to 14 percent of sequenced clinical samples in our most recent time period.”  

The latest data out of the University of Minnesota’s Wastewater SARS-CoV2 Surveillance Study, tracking data from seven regions through Nov. 6, shows a general increase in COVID-19 levels across the northern and central parts of the state, as well as south central Minnesota, over both the prior month and week. Several regions did experience decreases, but the southeast is the only region to experience both a monthly and weekly decrease in COVID-19 wastewater levels, both decreases were relatively modest. 

Data for the week ending on Nov. 6 shows a 22 percent decrease of COVID-19 wastewater levels in the northeast region over the prior month, but the northeast saw a 66 percent increase over the prior week. This is the largest weekly increase in this update, followed by a 34 percent increase in the northwest. The opposite trend occurred in the southwest region, which has recently seen large increases, in some instances over 100 percent. The southwest saw a monthly increase of 73 percent but an 11 percent decrease over the prior week. This decrease marks the first one in the southwest in three weeks; the last declines for the region appeared in data for the week ending on Oct. 16. 

The COVID-19 levels of wastewater in the Twin Cities Metro (the study’s largest region, including 13 plants serving 2.8 million Minnesotans) shows a continuing, albeit gradual, increase. Note that this study’s data goes through Nov. 6, but the Metro Plant wastewater data from the Metropolitan Council, mentioned above, is more recent.  

CDC: Holding steady in a good place, but not in the clear 

In Minnesota only Rice County is rated as high risk according to the CDC’s latest “Community Level” ratings. Since Oct. 13, the number of Minnesota counties rated as high risk has been between zero and two, and if you remove Oct. 6, which had five high-risk counties, this trend goes back to Sept. 8. The number of counties rated medium risk increased to 18 from 11 last week. The high- and medium-risk counties are mostly in the southern and central part of the state, with several in the northwest. Hospital admissions are also highest southwest Minnesota.  

COVID-19 transmission, however, is somewhat down this week, according to the CDC. Seventeen counties exceed the threshold for high COVID-19 transmission of at least 100 cases per 100,000, down from 33 counties last week. Pope County had 200 or more cases per 100,000 in the latest update, and Grant County registered more than 400 cases per 100,000. While this is good news, 54 counties register between 50 and 99 cases per 100,000, the greatest number of counties since at least this past summer.  

Minnesota’s vaccination rate remains low—but exceeds most of the nation

The Minnesota Department of Health is reporting that only 17 percent of Minnesotans are up-to-date on their COVID-19 vaccinations and boosters. Vaccination rates are highest among those age 65 or older, since that group has been prioritized due to their higher risks of COVID-19 deaths. 

COVID vaccination rates in MN by age
COVID-19 vaccination rates are highest among those age 65 or older.
David H. Montgomery | MPR News

While those vaccination rates may sound low, rates are even lower in other parts of the country. As we report in our recent Inoculation Nation project update, Minnesota has the nation’s seventh highest rate of COVID-19 booster uptake.