Uptick in COVID-19 hospitalizations and a surge in RSV cases in Minnesota

Map of percent of pediatric hospital beds available last week
Twin Cities Metro had the fewest available beds by percentage.
Elisabeth Gawthrop | APM Research Lab

A week ago, CDC Director Rochelle Walensky tested positive for COVID-19, just a month after getting the updated, bivalent booster shot. Her symptoms were reportedly mild, but it prompted us to look at the latest vaccine breakthrough data from the Minnesota Department of Health.  

The bottom line is that the vaccines are still effective: For adults over 65 years old, people who are not fully vaccinated have been seven times more likely over the course of the pandemic to be hospitalized for COVID-19 than people who have gotten at least one booster shot. 

That effectiveness has waned somewhat when looking only at more recent data. But for the same 65+ age group, the non-vaccinated are still nearly four times more likely in the last 60 days to have been hospitalized compared to people who are boosted. The Minnesota vaccine breakthrough data does not distinguish, however, between which or how many boosters people have had. So some of the apparent waning effectiveness could be a result of not as many people having had a recent booster. More details and breakdowns are available from the health department.  

In Minnesota, around 11 percent of eligible people have received the latest booster. And with just six percent of Americans overall having gotten the updated boosters, the White House is focusing this fall on getting more people the new shot, according to the Washington Post.  They also plan to provide free delivery of antiviral prescriptions through Walgreens, so be on the lookout for that should you become sick.  

The likelihood you might get the virus looks like it might be on the rise, with an increase this week in hospitalizations and COVID load in wastewater. Whether or not this marks the start of a major surge remains unknown. This week we also look at RSV — a virus that may be of greater concern right now to parents of young children.

Hospitalizations rise, cases up in some regions

After several weeks of declining COVID-19 cases across nearly all of the state, several regions this week saw a small uptick in cases. Case rates increased in northeastern, east-central, southwestern and (barely) southeastern Minnesota. A reminder, though, that these are just cases that are officially reported and do not include unreported at-home tests.

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weekly covid-19 cases in mn regions
According to official reports, cases have ticked up slightly in several Minnesota regions, but not the Twin Cities.
David Montgomery

Unfortunately, hospitalization data doesn't provide any better news. ICU admissions jumped up – including a couple days of admission rates not seen since the end of the early 2022 omicron surge. Non-ICU admissions also started to increase, though they are still lower than they were for much of the summer. 

new icu and non-icu hospitalizations in MN
ICU admissions jumped dramatically in the last week.
David Montgomery

Deaths have stayed approximately steady since early September. With the increase in ICU hospitalizations, however, deaths may start to rise again. 

minnesota covid-19 deaths by year
Deaths remain similar to rates seen since early May of this year.
David Montgomery

Modest increase in Metro wastewater; BQ.1, BQ.1.1 and XBB are here but not surging 

The most recent wastewater analysis in the state, from the Metropolitan Council and the University of Minnesota’s Genomic Center, show a 21 percent increase in viral load entering the Twin Cities Metro Plant for the week ending October 24 as compared with the previous week. That increase was driven by a large one-day spike; excluding that measurement the viral load was up by a more modest eight percent.  

COVID load in Twin Cities metro wastewater 10-28-22
COVID levels measured in wastewater at the Metro wastewater treatment plant were up last week, even excluding the spike on October 24.
David H. Montgomery | MPR News

In terms of COVID variants, the Metropolitan Council again reports that BA.5 makes up 91 percent of viral RNA. Separately, the Minnesota Department of Health continues to monitor variants and provided the following detail via e-mail:  

  • BA.5 continues to be identified in the vast majority of cases (84 percent of sequenced cases, or 88 percent when including its BF.7 and BQ.1 subvariants). 

  • BQ.1 (and sublineage BQ.1.1) has been identified in 15 cases. 

  • BA.2.75 total cases are up to 43.  

  • BF.7 has increased from 29 cases last week to 46 this week. 

  • We have now identified two cases of XBB, the recombinant lineage of BA.2.75 and BJ.1 (aka BA.2.10.1.1), including one with confirmed travel to New York prior to illness onset. 

The major takeaway: Of the newer variants that some suggest will lead to a major new wave of COVID-19, none appear to be surging in Minnesota. At least not yet. 

The latest data out of the University of Minnesota’s Wastewater SARS-CoV2 Surveillance Study, tracking data from seven regions through Oct. 16, continues to show mixed results over the last month. The Twin Cities Metro and the North West both saw large increases in COVID-19 levels over the last month of 25 percent and 32 percent, respectively. On the other hand, there were double-digit decreases over the last month for Central, North East, South West and South Central Minnesota.  

Data for the week ending on Oct. 16, shows decreases in COVID-19 levels in five of the study’s seven regions. Notably, the largest decrease, 35 percent, was seen in the South East region, which had just recently seen highly elevated COVID-19 levels. The North East and Central regions also saw double-digit declines over the prior week. The South Central region along with the Twin Cities Metro (the study’s largest region, including 13 plants serving 2.8 million Minnesotans) show modest increases over the prior week. 

CDC: COVID-19 “Community Level” map shows northeastern Minnesota at higher risk, and more counties at medium risk 

The map of Minnesota is more mixed than last week according to the CDC’s latest “Community Level” ratings. The CDC rated two counties in the state “high risk” this week, up from zero last week. Perhaps more concerning, 27 counties are now rated at medium-level risk, up from 11 last week and now including densely populated parts of the eastern Metro. Still, the 58 remaining counties are all rated low risk, including Hennepin, which is home to more than one in five Minnesotans. 

Although there are only two high-risk counties on the “Community Level” map, 33 of Minnesota’s 87 counties meet or exceed the CDC’s threshold for high COVID-19 transmission of at least 100 cases per 100,000 over the last week. This number is up from last week, although it is still below what it had been throughout September and even at the beginning of this month. Only four counties this week exceeded a weekly case rate of 200 per 100,000: Swift, Lake, Cook and Jackson.   

RSV and other seasonal viruses strain hospital capacity to treat children 

In recent weeks, we mentioned the concern of more children than normal coming down with severe cases of respiratory viruses, including enteroviruses and rhinoviruses. Now another seasonal virus is on the rise, and with flu season also just beginning, doctors are concerned about hospitals' capacity to treat children should these rates continue to go up.  

The latest virus of concern for kids (and older adults) is called respiratory syncytial virus, referred to as RSV, and in mid-October Minnesota had the highest weekly hospitalization rate for RSV since at least 2018. More than 100 people are currently hospitalized in the state, most of them children. 

RSV hospitalization rate in Minnesota
Respiratory syncytial virus (RSV) hospitalizations were the highest they've been in years earlier this month in Minnesota.
Elisabeth Gawthrop | APM Research Lab

And, while RSV is normally a seasonal virus starting *around* this time of year, rates started climbing weeks ago, which was earlier than normal. And last year, cases began to rise in the spring, and peaked during the summer, which was unusual. So unusual, in fact, that normally that data is not tracked during summer months (as illustrated in the graph above).   

This week, Cathy Wurzer spoke to state epidemiologist Dr. Ruth Lynfield about the situation in Minnesota. Dr. Lynfield explained that children are likely more susceptible to the virus because of the pandemic precautions in place the last few years that have led to them not developing the same immunity from exposure that was common before the pandemic.  

There's no data source that includes rates of infection for all the viruses infecting children right now, but there is data on the number of hospital beds available, which gives a sense of the burden of these viruses. Twin Cities Metro has the least capacity in the state by percentage - just two percent of pediatric beds were available last week. 

Map of percent of pediatric hospital beds available last week
Twin Cities Metro had the fewest available beds by percentage.
Elisabeth Gawthrop | APM Research Lab

This figure seems alarming, but pediatric hospital bed availability has been less than 10 percent for a great majority of weeks since summer 2021.

Pediatric bed use in Minnesota since September 2020
Pediatric bed use in Twin Cities Metro has been above 90% for most weeks since the summer of 2021.
Elisabeth Gawthrop | APM Research Lab

Younger children and older adults are the most likely to get very ill from RSV, but anyone can get infected by – and spread – the virus. So it's important for everyone to practice good hygiene, said Dr. Lynfield, including washing hands frequently, covering coughs and staying home when sick.  

"One thing that we often see with RSV is that the older siblings can get infected and bring it home," said Dr. Lynfield.  

"We're all in this together," she added. "Whatever people can do regarding getting vaccinated for influenza, getting vaccinated for COVID, getting their boosters for COVID, and being mindful of the people around them, that will help everyone."