A look at excess deaths during COVID-19, including firearm assaults and malnutrition

A nurse gives a Pfizer-BioNTech booster
After climbing for two weeks around the new year, average daily deaths finally fell for a few days. With the falling hospitalizations, there is hope that deaths will continue to follow suit.
Kerem Yücel | MPR News

The impacts of the pandemic extend far beyond those who have died directly due to COVID-19. Stress, mental health challenges and availability of healthcare resources have all been touted as contributing to higher mortality rates, in addition to the virus itself.

In 2022 in Minnesota, for example, COVID-19 plus an increase in deaths from firearm assaults, accidental poisonings, malnutrition and liver disease, led to a death rate 17 percent higher than would have otherwise been expected according to a study published last month by researchers from Mayo Clinic.  

The data is clear that the COVID-19 pandemic has coincided with a substantial increase in deaths, beyond what is expected by historical patterns. To visualize recent excess mortality in Minnesota and the United States as a whole, we used the latest data to update a previous analysis we conducted back in September. As we wrote then:  

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. 

In Minnesota, there was just one week last year — the week ending April 2 — when the actual number of deaths did not exceed the average number of expected deaths. But in addition to looking at how many more deaths than the average would be expected, the CDC also calculates an upper threshold of expected deaths, which they describe as “a one-sided 95 percent prediction interval of these expected counts.” The weekly number of deaths last year in Minnesota exceeded that upper threshold of expected deaths for 24 weeks.  

weekly excess deaths in Minnesota since 2017
In Minnesota, there was just one week in 2022 – the week ending April 2 – when the actual number of deaths did not exceed the average number of expected deaths.
Elisabeth Gawthrop | APM Research Lab

To see the exact numbers, see the interactive version of this graph published by APM Research Lab, including with data for other states and the United States as a whole.  

Excess death data is not confirmed yet for the early weeks of 2023. While we did see a rise in COVID-19 deaths during the end of December and beginning of January in the state, we don’t know yet how the overall mortality rates in recent weeks compare to the expected thresholds. 

The good news, however, is that this week’s data show that COVID-19 deaths in Minnesota have fallen overall after the recent peak. There is a lag in mortality data reporting, so we don’t have a clear downward trend yet, but hospitalizations continue to decline — a good sign that deaths may continue to as well. On the other hand, cases and COVID levels in wastewater are up in some parts of the state. Read on for details about where it looks to be circulating more of late.  

COVID deaths and hospitalizations fall, cases up in western Minnesota 

Vaccinations inched up a tenth of a percent or so in some categories, but, unsurprisingly, rates remain similar to last week. Children under five years old continue to be the least-vaccinated group. (If you missed last week’s update, we reported some new findings on the effectiveness of the bivalent booster.)  

total covid 19 vaccinations to date by age
While the great majority of adults have a completed COVID-19 vaccination series, the rate of booster uptake is much lower.
David Montgomery

In the eastern two-thirds of the state, officially-reported cases are relatively stable from the previous week. But cases are up across the western flank of Minnesota. It’s the second week in a row for rising cases in southwestern Minnesota, where case reports are up around 66 percent from two weeks ago.  

weekly covid 19 cases in minnesota regions
Cases are up this week in western Minnesota.
David Montgomery

Hospitalizations are down this week, for both intensive care unit admissions and non-ICU admissions. Recent ICU admissions are back down to the range seen in late summer and early fall. Non-ICU admissions are down significantly from numbers seen during the summer and fall.  

new covid hospitalizations in MN
COVID hospitalizations are trending down in Minnesota.
David Montgomery

After climbing for two weeks around the new year, average daily deaths finally fell for a few days. With the falling hospitalizations, there is hope that deaths will continue to follow suit.  

Minnesota covid 19 deaths by year
Deaths are down in the most recent data after a peak in early January.
David Montgomery

COVID levels up in Twin Cities Metro wastewater; statewide, half of regions see increase, while other half see decrease 

Situation in the Twin Cities Metro 

The most recent wastewater report from the Metropolitan Council and the University of Minnesota’s Genomic Center with data for the week ending Jan. 30 notes that “The total viral RNA load entering the Metro Plant increased by 18 percent last week compared to a week earlier” and that the XBB subvariant “made up 65 percent of the viral RNA entering Metro last week, increasing from the previous week’s level of 48 percent.”  

COVID load in Twin Cities metro wastewater
The total viral RNA load entering the Metro Plant decreased by 18 percent last week compared to a week earlier.
David Montgomery | MPR News

According to the Minnesota Department of Health’s data regarding variants in sequenced cases for the two-week surveillance period ending Jan. 14, “XBB lineages continue to ascend,” now comprising 15 percent of sequenced specimens compared to nine percent in the previous two-week period.

The MDH noted that “this is the third consecutive two-week period of growth for XBB lineages.” The proportion of specimens identified as BA.2.75 is also up for the fifth consecutive surveillance period, at 10 percent from six percent in the last period. And, while BQ.1.1 comprises the largest proportion of sequenced specimens compared to other variants, it has fallen from 45 percent last period to 40 percent this period. 

Statewide Situation 

We’re back to mixed signals after seeing declines in wastewater COVID levels throughout the state last week. According to the latest data out of the University of Minnesota’s Wastewater SARS-CoV2 Surveillance Study, there is a relatively even split between regions seeing increasing COVID levels and those seeing decreasing levels for the week ending Jan. 22.  

The study’s north east region saw an increase of 92 percent over the prior four weeks and an increase of 68 percent over the prior week; these were the largest increases experienced this period. The study’s south west region experienced a more modest increase of 33 percent over the prior four weeks and 16 percent of the prior week.  

While the north east and south west both saw a trend of a larger four-week increase and relatively smaller one-week decrease, the Central region saw the opposite. The region saw an 18 percent increase over the prior four weeks and a 63 percent increase over the prior week. This indicates a rather sudden increase after a longer period of gradual decline starting in early December.  

COVID levels in wastewater declined over both the prior four weeks and one week in the study’s north west, south central and south west Regions. The Twin Cities metro, the study’s largest region, saw modest declines of 10 percent over the prior four weeks and one percent over the prior week.   

CDC rates one county as high risk this week and 18 as medium risk 

According to the new Centers for Disease Control and Prevention’s “Community Level” COVID-19 assessments, Nobles County is the only county rated as high risk this week. This is a decrease from last week when three counties, including Nobles, were rated high risk.  

Although the number of high-risk counties declined from last week, the number of counties rated medium risk is more than double the number last week, from seven last week to 18 this week. The medium-risk counties are concentrated in the southwestern, central and northwestern parts of the state.  

The counties rated as medium risk or higher also have COVID hospital admissions at 10 per 100,000 or higher. Brown, Renville and Redwood counties, which are rated medium risk, each have 18 COVID hospital admissions per 100,000. 

Twenty-two counties have case rates that meet the CDC’s definition of high transmission (weekly case rates of 100 or more cases per 100,000), a decrease from the 32 that met that threshold last week. Nobles County and Pope County have a weekly case rate that exceeds 200 per 100,000.

The number of counties that meet the CDC’s definition of “substantial” transmission (weekly case rates of 50-99.9 per 100,000) is relatively similar to last week, 44 counties met that definition this week compared to 48 counties last week.  

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