New research suggests Minnesota's COVID outcomes may not have been as good as they seemed

Last week The Lancet published an article analyzing differences in state-level demographics, policies and even behaviors to see what bearing they had on both health and economic outcomes during the first 2.5 years of the pandemic.  

For Minnesotans, one finding of interest is that while the state had the sixth lowest unadjusted COVID-19 death rate (257 per 100,000 from Jan. 1, 2020 to July 31, 2022), once that rate is adjusted for age and the presence of “key comorbidities” (asthma, cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes, BMI, and smoking prevalence), Minnesota’s death rate shifts to exactly the middle of the pack.  

This suggests that state’s policy response may have had less to do with Minnesota’s relatively lower COVID-19 mortality than did the state’s pre-existing advantages in terms of lower comorbidities. However, the study more directly analyzed the impacts of various behaviors and policies, and the key findings include: 

• “Access to quality health care was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not.” 

• “The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate.” 

• “State governments' uses of protective mandates were associated with lower infection rates, as were mask use, lower mobility, and higher vaccination rate, while vaccination rates were associated with lower death rates.” 

• “State GDP and [4th grade] student reading test scores were not associated with state COVD-19 policy responses, infection rates, or death rates.” Fourth grade math scores, on the other hand, were associated with “policy mandates and protective behaviours.” 

• “Employment, however, had a statistically significant relationship with restaurant closures and greater infections and deaths.” 

While no one article will fully settle the debates that continue to rage around the proper policy response to the pandemic, this one does bring some additional rigor to those discussions. With all of that in mind, let's take our usual look at what the latest data has to say about where we are at with COVID-19 in Minnesota. 

Three things to know:  

1. Officially reported COVID-19 cases, hospitalizations and deaths decrease again in the most recent week 

2. Wastewater levels decline over prior month, but there are recent increases, including in the Twin Cities.  

3. CDC rates 5 Minnesota counties with medium COVID-19 community levels, all other counties rated low. 

Officially reported COVID-19 cases, hospitalizations and deaths decrease again in the most recent week 

Yesterday’s weekly data update from the Minnesota Department of Health showed that the daily average of newly reported cases had dropped to 319 for the week ending March 23. This is 66 cases per day lower than the week prior, and follows the similar drop reported last week.  

While “officially reported cases” only tell part of the story since they exclude cases identified through at-home tests (not to mention asymptomatic cases that may go completely undetected), it is notable that the declining trend is similar in various regions across the state. 

The daily average of new COVID-19 hospital admissions is also trending downward. The health department’s data show an average of 28 COVID hospitalizations per day, including four admissions to intensive care units, for the week ending March 23. This is down from a daily average of 38 admissions the week prior and 45 the week before that.  

The recent decline in COVID-19 hospitalizations closely mirrors last year’s pattern. Late last April COVID-19 hospitalizations increased. So far there are no signs that we will see that rebound again this year, but only time will tell. 

The Department of Health’s COVID-19 mortality data takes longer to confirm so is only complete through the week ending March 9. During that week an average of six people per day died either from COVID-19 or with COVID-19 as a contributing factor. While this is six people too many, it is down just slightly from the week prior. 

The state’s Department of Health is also reporting that one-quarter of Minnesotans are up to date with their COVID-19 vaccinations, including any necessary boosters. Just under 8,800 Minnesotans received a shot in the week ending March 25, down from over 9,200 in the prior week and an average of over 16,000 per week throughout January and February. 

Wastewater levels continue to decline over prior month, recent increases in Twin Cities and several other parts of the state 

Twin Cities metro update 

The total level of COVID-19 virus in Twin Cities wastewater increased by 9 percent for the week ending March 27 compared to the previous week, according to the latest data from the Metropolitan Council and the University of Minnesota’s Genomic Center. 

Taking the long view, the Metropolitan council reports, “Levels over the past two weeks are lower than they have been at any time since early April 2022, at the start of the BA.2 wave.”  

XBB remains the dominant subvariant, comprising 93 percent of the viral RNA load entering the Metro wastewater plant.   

Statewide update 

Continuing recent trends, COVID-19 levels in wastewater decreased across the state over the prior month, according to the latest data out of the University of Minnesota’s Wastewater SARS-CoV2 Surveillance Study. 

All the study’s regions experienced substantial declines in levels over the prior month for the period ending on March 15. The North East and South West regions each saw a monthly decline over 60 percent. The lowest monthly decline was 42 percent in the study’s South Central region. 

The South West region, which had a monthly decline of 82 percent, also had a substantial decline over the prior week of 55 percent.  

Unlike our update last week, when we reported all regions experienced monthly and weekly declines for the period ending March 8, two regions experienced significant weekly increases for the period ending March 15. The South Central region had a one-week increase of 100 percent, and the North East region had a one-week increase of 65 percent.

CDC indicates low community levels for all but five Minnesota counties

 Most Minnesota counties, 82, are rated low for COVID-19 community impact this week according to the CDC’s latest Community Levels assessment.  

The remaining five counties—Aitkin, Clay, Martin, Rock and Pipestone counties—are rated medium, adding several spots of yellow to what is a very green map.  

This continues the trend we have seen over the prior two weeks: zero Minnesota counties with a high community level and only a handful of counties rated with a medium community level (2 last week and 5 the week prior). 

The CDC recommends that anyone in a county with a medium COVID-19 community level should wear a high-quality mask indoors and consider testing regularly if they are at higher risk of getting sick or are in regular contact with those who are at higher risk.  

This week, only four counties — Aitkin, Clay, Kittson and Wadena — meet the CDC’s case-rate threshold for high community transmission of at least 100 cases per 100,000. Both Aitkin and Clay counties have COVID-19 case rates above 200 cases per 100,000, which is what places them in the medium-community-level category even though they have low COVID hospitalization rates.

COVID-19 is still circulating and it is important to remain vigilant, especially if you are at high risk or are in regular contact with those who are. The CDC also measures community transmission levels, which you can find here. Two things to note: one, the CDC has emphasized community levels for risk assessment now that more of the population has developed immunity through vaccination or prior infection; two, transmission levels are determined by case rates and test positivity rates, but the latter are likely inflated now that testing is often done at home and not regularly reported. 

Reminder: For additional information see the COVID in Minnesota Key data page; new data is added throughout the week.

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