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A peak in the latest wave of COVID-19 could come next month, as some models have predicted, but hospital leaders in Minnesota are bracing for a winter in which the persistent pandemic combines with other respiratory viruses to breed a miserable flu season.
Minnesota was spared a high-profile COVID-19 and flu “twindemia” last winter due to wearing masks and shutdown orders that limited person-to-person contact, but an unprecedented summer wave of Respiratory syncytial virus, or RSV, shows what can happen without these protections, said Dr Gregory Poland, a vaccinologist at the Mayo Clinic in Rochester.
“I’m not going to talk about a twindemia. I’m going to talk about a tridemia or a quaddemia,” he said. “We’ve already seen evidence of that. We already have cases of the flu in Minnesota. We’ve already seen evidence of an RSV outbreak. The pandemic, at least right now, is not going anywhere. find susceptible who are not vaccinated or whose immunity wanes over time.
Forecasts for influenza vary. The mild flu season in the southern hemisphere this summer suggests a mild season in the United States this winter. However, the absence of the flu last winter could make people more vulnerable. Health officials have said they need to at least prepare for a severe season and urged people to get vaccinated against the flu and COVID-19 – including the new booster doses recommended for certain vulnerable groups.
“It is worrying to think of even a ‘normal’ influenza season superimposed on what we are currently seeing with COVID-19, let alone a severe season,” said Kris Ehresmann, state director of infectious diseases, in a statement. “Our healthcare system is currently under stress from COVID-19. “
Pandemic models from the Mayo Clinic and the Centers for Disease Control and Prevention predict modest increases or decreases in COVID-19 levels in early October in Minnesota, which could follow states such as Missouri, which have experienced larger outbreaks more early this summer that have since peaked.
Minnesota reported a 6.9% COVID-19 test positivity rate on Monday that is above the state’s 5% caution threshold for viral spread but below a 7.1% high last week . COVID-19-related hospitalizations also fell from 794 Tuesday to 755 Friday.
The surge in hospitalizations is followed by more deaths from COVID-19. The state reported 22 deaths from COVID-19 on Monday, bringing the pandemic’s toll to 8,098. Monday’s report included a Hennepin County resident aged 30 to 34 – the state’s 44th death in the pandemic involving a person under the age of 35.
The pandemic has disrupted seasonal disease patterns, including the flu season last winter. Poland said the total number of influenza cases in the United States last season was equal to the number of days seen in other seasons.
In Minnesota, 35 flu-related hospitalizations were reported in the past season, up from a range of 1,538 to 6,446 in the previous five seasons.
Doctors said this summer’s RSV outbreak was unprecedented, combining with COVID-19 to obstruct Minneapolis and St. Paul’s children’s emergency departments. The kids reported 210 RSV infections last week – at the end of summer when they usually wouldn’t expect any.
RSV is a common cause of the common cold that can be more severe in preschoolers and poses a risk, in association with the flu and COVID-19, if widespread, said Dr. Marc Gorelick, director General of Children’s Minnesota.
“If everyone gets it, and even just a small% gets really sick, it still makes a lot of kids,” he said.
Predicting any of these viruses is difficult and involves many more factors than those included in current predictive models, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
A popular theory is that RSV spread after people stopped taking the precautions. The rate of Minnesotans wearing masks in public most or all of the time fell from over 60% in May, when a state mandate was in effect, to less than 20% in July. The rate has since risen to 46%, according to data from the COVIDcast survey.
However, Osterholm noted that RSV has increased unusually in some countries that did not have mask requirements or other mitigation measures in place.
Models are also unable to account for this summer’s unpredictable COVID-19 pattern, which it says has spread like ‘viral lava’ in some states but has yet to increase in New York or Los Angeles.
Osterholm said he predicted COVID-19 will remain a problem in the United States this winter, even though there is a drop from peak infection rates. Minnesota’s first-dose COVID-19 vaccination rate is 74.6% among eligible people aged 12 and older, and 63.4% overall, leaving opportunities for the virus to spread.
“We still have a lot of human wood to burn here,” Osterholm said.
Concerns remain about the rapidly spreading delta variant of the coronavirus infecting fully vaccinated people. Minnesota on Monday reported 4,717 cases of major infections that were identified over the past week. This represents 30% of the 15,896 coronavirus infections identified over the past week – although the breakthrough cases and the total number of cases are not reported in the same way, so the comparison is rough.
In total, Minnesota has identified 28,047 breakthrough infections – or 0.9% of the state’s more than 3.1 million fully vaccinated people.
Last week, federal officials advised third booster doses of the Pfizer COVID-19 vaccine over concerns about diminished immunity after the first two doses. Recommendations for Moderna and Johnson & Johnson vaccines are pending.
Following federal guidelines, the state told suppliers on Friday that they should give Pfizer recalls to people 65 and older and people 50 to 64 with underlying health conditions. Providers may consider giving reminders to people 18 to 49 years of age with underlying health conditions and to people 18 to 64 years of age with increased exposure to the virus in the workplace.
Poland said people should take advantage of the fact that flu and COVID-19 vaccines can be given at the same time, preferably in separate arms to attribute side effects.
“You can go there and get both vaccines at the same time,” he said. “I hope people will.”
Jeremy Olson • 612-673-7744
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