REGIONAL- It’s a week of mixed signals for COVID activity in Minnesota, not an unusual circumstance considering the limited measures of surveillance available now compared to earlier in the pandemic.
Suggesting that St. Louis County health service area may have reached a peak in the latest winter surge sweeping across the nation, the hospital admission rate dropped last week by 31 percent, bucking the national upward trend of 3.2 percent, according to the Centers for Disease Control. St. Louis County and surrounding counties that are part of the CDC’s designated service area remain at a medium level of COVID activity.
Conversely, measures of COVID viral load in wastewater in northeast Minnesota that had dropped for two consecutive weeks rose again in the most recent readings by 14.1 percent, trending opposite the statewide average.
The CDC’s county levels map paints a more encouraging picture for Minnesota overall, with only 17 counties now rated as having medium levels of COVID activity and five rated as high.
Yet nationally, the CDC data suggests that we could be in the midst of the second largest surge of COVID since the start of the pandemic. Wastewater data collected by the CDC is higher nationally than it’s been in two years. However, the current surge is nowhere near the magnitude of the pandemic’s massive Omicron spike in January 2022, when weekly hospital admissions soared to over 150,000. Weekly hospital admissions currently are running around 34,000, more than double that at the end of October.
Dr. Michael Osterholm, nationally recognized epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said in his Jan. 11 podcast that it has become increasingly difficult to assess the extent of COVID activity in the country.
“There’s been talk and headlines about the U.S. being in the midst of the second largest COVID wave since the beginning of the pandemic,” Osterholm said. “And while there is no arguing that we’re in the midst of a surge, it’s tough to really know exactly how big it is given the limited tools we have for tracking and deciphering activity. Remember, we have virtually dismantled all of the surveillance systems we had in place throughout most of the pandemic. I wish I could say we have lots of data. We don’t.”
And while levels of hospitalizations, serious illness and deaths haven’t approached levels seen at past high points in the pandemic, Osterholm is convinced COVID itself remains extremely active.
“Today I can tell you, though, that it’s my personal experience and that of many of my colleagues and friends, that there is much COVID in our communities right now, as (much as) we’ve probably seen it any time in the pandemic. That includes even the days of Omicron,” Osterholm said. “We are not going to go back to the days of 2020 to 2022-early 2023, where at that time in the pandemic large surges in cases often meant also large increases in the numbers hospitalized and the number who died. That is not where we’re at today, but we still have a challenge because we are still seeing a burden of illness that I think is absolutely unacceptable.”
Osterholm noted that the wastewater data could be skewed by the dominance of the JN.1 COVID variant, which accounts for around 60 percent of cases nationwide. JN.1 has been associated with diarrheal type illness, and Osterholm said it could be possible that those infected are putting more excreted waste into the wastewater system. Comparing current levels to past levels could lead to artificially inflating the extrapolated levels of community COVID activity.
“At this point, it’s not straightforward – we don’t know how to interpret it,” Osterholm said. “But clearly this virus isn’t done with us and the message is being lost on people.”
Osterholm lamented the low uptake of the latest COVID vaccine, which has been shown to be effective in reducing the risk of hospitalization, serious illness and death.
“Right now, less than one in five adults in this country have received a dose of the updated vaccine,” he said. “Why is it in nursing homes less than two in five have received this particular new dose? And why is it among those in long-term care facilities who work there that we’re seeing, in many instances, single-digit numbers of people vaccinated? I believe that the sharp rise of JN.1 and the accumulation of cases has been exacerbated by the fact that Americans are now severely under vaccinated when it comes to the updated vaccine.”
Osterholm noted that immunity has also waned for those who were infected at least six months ago or more, which makes the overall population more susceptible to JN.1.
Osterholm also talked about what he termed one of the “most unfortunate situations” of the pandemic, the severe underutilization of the antiviral Paxlovid for treating COVID. A recent study showed that Paxlovid reduced hospitalization risk by 26 percent and the risk of mortality 28 days after infection by 78 percent. However, of the million people in the study, only 9.7 percent had been treated with Paxlovid by their doctors.
“One of the areas that I have been very frustrated by is the number of physicians who don’t yet understand how effective this drug can be and who have often misled patients,” Osterholm said. “And I don’t believe intentionally, but they have misled patients into believing, oh, don’t get it, you’ll just get a rebound illness from it. We have data showing that’s not true. I think that’s been a real problem. We have to do more to educate our medical community.”
“Another key issue,” Osterholm continued, “is the timeline for prescribing and taking Paxlovid. People often don’t seek it out until their symptoms get worse during their infection. But once they do, it’s too late into the infection to be effective. You really need it in those first five days. So we have a lot of work to do in terms of educating people that if they do develop COVID, they should seek Paxlovid immediately.”