REGIONAL- As Minnesota was experiencing a post-Thanksgiving rise in coronavirus cases, state Health Commissioner Jan Malcom and state Epidemiologist Ruth Lynfield appeared together last week for the first time in months to warn of the current “triple threat” of COVID, influenza, and respiratory syncytial virus and once again encourage people to get vaccinated.
“COVID is very much circulating in our community,” Lynfield said. “We have mostly avoided the fall and early winter surges that we’ve experienced in the past two years; however, we are seeing elevated rates and hospitalizations coming after Thanksgiving holiday.”
Lynfield also noted that this year’s flu season has come earlier and is more severe than in the past couple of years.
“After two very mild influenza seasons in 2020 and 2021 we are seeing a heavy early season surge in influenza,” she said. “There have been more than 2,100 hospitalizations for influenza reported to MDH, about twice the number of hospitalizations seen for the last two winters. We’ve also seen almost 900 outbreaks of influenza-like illness in schools so far this year. Additionally, we’ve had close to 40 outbreaks of influenza-like illness in nursing homes, and the frail elderly have a very high risk of severe illness due to influenza.”
Lynfield reported that 41 Minnesotans have died from influenza this season, and that the overall situation is more challenging because of shortages of influenza antiviral medications that are particularly useful for those with underlying medical conditions, the elderly, very young children, and pregnant women.
St. Louis County has been seeing the same kinds of trends, according to county Public Health Program Coordinator Diane Seiloff Yourczek.
“We definitely are still seeing COVID here in the county,” she told the Timberjay. “As far as other respiratory illnesses, you know, it’s flu season, we’re in full swing. And actually, we’re seeing more activity than we normally would see at this time of flu season.”
RSV infections are of particular concern for youngsters, Lynfield said.
“This fall we have experienced an early and severe RSV season, leading to much higher hospitalizations and emergency room visits,” she said. “Since September we’ve had nearly 1,500 hospitalizations for RSV, including more than 900 in children under the age of one. This has led to challenges in health care, particularly in pediatric care.”
Yourczek explained how RSV presents a threat not only to young infants but to elders as well.
“In young infants and older adults, RSV can lead to inflammation of the small airways of the lung and pneumonia. That’s what we get really concerned about,” she said.
Healthcare hit
Malcolm addressed the combined effects of the three diseases on the health care system.
“Those three things together have driven up the need for urgent care and hospital services in particular, although it is also impacting other parts of the healthcare system like primary care, home care, group homes and the like. What this means is long waits for care and very long hours for our healthcare workers.”
Winter surges of COVID the past two years have flooded hospital inpatient and ICU units creating bed shortages, but with the new bivalent boosters and the less severe strains of the Omicron variant circulating, health officials were confident COVID would be less of an issue for capacity this year.
That’s been the case so far, but influenza and RSV have picked up the slack. Here in the Arrowhead region, non-ICU and ICU beds in use last week nearly matched the numbers around the peak of last January’s huge Omicron COVID wave, although COVID accounts for only a small fraction of current hospitalizations.
Vaccinations
The current bivalent COVID vaccine, tailored to be more effective against the BA.4 and BA.5 Omicron variants that gripped the nation in late summer, has been touted by health officials as a way to increase individual immunity and decrease risks of infection, hospitalization, and deaths. But beyond an initial jump in vaccinations immediately after the Pfizer and Moderna boosters were approved in August, uptake of the boosters has failed to take off.
“As of last week, less than 20 percent of Minnesotans were up to date with their COVID-19 vaccines,” Lynfield said.
Two weeks ago, the Centers for Disease Control authorized the use of the bivalent vaccines for children six months through four years old, but demand for those, too, is expected to be minimal. In the six months since vaccinations were authorized for this youngest group, only 17.2 percent of Minnesota children in that age range have received a first dose of the vaccine. There has been no significant change since summer in the percentage of parents who have said they would not get their children immunized for COVID, or for those who said that they wanted to “wait and see” before making a decision.
Health officials have cited a number of reasons for the apparent lack of enthusiasm for the bivalent vaccine, chief among them the general sense of COVID fatigue and the desire to put the pandemic in the past.
Another factor has been the question about the potential effectiveness of the bivalent vaccine as the specific virus variants it was designed to combat. BA.5 is causing only ten percent of the current caseload, as opposed to 83 percent of all cases just three months ago. BA.4 is not believed to be contributing to COVID cases anymore.
However, data on breakthrough cases continues to show that those who have been fully vaccinated for COVID have lower rates of severe illness, hospitalization, and deaths than those who are unvaccinated or only partially vaccinated.
Lynfield said flu shots are also lagging behind normal trends.
“Our vaccination rates are about ten percentage points lower than they typically are for influenza in various age groups,” she said. “I would not at all be surprised if we have a deep surge at some point over the winter, so please get your vaccine.”
Malcolm and Lynfield both emphasized that getting the COVID bivalent booster and the flu shot are still the best preventative action people can take, and that both can be administered at the same time, rather than having to schedule separate appointments for them.