Intensive care bed utilization in Minnesota reaches pandemic level highest

No new cases of COVID-19 involving the omicron variant of the coronavirus were reported in Minnesota on Monday, but the dominant delta variant was creating numerous problems for the state.

COVID-19 hospitalizations in Minnesota jumped to 1,570 on Friday, including 346 people in intensive care. The state reported a 98% occupancy rate for adult intensive care beds including COVID and non-COVID patients, the highest in the pandemic.

Minnesotans can reduce the burden by getting COVID-19 vaccines and boosts and limiting the risk of viral exposure in gatherings and crowds, said Dr Andrew Olson, hospitalist and COVID-19 response chief for M Health Fairview. Of the 307 COVID-19 patients in hospitals in the system, 72% are unvaccinated.

“I think life can go on,” he said, “but life can’t go on pretending nothing is happening.”

Minnesota officials are watching closely for signs of a COVID-19 outbreak following a viral spread during Thanksgiving. State-reported positivity rate for COVID-19 diagnostic tests increased for the first time in two weeks to 10.4%, keeping it above the high risk threshold of 10% for substantial viral spread . However, the rate dates back to the seven-day period ending November 26, so the impact of the holidays remains uncertain.

The state is also monitoring additional infections involving omicron, which has been identified as a variant of concern after being identified in South Africa due to its rapid spread and its potential ability to evade immunity from infection or previous vaccination.

“We don’t yet know what impact this will have on the pandemic,” Dr Andrew Badley, infectious disease specialist leading the Mayo Clinic’s COVID-19 research working group, said Monday. “There are reports that disease penetration is lower with the omicron variant, which means people are getting less. If that’s true, that’s a very good thing.”

On the other hand, omicron could produce so many infections that it would result in more hospitalizations even if the rate of serious illness is lower, he said. Monoclonal antibody therapies might not work as well against omicron infections, although Badley said they would likely offer some benefits.

Minnesota last week reported one of the country’s first cases of omicron in a Hennepin County man who traveled to New York City for a convention in late November. State surveillance revealed seven more potential cases of omicron, but genomic sequencing found four did not involve the variant. The results of three more are pending.

The delta variant is the dominant strain in Minnesota, which has recorded the highest rate of new infections in the United States over the past seven days, according to data from the Centers for Disease Control and Prevention on Monday.

The Minnesota Department of Health reported 38 more deaths from COVID-19 and 6,122 coronavirus infections on Monday, bringing the pandemic total to 9,654 deaths and 933,025 infections.

Staffing shortages in nursing homes have put pressure on hospitals, giving them nowhere to send patients ready to go but too fragile to return home. The backup can be seen even in emergency departments where COVID-19 and other patients requiring extended care board for hours or days while waiting for open inpatient beds.

“We don’t have a choice right now,” said Olson, “but it’s a lot less safe than being in an inpatient unit.”

The state responded on Monday with the opening of a fourth alternative care site at Benedictine Living Community-Regina in Hastings. The 17-bed site will join those in Brainerd, St. Paul and Shakopee to provide transitional care to patients after their hospitalization.

Governor Tim Walz also announced that 50 specially trained members of the Minnesota National Guard will arrive as early as Tuesday to support staff at nursing homes in New Hope, Onamia and Fergus Falls. A new training program to place 1,000 certified nursing assistants in long-term care facilities by January 31 has also been launched.

“We continue to deploy all the resources we have to support our overworked and understaffed doctors, nurses and long-term care staff who have been fighting on the front lines of this pandemic for almost two years,” said Walz.

Staff pressures also reduced bed capacity at Minnesota hospitals, although they reported that wastage due to immunization mandates was low. HealthPartners said they are 99% on their mandate for workers to get vaccinated or file exemptions. Of the 133 workers put on unpaid leave for 30 days when they missed the October 29 deadline, 70 fulfilled the mandate at the end of November and 63 did not return to work.

Hospitals in Greater Minnesota were admitting the majority of COVID-19 patients earlier this fall, but the share in Twin Cities hospitals fell from 47% on Nov. 1 to 56%.

Mercy Hospital was the busiest in terms of COVID-19 volumes, serving the heavily populated metropolitan area but also rural counties with low vaccination rates. The hospital recorded an average of 122 COVID-19 hospitalizations per day during the seven-day period beginning November 19 between its Coon Rapids and Fridley campuses. Two-thirds of his 31 intensive care patients also had COVID-19.

Hospitals are delaying surgeries, but also have to perform surgeries they delayed a month or two ago in hopes the pandemic wave has now abated. Dr Ryan Else, vice president of medical affairs at Mercy, said there has been an increase in the number of patients being discharged home with rehabilitation instructions and outpatient support, including COVID-19 patients who are sent home with supplemental oxygen.

Breakthrough infections in fully vaccinated Minnesotans continue to represent a growing part of the pandemic wave. Health officials believe immunity begins to wane six months after vaccination, putting early recipients at risk and in need of booster doses.

People vaccinated accounted for 42% of infections in the five weeks between October 3 and November 6, compared to just 31% from May to September.

The majority of hospitalizations and deaths from COVID-19 are unvaccinated Minnesotans, even though they only make up a third of the state’s population. The 133 deaths from COVID-19 reported in the week starting October 31 included 85 unvaccinated people.

“We are starting to see a slight increase in the number of vaccinated patients admitted,” Else said. “What we are seeing with this, however, is that patients who have been vaccinated have much better results.”