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The bad news: COVID-19 hospitalizations are up in Minnesota. The good: Fewer people are dying.

In previous waves of COVID-19 infections in Minnesota, increased hospitalizations were soon followed by increased daily death tolls. Not this time, so far.

Minnesota is averaging more than 1,500 new COVID-19 cases per day, and nearly 600 people are in the hospital.
Minnesota is averaging more than 1,500 new COVID-19 cases per day this week, and more than 600 people are in the hospital.
REUTERS/Nick Oxford

Early this summer, things were looking up on the COVID-19 front: for stretches of June, Minnesota was reporting fewer than 100 new COVID-19 cases per day and hospitalizations dipped below 100 for the first time in months.

Today, the news is less good. Minnesota is averaging more than 1,500 new cases per day this week, and more than 600 people are in the hospital.

But something is different about this new, fourth wave of COVID-19 in Minnesota that sets it apart from previous waves: fewer people are dying.

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Cases up, hospitalizations up, deaths flat

Previous waves of this virus followed a predictable pattern: First, cases rose. Soon, hospitalizations rose as some of those cases became severe enough to require medical care. A couple weeks later, death tolls rose as some of the hospitalized succumbed to the virus.

Even as cases subsided, it took a few weeks for the lagging hospitalizations, and then deaths, to slow down.

In this wave, cases have risen. Hospitalizations, too. But compared to a week of similar caseloads in mid-October last year, when Minnesota averaged 15 deaths per day, the state is now reporting an average of 7, a number that has barely budged for weeks and, despite more hospitalizations, is up only slightly from earlier in the summer, when there were very few new cases reported each day.

The charts below show hospitalizations and deaths due to COVID-19 since mid-September of 2020, the beginning of the large fall wave of COVID-19 cases. In that wave and the smaller wave from late winter/early spring 2021, a significant increase in hospitalizations was followed by an increase in daily death counts. But in the current wave, beginning in roughly mid-July, an increase in hospitalizations roughly on par with that of the spring wave does not show a corresponding increase in daily deaths. Instead, the death totals are relatively flat.

Minnesota COVID-19 hospitalizations, September 15, 2020–August 25, 2021
Source: Minnesota Department of Health
Minnesota COVID-19 deaths, September 15, 2020–August 25, 2021
Source: Minnesota Department of Health

Why are deaths lower? Doctors say vaccinations are to thank.

Vaccines at work

As of this week, 56 percent of Minnesotans have been fully vaccinated against COVID-19.

“Having a large number of people vaccinated means that a lot of people aren’t getting sick, and of those who do, their [rates of] being hospitalized or having severe conditions is far lower,” said Dr. Jack O’Horo, an infectious disease hospitalist at the Mayo Clinic. “That correlates fairly well as you look nationwide. The areas with higher rates of vaccination are seeing lower rates of hospitalization.”

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In particular, high vaccination rates among those most at risk are cutting death rates, said Dr. Andrew Olson, M Health Fairview’s director of COVID hospital medicine. Earlier this year, deaths began to drop shortly after vaccines were rolled out, starting with the most vulnerable.

Throughout the course of the pandemic, more than 50 percent of deaths have occurred in people living in long-term care facilities, and 87 percent have been among Minnesotans age 65 and up, who are at higher risk of severe COVID-19 complications.

Now, 91 percent of Minnesotans age 65 and older are fully vaccinated against COVID-19, and while some are experiencing breakthrough infections and in rare cases, hospitalization, those cases are generally much less severe than they would have been had they not been vaccinated, Olson said.

“When people come to us, to the hospital and say, ‘I’m vaccinated, why am I in the hospital?’ Why did I get so sick?’, my answer is ‘Well, because you didn’t die,” Olson said.

More treatment options

Another factor preventing deaths relative to the pandemic’s early days is better treatments.

When COVID-19 first emerged, there were no best practices for treating the virus.

Now, treatments like steroids, anti-inflammatories, remdesivir — an antiviral that reduces the virus’ ability to replicate — and monoclonal antibodies are commonly used to help give patients a better chance at beating the virus.

Remote monitoring and home care have also helped divert patients who are sick but don’t need to be in the hospital from hospital beds, O’Horo said. Keeping hospitals from being over capacity is also critical in managing good care.

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“Generally speaking, system strain is a significant factor that predicts outcomes. So when we look at a hospital that’s overwhelmed, its ability to provide high quality care to everyone who’s admitted is not necessarily at its highest during times when they are operating at their peak capacity,” O’Horo said.

Not out of the woods

Still, COVID-19 cases in Minnesota are rising and a large number of Minnesotans remain unvaccinated. The State Fair and the resumption of in-person school are putting more people in contact with one another even as the more infectious — and potentially more severe — delta variant spreads.

While deaths have remained relatively low thus far in this wave, there are still many unvaccinated Minnesotans, and deaths could increase if infections continue to rise — and particularly if the medical system is overwhelmed, O’Horo said.

“This is really just a pyramid where we know there’s the base number of infected, and the smaller number of hospitalized and smaller number of deaths. As long as the base of that continues to expand, each of the other categories will as well,” he said. “ I expect we will see deaths climb, but how high and how much that’s going to be blunted is going to be difficult to predict.”

While much has been learned about how to care for COVID-19 patients in the hospital, the best defense against the virus remains vaccination, which at this point, have been much more widely tested in the population than the treatments used for COVID-19.

“There are many, many, many, many, many times more people in the vaccine trials than in any treatment trial,” Olson said. “If you say, well, there weren’t enough people in the [vaccine] study, but then you go to the hospital and take the treatment they’ve given you in the hospital, you are now going on much smaller studies.”