Minnesota hospitals brace for omicron wave even as COVID-19 declines in ICUs

COVID-19 hospitalizations requiring intensive care declined from 374 on Dec. 16 to 255 on Friday in Minnesota, easing pressure on hospitals as they respond to the omicron wave of the pandemic.

Hospital leaders said the decline might be temporary, because the fast-spreading omicron variant has increased coronavirus infections, which could soon produce more COVID-19 admissions.

Minnesota on Monday reported another 10,810 coronavirus infections and 44 COVID-19 deaths. The positivity rate of COVID-19 testing also reached a record 16.6% in the seven days ending Dec. 31, indicating substantial viral spread.

Another surge would be ill-timed, because providers had to phase out two monoclonal antibody therapies that don't work against omicron and have received scarce supplies of new antiviral pills, said Dr. Jeremy Cauwels, chief physician for Sanford Health, which operates hospitals in Minnesota and the Dakotas.

"If you count the Pfizer oral medication and the antibody that's still effective, we have enough doses systemwide for maybe 100 people," he said, "and we were previously infusing hundreds per week."

Minnesota has prioritized limited outpatient antibody infusions for the neediest COVID-19 patients but soon might need to use a lottery if those patients outnumber supplies.

The region also might be in "for a bit of a doozy" of an influenza season, with flu patients taking up beds freed up over the past three weeks, Cauwels said. "We literally replaced 40 COVID patients with 40 influenza patients."

Omicron's rapid spread is infecting workers and disrupting health care operations. Cauwels returned from five days of isolation after testing positive for COVID-19, which he said he likely contracted during holiday travel at a busy airport.

Minneapolis-based Allina Health reported 167 staff were removed from work on Wednesday because of COVID-19, up from 68 on Jan. 1.

Allina and St. Cloud-based CentraCare responded this week by restricting hospital visitors to those assisting with childbirth or seeing patients in medically complex or end-of-life situations. CentraCare also started requiring medical-grade masks for visitors based on evidence that cloth masks aren't as effective against omicron.

"The omicron variant appears to sharply spike and then decline," said Dr. Hsieng Su, Allina's chief medical executive. "According to the models, things will likely get worse later in January before we see them get better. We need everyone working together to get through this peak."

COVID-19 cases or viral exposures in recent days affected half the staff at the IBX Oakdale lab, which processes COVID-19 tests collected at free Minnesota testing sites. IBX's New Jersey lab had worker outages as well that increased the turnaround time of test results and is now sending workers who have completed their COVID-19 isolations to Minnesota to fill shifts, chief executive Robin Grimwood said.

"We expect that there will be some delays in getting results to Minnesotans and ask for patience as we work through this difficult period," he said in an e-mail.

Omicron has reportedly caused lower rates of severe COVID-19 in other states and countries with earlier waves, and Minnesota leaders are hopeful that will happen here.

The decline in ICU patients is one optimistic sign, even though total COVID-19 hospitalizations in Minnesota have increased from 1,314 on Jan. 1 to 1,435 on Friday. Only 18% of Friday's COVID-19 hospitalizations involved patients in intensive care, the lowest rate since last March.

However, Cauwels said hospitals are in transition, still mostly treating patients whose COVID-19 was caused by the delta variant that was dominant until omicron replaced it last month.

"We haven't seen enough yet to say omicron causes less people in the intensive care unit, or something like that," he said. "I know there are rumors of that out on the coasts. There are rumors of that in places that have had more omicron."

High levels of immunity from the recent delta wave and COVID-19 vaccination progress could blunt the severity of omicron's impact on Minnesota.

More than 70% of eligible Minnesotans 5 and older are fully vaccinated against COVID-19, according to the Centers for Disease Control and Prevention. Of those fully vaccinated, nearly half have received booster doses. Minnesota has the nation's highest rate, at 77%, of fully vaccinated seniors who have received boosters.

More than 85% of Minnesota's 10,810 COVID-19 deaths were seniors, but the proportion involving younger adults increased in the last half of 2021. Monday's report included the death of a St. Louis County resident age 30-34.

Age-adjusted rates of COVID-19 hospitalization and death remain more than 10 times higher among unvaccinated Minnesotans, according to the latest state breakthrough infection data released Monday.

The data also suggest that booster doses are paying off in people who experienced waning immunity after their initial shots. Fully vaccinated people made up a rising share of COVID-19 hospitalizations and deaths this fall. However, they made up only 25% of COVID-19 hospitalizations in the week ending Dec. 12, down from 34% five weeks earlier. The proportion of COVID-19 deaths involving fully vaccinated people declined from 40 to 31% in that period as well.