Some downtrends mean good news. But does this mean that the epidemic is over?

“The epidemic is over.” President Biden made the statement in an interview that aired last Sunday on 60 Minutes. He continued, “We still have a problem with COVID, we are still doing a lot of work to solve it. But the pandemic is over.”

The White House later clarified that Biden was talking about the “pandemic phase” of the disease and emphasized the importance of getting one of the new bivalent booster shots to reduce personal risk.

Regardless of the exact meaning of the word pandemic, what is the latest COVID-19 data showing us about the current state of COVID-19 in Minnesota?

We also look at a couple of mortality metrics that show a shift in the impact of the virus in recent months, although we’ll leave it to you to decide whether that means the pandemic is over.

Deaths appear to be declining again, but recent declines in cases, and level of hospitalizations

After several weeks of declining cases, the number of official cases rose slightly in most areas of the state. Southeastern and southwestern Minnesota were an exception. This may serve as validation for the spike in COVID levels found in metro wastewater last week. But as detailed later, those are back in decline, so it will be interesting to see if the reported cases follow suit next week.

COVID-19 cases have stabilized or increased somewhat across the state according to the latest Minnesota Department of Health data.

David H. Montgomery | MPR . News

While hospital admissions have not increased overall, their decline has stabilized over the past week.

New ICU and non-ICU hospitalization in MN 2022 on September 23

Daily hospital admissions due to COVID-19.

David H. Montgomery | MPR . News

Deaths reached their relative peak in the past six months in late August. Death data from recent weeks is still incomplete, but deaths so far do not appear to be as high as they were in late August.

Trend in COVID-19 deaths in Minnesota 9-23-2022

Daily deaths from COVID-19 according to the Minnesota Department of Health.

David H. Montgomery | MPR . News

Wastewater: good news from across the state

Last week, the Metropolitan Council and the University of Minnesota Genomics Center reported a slight increase in COVID-19 levels measured at Metro’s wastewater treatment plant, and said, “We’re starting to see BA 2.75 at levels of about 1 to 2 percent in the Metro effect.” .” It looked ominous.

Now, for the week ending September 19, they report a 29 percent drop in COVID levels. They also point out: “We intermittently see BA.2.75 at levels of about one percent in the Metro effect.” An increase in any of these numbers for the second week in a row could be alarming.

As it stands, levels now look like they are continuing the slow downtrend dating back to July. That’s reassuring though that it’s still higher than last September when the state was entering the COVID-19 delta wave.

COVID loading in wastewater in the Twin Cities 9-23-22

The latest weekly readings show a decrease in the levels of COVID-19 detected in the wastewater of the Twin Cities.

David H. Montgomery | MPR . News

The latest data from the University of Minnesota’s SARS-CoV2 Wastewater Monitoring Study shows good news again this week. The project, which tracks data from seven regions through September 11, shows monthly and weekly declines in all regions, with only one exception: a tiny one-percent increase in northeastern Minnesota.

Few areas of risk on the CDC map again this week

Lincoln County in southwestern Minnesota, with a population of 5,567, is the only orange county on the Centers for Disease Control and Prevention’s COVID-19 risk assessment map released yesterday. Only 13 counties are yellow, down from 24 last week. Orange indicates risks of contracting the COVID virus, residents must wear masks in public enclosed spaces as directed by the CDC, and yellow indicates moderate risk.

The remaining 73 areas, which include the state’s major population centers, are more spring-like, indicating a lower risk.

However, fifty-five of the state’s counties have weekly COVID-19 case rates in excess of 100 per 100,000, which is the CDC’s threshold for high transmission. Five counties had rates of or more than 200 cases per 100,000 for the week ending September 21: Carleton, Kuching, Lincoln, Polk, and Traverse.

A closer look at COVID-19 death rates in light of claims that the pandemic is over

One way to assess claims that the pandemic is over is to take a closer look at mortality trends: If COVID-19 is still causing or contributing to so many deaths, it may be difficult to claim an end to the epidemic.

As noted in our latest Color of Coronavirus Project update, COVID-19 deaths are trending up nationwide from May through July. COVID-19 was still causing more than 400 deaths per day in July nationwide.

This alone, however, may not settle the debate. What if COVID is no longer the main cause of all these deaths, but a contributing factor, among others? And how does this relate to total deaths?

If the overall death rate was lower, it may be possible that the assumed contributions of COVID to all of these deaths were not really making a difference in the overall death rate. Some researchers assume, for example, that doctors simply code deaths as COVID-related if a patient tests positive for the virus, even if they can’t be sure how much the virus contributed to the person’s death.

While we don’t claim to settle this debate, this week we’re looking at a few data sets that provide some evidence that the impact of COVID is waning.

In recent months, COVID has not been cited as the leading cause of death

Infectious disease expert Dr. Shira Doron told NPR last week that more than 70 percent of the novel coronavirus hospitalizations in her hospital recently are people who come in for something else and find out they have the virus.

How much COVID contributes to death is ultimately a call to judge the person who witnesses the death. If COVID is believed to be the leading cause of death, it will be listed as the primary cause. If the endorser (often a physician) believes it is one of several causes of death, it will be listed as a contributing factor or one of several causes.

This difference was captured in publicly available mortality data, and this week we used it to analyze the percentage of all COVID-related deaths where COVID is the leading cause versus the contributing factor.

The proportion of COVID deaths in the United States that lists COVID as a primary factor

Centers for Disease Control and Prevention (CDC) data shows that the changing proportion of COVID-related deaths is primarily caused by COVID-19.

Elizabeth Gawthrop | APM Research Lab

The proportion of COVID-related deaths primarily attributable to COVID has dropped dramatically this spring. For most of the epidemic, COVID was listed as the primary or primary cause of death in 85 to 95 percent of deaths where COVID was listed as a cause of any kind. But while Dr. Doron may be right about the COVID status of patients at her hospital, even in recent months, COVID is still listed as the leading cause of death for about 65 percent of COVID-related deaths.

Excess deaths are lower, but still noticeable

If one is skeptical about coding deaths as related to COVID, the most obvious metric is simply the total number of deaths from all causes. If COVID deaths, even deaths in which COVID is one of the many contributing factors, results in a higher-than-normal overall number of deaths, that obviously remains a problem.

Mortality has a seasonal pattern – more people tend to die in winter – but it is fairly consistent from year to year. So the total number of deaths in a given week or month can be compared to the number of deaths usually expected in that time period. Any number above expectations is called “excess mortality”. The CDC explains more about this here, as we’ve also downloaded the data for this section.

We cannot assume that all the excess deaths are direct COVID deaths, but it is likely that at least many of them are indirectly related to the epidemic. Other causes can include failure to obtain adequate health care for other conditions due to epidemic problems or fear, or stress from the mental health toll of the epidemic.

Excess deaths in the United States since 2018

Excess deaths show the impact of the pandemic regardless of how deaths are coded for COVID-19.

Elizabeth Gawthrop | APM Research Lab

For the nation as a whole, we are seeing a sustained period of moderate excess deaths, compared to periods of more ups and downs in the past. In March 2021 and March 2022, deaths fell below the ‘expected deaths’ threshold for two months, then rose somewhat but remained closer to expected deaths than during the height of the waves. In 2021, deaths began to rise again in August. So far, we haven’t seen the same bounce.

Minnesota excess mortality rate since 2018

Minnesota has had a lower death rate recently compared to the national average.

Elizabeth Gawthrop | APM Research Lab

Looking at the same scale for Minnesota shows two things. First, there were fewer weeks with deaths above the threshold expected in an epidemic overall than in national data. Second, deaths have remained below the expected threshold for most of this year after the Omicron wave in early 2022. Since mid-February, deaths have exceeded the upper limit of projected deaths in just five weeks. Again, we can hope for less, but it remains to be seen if the seasonal cycle of increased COVID hospital admissions and deaths in the fall repeats itself this year.

Neither the recent continuous rate of more than 400 deaths per day, nor the low death rates coded with COVID as the main cause, nor the low prevalence of excess deaths completely solve the question of whether the pandemic is over. But we hope the data will provide you with a more informed picture of where we are as a nation and as a country. As we move into uncertain fall and winter, epidemiologist Michael Osterholm’s saying “we may be over the epidemic, but that doesn’t mean the epidemic is over with us” seems appropriate.

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