The age of those hospitalized because of COVID-19 in the Brainerd lakes area is trending younger amid the current wave of increased cases in the state.
Dr. Peter Henry, chief medical officer at Essentia Health, said Wednesday, April 21, the recent spate of hospitalizations wrought by the disease caused the coronavirus brought the average age down by about a decade.
“The great majority of people that are hospitalized with COVID are older individuals, but instead of seeing people 65-plus, we’re seeing people 50 to 65 being hospitalized, which is different than what we saw in the fall as well,” Henry said during a video interview. “The great, great majority of people that are being hospitalized are those that are not immunized or have had only one immunization, and then very close to the time that they got immunized they contracted the illness.”
Cuyuna Regional Medical Center in Crosby is experiencing similar trends, said Dr. Rob Westin, chief medical officer, during a phone interview Friday. Westin said it makes sense the average age is declining, given the fact people older than 65 are vaccinated at a much higher rate than other age groups in the state.
Vaccine tipping point?
In Crow Wing County, 80.5% of residents ages 65 and older are at least partially vaccinated. That number drops to 51.2% for 50- to 64-year-olds. Both these statistics are below the percentages in the state as a whole, with 85.9% of those in the oldest age group reportedly with at least one dose and 58.7% of those ages 50-64. With a 50% vaccination rate among those 16 and older, Crow Wing is performing better than every other area county with the exception of Aitkin, which reports a 52% rate. Neighboring Morrison County sat at 41% as of Friday, while Todd County has fallen well behind at 36%.
Despite the state falling well short of the 80% immunization target, vaccine supply appears to be reaching the point locally where it’s exceeding demand. Both Essentia Health and Crow Wing County Public Health reported unfilled appointments this week with doses now widely available. Essentia announced this week it would begin offering vaccine on a walk-in basis on specific dates at its Brainerd clinic. In Crosby, about half of appointments at a vaccine clinic hosted by CRMC three weeks ago were filled by residents from the Twin Cities metro area. Spokeswoman Peggy Stebbins said the health care system expects it will no longer host large-scale clinics and shift toward individual patient appointments.
Although optimistic that new cases and the region’s positivity rate are trending downward, Henry said he can’t help but be pessimistic about the trajectory of vaccine uptake in the community just a few months into the vaccination campaign.
“We still have a number of people who are susceptible to the disease that can contract disease and also continue to spread the disease as well. And as we have seen a slightly increased number of variants in the state that always is very concerning as well,” Henry said, adding the variants are shown to be as high as 50% more transmissible. “ … That plays obviously a role. The key thing about variants is that (viruses) can mutate, that’s what they do. And they need hosts to do that. They need to have infections to be transmitted, because that’s when they mutate. So the more people we can get vaccinated to prevent from getting the disease, the less likely that we’re going to have the introduction of newer variants.”
Henry added severe symptoms and hospitalizations are not the only impacts over which to be concerned, with as many as 1 in 5 COVID-19 patients experiencing long-term impacts on their health. Known as “long COVID,” lingering effects range from reduced cardiovascular function to cognitive impairment to a variety of other symptoms practitioners are still trying to understand.
“I think what we want to try to impress upon people is not to worry so much about the adverse long-term effects of the vaccine, because we know that this technology is well proven. We have now been having the vaccine in use for almost six months in this country with no significant major issues,” Henry said. “ … But we know that thousands of people have had serious ailments and now are having the adverse effects that are persisting from the COVID-19 infection. … This isn’t the flu. The residual effects from this particular infection are significant.”
Westin said while senior citizens are more likely to be vaccinated, there’s still 15-20% who are not and remain vulnerable to some of the disease’s more serious impacts, including death. That risk increases when people in other age groups are not vaccinated, he said.
“You’re still dealing with a highly vulnerable population that if there’s more virus out there, you’re going to see elderly get sick with it, too. So they’re definitely still getting sick in that age group and they’re the sicker ones at base, so when they get sick, they’re ending up in the hospital,” Westin said. “ … Vaccine is one of the biggest tools that we have in this battle against the virus, to turn it around. We’ve seen it have success early, and now that it’s starting to reach different demographics, it's (the virus) found another foothold. And if we have that younger population immunized, it’s going to help us slow it down again.”
A look at Crow Wing’s hospitalized
Minnesota Department of Health statistics provided by Crow Wing County illustrate what Henry and Westin are observing in their facilities.
Between March 26, 2020 — the date the first hospitalized county resident, an 86-year-old woman, took a COVID-19 test — and the end of February 2021, the average age of those hospitalized generally hovered between 68-69 years old. Since the beginning of March 2021, however, more recent hospitalizations brought the entire trendline below that point to 66.5 years. As of Friday, 5.1% of all those who’ve tested positive or were presumed positive in the county were admitted to the hospital.
Broken down by month, the average age of the 38 Crow Wing County residents who tested in December 2020 and ended up in the hospital was 70.6 years old. This March, there were 27 hospitalizations with an average age of 56.8 years old. April thus far has 25 hospitalizations, 22 of which combine for an average age of 60.8, with a week to go. Demographic data on the three most recent hospitalizations was not available Friday.
Average ages don’t quite illustrate the full picture. While those age 50 and older account for the majority of hospitalizations among Crow Wing County residents, there’s still a notable number of people younger than 50 who’ve required hospital care. Of the 316 hospitalizations for which data is available, 50 were people 49 years old or younger. Eleven people in their 20s have been hospitalized, along with five in their teens and one 8-year-old girl, who went to the hospital earlier this month.
When it comes to intensive care stays, 15 Crow Wing County residents were ill enough to be treated in the ICU so far in 2021, out of 88 throughout the entirety of the pandemic. Of those 15, four reportedly had no underlying conditions at all, including a 15-year-old boy, a 37-year-old woman, a 45-year-old man and a 52-year-old woman. Five of those were affirmed to have underlying conditions, while for the remaining 2021 ICU patients, that information was incomplete.
Although fewer Crow Wing County males have tested positive than females — 2,977 versus 3,298 — males are overrepresented among the hospitalized population. A total of 170 males were hospitalized compared to 145 females. The gender of one hospitalized individual was left blank. Among ICU patients, 54 were male and 34 were female.
Keeping the momentum going
More than a year since COVID-19 arrived, Henry said despite somewhat concerning recent trends, overall there’s much improvement to note. Among those who’ve tested positive, those needing hospitalization has dropped by 20%, he said — a reflection of high vaccination rates in the older, more vulnerable populations as well as vast improvements in the medical community’s understanding and treatment of the disease.
The availability of monoclonal antibody therapy combined with other therapies takes a significant bite out of more severe symptoms and prevents hospitalization, Henry said.
“Probably 80% fewer people get hospitalized that get the therapy than do not get the therapy, and that’s really the message, that we have plenty of that medication. It’s very important to get tested if you have symptoms and not just assume it’s a cold or a normal viral infection that you see these times of year. With the therapy, the earlier it’s given, the more effective it is,” Henry said.
Meanwhile, the hospital staffing issues experienced during Minnesota’s late autumn surge — blamed on illness and exposure keeping staff members home in isolation or quarantine — are greatly alleviated with the majority of health care workers now vaccinated, Henry and Westin agreed. If the state were to continue to see a rise in COVID-19 hospitalizations, the chief medical officers said that pressure this time around would be alleviated tremendously. Henry said fewer COVID-19 patients also means Essentia staff can focus on those who’ve delayed care for chronic and other serious conditions.
“I just see our staff, our immunized people, our community, seeing the benefit of the protection and being able to be a little less fearful,” Westin said. “ … Even when you were wearing masks and trying to social distance, there was always that underlying trepidation or fear that you still could be spreading something. I think when you have immunization on top of it, you feel a little less anxious.”
Where it goes from here, though, is dependent on how much the virus continues to spread and mutate — potentially putting both therapies and vaccinations at risk of becoming less effective. Henry noted early evidence shows some of the variants currently circulating are shown to have this negative impact on monoclonal antibody treatments. Last week, the U.S. Food and Drug Administration revoked its emergency authorization for Eli Lilly’s antibody therapy when administered alone. Its effectiveness remains, however, in combination with other therapies.
“I just want us to continue to encourage people to get vaccinated. It’s safe, it’s effective. It’s the No. 1 thing they can do to protect themselves, and just as importantly, their family, friends and the people that are most susceptible,” Henry said. “ … I just wish we could try to get through the barrier of the resistance for not getting vaccinated. It’s very personal for everybody. Everybody has their own reasons but … it is our way to the future of getting rid of masks, getting rid of social distancing, but we have a long ways to go.”