Minnesota ERs stressed by 'quad-demic' of COVID, flu, RSV, norovirus

Patients are piling up in Minnesota emergency rooms once again, but it’s not just from COVID-19.

State health officials say influenza is making a comeback, combining with COVID, norovirus and respiratory syncytial virus (RSV) to put more pressure on Minnesota hospitals than they’ve faced since the end of the pandemic. Thursday’s weekly update of COVID activity only showed modest increases in infections and severe illnesses in Minnesota, but the state’s tally of influenza-related hospitalizations surged to levels not seen in at least five years.

More than 40% of Minnesota’s 1,763 flu-related hospitalizations this fall and winter occurred just in the week ending Jan. 4, according to Thursday’s report, which elevated Minnesota from the low-risk range to the high-risk range for influenza in one week.

“We’re still on the leading edge of what is going on. We really saw things start to escalate right around Christmastime,” said Dr. Laurel Ries, a family practice doctor in St. Paul and president of the Minnesota Medical Association. “Some of the hospitals are over capacity pretty significantly with lots of people waiting for beds in the ER.”

Wait times listed online at Minnesota emergency rooms varied dramatically when checked at 10 a.m. Thursday morning. Essentia Health reported a 75-minute wait at St. Mary’s Medical Center in Duluth while North Memorial Health estimated that patients would wait at least 2 hours and 45 minutes for care at its emergency room in Robbinsdale, but only 20 minutes in Maple Grove.

Allina Health is checking with its hospitals multiple times per day to see if it has capacity at less-busy sites that can relieve pressure on others, said Dr. Dan O’Laughlin, vice president of acute care services at Allina’s hospitals: “Any one hospital is going to ebb and flow and it’s going to vary quite a bit, but the big picture is important right now. We’re seeing a significant spike.”

The combined impact of COVID and seasonal respiratory diseases is somewhat new, because the coronavirus that caused COVID was so dominant during the pandemic that it suppressed influenza activity in the winters of 2020 and 2021, said Stephanie Meyer, a senior epidemiologist in the emerging disease section of the Minnesota Department of Health. Prior to the pandemic, influenza season almost always accelerated after the holidays, when families gathered and relatives exposed one another to germs that they then took back with them to their homes and workplaces.

“We don’t know for sure what the norm is going to be because we just haven’t had enough time with all of these viruses sort of normalizing and finding their niche together to see combined what this is going to look like,” she said.

Hospital leaders urged the public to help by making prudent medical decisions. Ries said some leaders hesitated to publicly discuss the overcrowding situation, which can discourage sick people from seeking care, and encourage worried well people to go to the ER for something as simple as a flu test.

“Go to the ER if you are super-sick,” she said. “If you are not super-sick, go to urgent care, go to your clinic, schedule a virtual appointment.”

About 48% of Minnesota adults have been vaccinated against influenza so far this season, which is better than the national rate of 43% but worse than the state’s performance in years before the pandemic, according to the Centers for Disease Control and Prevention. The lower uptake, combined with a reportedly weaker-performing vaccine this season, has made people more susceptible. Earlier usage of the vaccine in the Southern Hemisphere only reduced hospitalizations by 35% among people at elevated risk for flu-related complications, a CDC report showed.

Ries said the vaccine still offers protection, and that people still have time to seek it at their local clinics and pharmacies.

Seventeen of this season’s 20 flu outbreaks in Minnesota’s long-term care facilities have occurred in the past two weeks, which adds to the statewide pressure. Elderly people are at greater risk for severe complications from infectious diseases, so outbreaks in nursing homes can result in more hospitalizations. The outbreaks also can make it harder for nursing homes to admit new patients, causing further bottlenecks for hospitals as they try to discharge recovering patients and make room for new ones.

“Yesterday we cared for 294 patients, with at least 30 patients waiting for inpatient beds – many needing to wait longer than 24 hours in the ED for a bed,” said Dr. Rochelle Zarzar, senior medical director of emergency services at HCMC. The downtown Minneapolis hospital issued a mask-wearing order, starting Thursday, for all workers who have direct contact with patients.

COVID levels in wastewater have risen to amounts not seen since last winter, according to testing data published by the University of Minnesota, but COVID-related hospitalizations have not. The same amount of viral activity last year produced twice the rate of COVID hospitalizations than Minnesota has encountered so far this winter, the U dashboard shows.

Broader respiratory illness data shows the combined impact of multiple infectious diseases. Only 1% of visits to Twin Cities ERs last month involved patients with flu-like or COVID-like symptoms, but that rate has shot above 7% in the last week.

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