ST. PAUL — Minnesota is in its fourth surge of the coronavirus pandemic, and health experts say this wave of cases and infections is different and doesn’t appear to be letting up anytime soon.

Unlike previous waves, this one is driven by the more contagious delta variant that has sickened tens of thousands, sent thousands to hospitals and killed hundreds. Health officials don’t see a quick or easy way out.

“We have a lot of COVID right now. It’s raining COVID and we need to do everything we can to decrease transmission,” Dr. Ruth Lynfield, state epidemiologist with the Minnesota Department of Health, said last week on a call with reporters.

Unlike the past surges, much of the state has been vaccinated against the virus and more younger Minnesotans are getting sick. And where in the past surges saw a quick spike in infections followed by an eventual retreat, this time the growth has been an unyielding crawl upward.

About twice as many kids are getting sick during the latest surge than last fall when Minnesota saw its biggest spike in COVID-19 cases. More than half of teens are now at least partially vaccinated, but children under 12 are not yet eligible for any of the three shots.

Newsletter signup for email alerts

Additionally, the number of severe cases in unvaccinated residents is trending younger roughly nine out of 10 seniors have been inoculated.

However, more than 2.2 million Minnesotans have yet to get the shot and residents in the 18- to 49-year-old age group are the most likely to not be vaccinated.

Vaccines are not perfect and breakthrough infections are on the rise. Yet, more than 99 percent of the 3 million fully vaccinated Minnesotans have not reported a breakthrough infection.

Nevertheless, there have been 18,790 breakthrough cases, 1,095 hospitalizations and 108 deaths of fully vaccinated people. Health officials say nearly all vaccinated people with severe infections are elderly and most younger people with breakthrough infections have mild or no symptoms.

Timing could be key

The fact the summer surge is now stretching toward the fall has health officials concerned.

Schools are back in session and more activities are moving indoors as fall weather approaches. Since the pandemic began, more than 415,000 of the state’s nearly 682,000 cases, 19,400 of the roughly 37,000 hospitalizations and 4,820 of the nearly 8,000 deaths have occurred in fall and winter months.

“When people gather, transmission happens. A layered approach to prevention is highly, highly recommended for anytime we are in large gatherings,” said Jan Malcolm, state health commissioner. She noted that more than 150 infections have already been tied to the Minnesota State Fair.

Health officials say multiple layers of coronavirus mitigation includes getting vaccinated, wearing masks and social distancing in crowded places, being tested when exposed and staying home when ill.

How is this surge different?

So far, this summer’s surge has been more of a slow upward crawl rather than the past spikes Minnesota saw earlier in the pandemic. That appears to be almost entirely due the effectiveness of the three vaccines available in the U.S.

A few key differences:

  • The peak in new cases in past surges happened around 30 days in, then the numbers began to fall. The current surge continues to grow, slowly, as it nears 60 days.
  • It’s the same with hospitalizations. The rate of new hospitalizations peaked after a few weeks in past surges. Hospital beds continue to fill up in this surge.
  • Test-positivity rates are nowhere near as high as they were before vaccines were widely available.
  • Daily deaths are down this time around. The seven-day rolling average of this surge has never topped 10, so far. Each of the past surges did, with the fall of 2020 topping 70.

But that doesn’t mean Minnesota is out of the woods. Vaccine hesitancy, younger people who are not yet eligible for the shot and the more contagious delta strain have threatened to push the fourth surge past previous thresholds. And there are no more statewide mandates on masks, business capacities and gathering sizes to help stem the virus’ spread.

Watching schools closely

Public schools are one of health officials’ biggest concerns, especially considering that vaccines have not been approved for those younger than age 12; and that 47 percent of those ages 12-15 and 41 percent of those ages 16-17 remain unvaccinated.

School has only been in session two weeks and health officials are getting hundreds of reports each day of cases tied to public schools.

Unlike last fall, there is no statewide emergency in place, so districts are left to decide the best ways to manage the pandemic. Approaches vary from mandatory masks, social distancing and quarantining of those who have been exposed to more hands-off approaches.

The number of school buildings with confirmed outbreaks of five cases or more grew from six to 26 in just a week.

Vaughan-Steffensrud Elementary School in Chisholm in northern Minnesota hasn’t yet made the state list of confirmed outbreaks, but on Thursday leaders announced students would learn remotely for two weeks because of substantial transmission.

The school is located in St. Louis County, where the Centers for Disease Control and Prevention says community transmission of the coronavirus is high. Nearly all of Minnesota’s 87 counties have similar levels of virus spread.

“That’s exactly the reason for some of the concern at this stage of the game. We start the school year at much higher community-transmission rates than we were at last school year and more cases among kids,” Malcolm said.

Concerns about hospital capacity

There’s also continued concern about hospital capacity, especially in rural areas were options may be more limited.

There were more than 700 patients hospitalized last week, including more than 200 in critical condition. That’s the most critical patients recorded all of this year and overall hospitalizations are rivaling the spring 2021 surge.

The number of hospitalized patients peaked at more than 1,800 last December during the state’s worst surge.

Hospital capacity is strained with available beds dwindling in much of the Twin Cities and southeastern part of the state, health department data show. Hospital leaders say that’s not just due to COVID-19; the pandemic caused many to put off care and the number of patients with ailments like heart attacks and strokes is near double what is normally seen.

But the true concern is over the availability of the highly-trained staff needed to treat seriously ill patients. Doctors and nurses are leaving the profession, health officials say.

“There are fewer health care workers on the job today than there were last year,” Malcolm said, “due to the extreme stress and burnout they have experienced for 18 months now. ”

Malcolm added: “It is getting harder for some hospitals to find open, staffed beds at the right level of care for critically ill patients. This is an issue statewide impacting small, rural facilities and large metro systems.”

What could help

Health officials maintain that robust coronavirus mitigation measures are one of the easiest ways to slow the spread of COVID-19, including the more contagious delta strain.

But there are also some coming decisions by federal regulators and the CDC and Food and Drug Administration that could help increase protection.

As soon as this week, federal regulators are expected to decide whether vaccine booster shots are needed for much of the population. There are concerns over whether the protection vaccines provide wanes over time and could make people who’ve been inoculated more susceptible to virus variants.

The White House has encouraged boosters for everyone eight months after their last dose of vaccine. The World Health Organization has criticized the idea while so many in developing countries haven’t had access to any vaccine.

“We will learn more very shortly about the data and (federal regulators) deliberations,” Dr. Lynfield said.

There’s also continued talk about whether Pfizer, and possibly Moderna, will apply for emergency authorization to administer their vaccines to children ages 5 to 11. That decision is anticipated sometime this fall, possibly by the end of October.