Minnesota ERs stressed by waves of COVID, flu, RSV, norovirus patients

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 hospitals than they’ve faced since the pandemic. Thursday’s update of COVID activity only showed modest increases in infections and severe illnesses, but Minnesota’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 high risk for influenza.

“There’s no space in the hospital,” said Dr. Brandon Trigger, medical director for the emergency department at M Health Fairview’s Southdale Hospital in Edina. “We’re seeing patients in hallways, in triage bays, in every kind of nook and cranny of our hospital that we can find, and with any nursing or support staff we have.”

Wait times listed online at Minnesota emergency rooms varied dramatically 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.

Leaders of metro hospitals met Thursday to discuss strategies to address the crowding and ensure ER capacity for strokes, heart attacks and car-crash injuries, said Dr. Rahul Koranne, chief executive of the Minnesota Hospital Association. “We always want to preserve trauma capacity.”

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

Allina Health is checking with its hospitals multiple times per day to see if less-busy sites 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,” he said.

Trigger said Southdale may repurpose surgical, postpartum and mental health beds as needed to admit patients and free up ER space. Trauma cases are unlikely to be delayed at Minnesota ERs, he added, but other patients with urgent needs may wait longer.

“Folks with appendicitis, instead of waiting an hour, they’ve got to wait six or eight hours until they can get their scan and we can get them to the operating room,” he said.

Hospital leaders urged the public to help by making prudent medical decisions. Some doctors hesitated to discuss the situation publicly, 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, said Dr. Laurel Ries, a family practice doctor in St. Paul and president of the Minnesota Medical Association.

“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.”

Fewer than 30% of Minnesotans are up to date with flu vaccinations, according to the latest data, a rate below average for a state that routinely posted some of the nation’s highest immunization rates before the pandemic. The lower vaccination rate, combined with a reportedly weaker-performing vaccine this season, has left 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, according to the Centers for Disease Control and Prevention.

Ries said the vaccine still offers protection and that people still have time to obtain it at 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 in 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 viruses. Only 1% of visits to Twin Cities ERs last month involved patients with flu-like or COVID-like symptoms, but that rate shot above 7% in the last week.

The hospital association issued a reminder list Thursday of ways to prevent illness, including staying home when sick, washing hands, covering coughs, avoiding close contact with sick people and wearing masks when appropriate.