Clay County Public Health epidemiologist Becky Schmidt says vaccinations have helped minimize the spread of COVID-19. (Photo/Nancy Hanson)

Nancy Edmonds Hanson

The COVID-19 emergency has ended. The Centers for Disease Control made it official in May: After three years of emergency measures to combat the deadly virus, infection levels have slowed to the point that the tools now in place are believed to be adequate to handle it.

That’s good news – but only part of the story. The end of the nationwide emergency does not mean the virus has been completely vanquished. Nor does it mean that we’re out of the viral woods.

“Our numbers here in Clay County appear to be way down, compared to where we were even a year ago,” says Becky Schmidt. “But that doesn’t mean COVID is over. It’s not like polio, which we’ve been able to eradicate. The virus is going to be with us for a long time to come, just like influenza.”

Becky is Clay County Public Health’s epidemiologist, its expert in the branch of medicine that deals with the incidence, distribution, and possible control of diseases. After playing the central role in the county’s response to the viral crisis, the agency’s staff has had a chance to refocus on the ongoing health issues in its broader mission: the Clay County Public Health Clinic, family health, the detox center, environmental quality and the rest. “We’ve always worked behind the scenes,” she observes, “but now people are aware of the fantastic work our staff does to keep people healthy. That’s one positive thing that came out of the pandemic.”

Just 70 COVID cases have been reported in the county since July, a tiny fraction of the number at the pandemic’s peak two years ago. “That number is unreliable, though,” she cautions. “We know cases are way, way under-reported because of home testing. About 22,000 Clay County residents have had reported infections since the agency began collecting statistics in March 2020. Locally, 130 people died over the course of the pandemic, among the statewide total of 15,503.

Becky cautions that reports of the current infection rate are highly unreliable. “We know that the number reported to us is very, very low,” she says, citing the easy availability of home testing and the prevalence of milder infections that don’t require hospitalization. Nevertheless, the numbers do support the easing of the emergency. “It’s been awhile since we recorded our most recent death,” she says. (It was in March.) “And only two or three people have been hospitalized in the last four months or so.”

She credits the easing to several factors. One is the welcome increase in what health-care pros call “herd immunity,” the resistance to the spread of a disease based on vaccinations and previous infection. About 24% of Clay County residents are fully vaccinated, according to the Minnesota Department of Health, 1% fewer than the statewide average; the proportion rises to about 70% for those over 65.

The epidemiologist suggests that COVID will likely follow the pattern set by influenza, with new viral variants continuing to emerge over time – some milder, as Omicron has proven to be, but others potentially more dangerous. “We anticipated that COVID would fall into the same kind of seasonal pattern as influenza, which peaks in winter,” she says. “That hasn’t happened, at least not yet, and we don’t know why. Infections have come in waves, but they don’t necessarily follow that pattern.”

Meanwhile, a newer threat, RSV (respiratory syncitial virus) has risen in prominence, while the most predominant virus of the past century, influenza, has slipped into the back of people’s minds. A new vaccine is now available to protect older people and those with immune deficiencies. This year’s influenza vaccine, too, has been formulated for the viral strains likeliest to cause infections during the prime flu season from October through April.

While older adults are most at risk for the triple-threat viral diseases, the politicized controversy over COVID and the vaccines developed to combat it have caused ripples in the health of the very young. One of Clay County Public Health’s target populations is children, for whom a variety of shots are recommended, beginning in infancy.

Five vaccines are required for children attending public school: Hepatitis B, DtaP (diphtheria, tetanus and pertussis), polio, varicella (chickenpox) and MMR (measles, mumps and rubella). The rate of vaccination, though, has fallen since 2020, when the pandemic began. In 2019, only 20% of Clay County children lacked vaccinations. Today more than one-third – 34% – have not received the required vaccines.

“That’s concerning,” Becky says. “We expected it to bounce back after the height of the pandemic, but that hasn’t happened yet.” Statewide,  just 64% have received the childhood series in the most recent reported year.

Politics has apparently played a part in that shortfall, with opposition to the COVID vaccine perhaps spreading into reluctance to accept other preventive measures. Minnesota law requires children to be vaccinated … unless parents request an exemption based on their beliefs.

“Vaccine hesitancy has caused substantial damage, with more to come,” Becky concedes. “WHO (the World Health Organization) lists vaccine hesitancy as one of the top 10 global health threats.” The irony is clear: “Less developed countries don’t have access to these life-saving vaccines and want them, while we’re seeing them rejected by a portion of the fortunate people in the developed world.”

She blames science illiteracy and misinformation spread via social media for much of the concerning trend. “We need to reach a level of 90 to 95% to achieve herd immunity.

“There’s no doubt that we will have another pandemic – not if, but when,” the disease expert emphasizes. “From a public health standpoint, we are as well prepared as we can be.” She cites lessons learned and recorded in hundreds of pages of after-action reports.

“Will we still be talking about mistrust of medical experts and the research that can protect us? Time will be of the essence. If we can’t get the response out as quickly as possible … that keeps me up at night.”