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When COVID-19 finally found its way to Worketu Gigesa — after two years of her family protecting her — the infection hit her hard.

The 97-year-old was admitted to Abbott Northwestern Hospital in Minneapolis this week, despite the circulating strains of coronavirus appearing to cause less severe illness than earlier versions in the pandemic.

"She didn't want to eat, she didn't want to drink, and she got weak," said her daughter, Demitu Abdissa. "I didn't know what was going on and I got worried and called 911."

Gigesa's experience reflects a statistical reality, even as the current COVID-19 wave shows signs of receding or leveling off in Minnesota ahead of a predicted milder summer. Whatever COVID-19 risk remains this spring, it has largely shifted back to seniors.

More than 90% of the COVID-19 deaths identified so far in May in Minnesota have been in people 65 and older — above the 66% among that population in December, when delta and earlier omicron variants took an elevated toll on younger, unvaccinated adults. The last time more than 90% of the state's pandemic deaths involved seniors was December 2020, before vaccine was widely available.

COVID-19 deaths have declined across all age groups in Minnesota since the start of 2022 — just more rapidly among younger adults. Provisional federal data showed a decline in COVID-19 deaths among nonelderly adults in Minnesota from 385 in December to seven so far in May. The comparable decline in senior deaths was 755 to 89.

The declines reflect strong levels of immunity, vaccinations and antiviral drugs to combat the pandemic, but people still need to protect others around them who are vulnerable, said Dr. Ruth Lynfield, state epidemiologist and medical director of the Minnesota Department of Health.

"You need to know your exposure history. Have you been infected recently? Have you been vaccinated and boosted?" she said. "Certainly throwing on a mask should be like carrying an umbrella. It shouldn't be a big deal and, if you're going to interact with someone who is very fragile, absolutely you want to do whatever you can to protect that person."

COVID-19 hospitalizations in Minnesota have increased from a recent low of 183 on April 10 to 446 on Thursday, but many have been incidental — meaning the patients were admitted for other reasons and tested positive upon routine screening. The number of patients requiring intensive care has increased over the past week, but still represents only 10% of the total COVID-19 hospitalizations. That rate reached 30% at other severe points in the pandemic.

Patients admitted for COVID-19 this spring are more likely to be seniors than they were during this winter's severe pandemic waves, said Dr. Mark Sannes, an infectious disease specialist for HealthPartners, which includes Regions Hospital in St. Paul and Methodist Hospital in St. Louis Park. However, these patients tend to also have other health conditions and symptoms.

"Is that COVID, or is that something else?" he said. "That is kind of the nuanced presentation that I think we are seeing in that older population right now."

Seniors still vulnerable

Gigesa lives with her daughter and son-in-law at their home in Minneapolis. Abdissa, a food service worker at the Minneapolis-St. Paul Airport, said she took the threat of COVID-19 seriously when the pandemic emerged.

"I just used a mask and cleaned all the time to protect her," she said.

Abdissa said she hasn't ever tested positive herself and isn't sure how her mother got infected — twice this year. The first infection in January was worse, but the second one in May was frightening because it came so quickly — and after COVID-19 vaccinations and two booster shots.

The vaccine likely helped, though, the daughter said: "That's why she is alive, I think."

The spread of the coronavirus appears much wider than is reflected in Minnesota's confirmed case counts, which include only publicly reported test results and not popular at-home rapid tests. The virus, as a result, has found its way back to vulnerable seniors and into nursing homes and other congregate-care facilities.

Infections among residents of the facilities reached 455 in the last week of April, according to Minnesota's latest weekly pandemic report. That is the highest total since early February, but still far below the peak in January.

Low staff vaccination rates aren't helping, but many infections are among vaccinated workers as well, said Jean Peters, president of Elder Voice Family Advocates. Lax infection control at understaffed facilities is likely fueling the spread of COVID-19 among residents.

"It is my belief that the temp checks, masking, hand washing, protective eyewear [practices] are not being followed," she said. "How can they be when staffing is stretched, and the staff that is there may not be trained or is overwhelmed as they try their best to provide the basic of cares?"

Nearly 46% of Minnesota's 12,649 COVID-19 deaths have involved long-term care residents. That rate dropped to a low of 20% of COVID-19 deaths in Minnesota this December, but has since increased back to 44% in May.

Hope for declines

Where the pandemic goes from here is unclear. Viral levels have been declining in much of Minnesota based on testing data and sampling of wastewater. However, viral levels are rising in northeastern Minnesota, and sewage sampling in the Twin Cities has found rising rates of the BA.4 and BA.5 coronavirus variants that caused a surge of COVID-19 in South Africa. The surge mostly involved milder illnesses, though.

"We hope now that school is out that numbers will come down even further," Sannes said, "similar to what we have seen the last two Junes."

Breakthrough infections in vaccinated people are more common this spring, but vaccines are still difference-makers in terms of the severity of illness, said Dr. Peter Henry, chief medical officer for the Brainerd Lakes region of Essentia Health. Among the 45 COVID-19 patients admitted to Essentia hospitals on Friday, 36 were unvaccinated or older adults overdue for boosters.

Broader use of the antiviral Paxlovid could help address risks to vulnerable seniors now that supplies have improved. Lynfield said the state has been reaching out to long-term care facilities to make sure they are comfortable determining which residents with COVID-19 qualify for treatment and offering it quickly enough.

Henry said Essentia calls every patient with a positive test and offers treatment if eligible. The doctor took Paxlovid after testing positive for COVID-19 this spring despite receiving two booster doses of vaccine. Worsening symptoms subsided after he took the pills.

"Then for three to four days it was like a cold," he said. "Not even a bad one."