FARGO — Health providers girding for the next wave of the coronavirus that will be fueled by the highly infectious delta variant expect that it will surge quickly, then peak and subside.

The big question is how rapidly the next wave will arrive.

COVID-19 infections in North Dakota started increasing after reaching a low of 118 active cases on July 5 and since have jumped almost six-fold, to 706 as of Aug. 8.

Dr. Avish Nagpal, Sanford Health’s chief infectious disease specialist, said he thinks the expected infection surge could arrive later in August, with peak hospitalizations following in September and deaths in October.

“I think we’ll see a rapid ascent in cases,” he said. “We may see our peak in August.”

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Sanford is planning for the surge — a key reason behind its recent decision to require all employees to get vaccinated by Nov. 1.

“We want to make sure we are ready for another surge before it hits,” Nagpal said.

The good news is that surges driven by the delta coronavirus variant come on strong, then fall rapidly.

“That is a silver lining,” Nagpal said. “It is reassuring that it comes down very rapidly.”

A projection by the University of Washington’s Institute for Health Metrics and Evaluation predicts that the increase in cases already evident will jump in October, with hospital beds for COVID-19 patients peaking at 311 beds, including 72 intensive-care unit beds.

Daily deaths from COVID-19 likely will continue to rise gradually through the rest of summer and increase sharply in the fall, the IMHE model predicts. Daily deaths could peak between 2.75 to 4.33 at the end of October or start of November.

Dr. Rich Vetter, chief medical officer at Essentia Health in Fargo, said the COVID-19 forecasting models he follows suggest a fall spike, with cases potentially peaking in late September to mid-October.

A fall surge is consistent with earlier waves of the coronavirus pandemic and in the way respiratory viruses behave, Vetter said. Transmission becomes easier as people gather more indoors as the weather cools.

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Also, some are girding for a possible spike in infections following the Sturgis Motorcycle Rally in the Black Hills, expected to draw 760,000 bikers from around the country. Dr. Anthony Fauci, the nation’s top infectious disease doctor, said he is “very concerned” the mass gathering could cause another surge in cases in the Dakotas.

“I mean, to me it’s understandable that people want to do the kinds of things they want to do,” Fauci said Sunday, Aug. 8, on NBC’s “Meet the Press.” “They want their freedom to do that. But there comes a time when you’re dealing with a public health crisis that could involve you, your family and everyone else, that something supersedes that need to do exactly what you want to do.”

The highly transmissible delta variant, discovered in India, quickly became the predominant strain in the United States. The delta variant accounted for 1.3% of cases, rising exponentially to 9.5% in June and exceeding 90% by August.

Most older and more vulnerable populations have been vaccinated, which should help to alleviate pressure on hospitals. “I think that’s going to help us,” Vetter said, adding that hospitals are more comfortable treating less severe cases at home.

But the delta variant is resulting in more severe illness, increasing COVID-19 patients’ length of stay, Nagpal said.

Fortunately, Nagpal and Vetter said, doctors now are much more experienced in treating COVID-19, and have medicines that can help with new treatments in the pipeline.

“We’d still highly encourage people who have had natural COVID to still get vaccinated,” Vetter said, adding that the vaccines have proven more effective than earlier infection in preventing infection or serious illness from the delta variant.

Previous infection from the coronavirus, Nagpal agreed, won’t be a significant factor in slowing the spread of the delta variant. “We cannot rely on natural immunity,” he said. “I don’t think that’s going to help us very much.”

States including Missouri and Arkansas had significant delta variant spikes despite high rates of infection earlier in the pandemic, so North Dakota’s high infection rate can’t be counted on as a mitigating factor.

Vaccination continues to provide the best protection, especially against serious cases resulting in hospitalization or death, Nagpal said.