North Dakota hospitals bracing for rise in delta variant COVID-19 cases. Are they prepared?

BISMARCK — North Dakota's health care system came dangerously close to meeting its breaking point during the state's fall peak in COVID-19 infections, but hospital administrators are hopeful the understaffed medical community can handle the looming threat of another surge driven by the highly-infectious delta variant of the virus.

The variant, first identified in India late last year, has spread widely across the country in just a few weeks. Many hospitals in the southern U.S. have struggled to contend with the avalanche of severe infections, which have come mostly in unvaccinated residents.

Essentia Health Chief Medical Officer Dr. Richard Vetter said it's likely a wave of infection will hit North Dakota, where nearly 60% of people are not fully vaccinated. In the last month, cases have increased more than fivefold and hospitalizations have doubled , though both figures remain much lower than the November apex of more than 10,000 cases and 300 hospitalizations.

CHI St. Alexius Bismarck Director of Hospital Medicine and Critical Care Dr. J'Patrick Fahn said the delta variant, believed to be 50% more contagious than the previous dominant strain, will fuel an uptick in cases over the next two to four weeks if current trends hold, but he noted that a surge likely wouldn't be as devastating as last year's peak.

A majority of older and vulnerable North Dakotans have been vaccinated against the virus, drastically lowering their risk of serious illness and death, Fahn said. Three-quarters of residents over 65 are fully immunized, according to the North Dakota Department of Health .

That means unvaccinated residents in their 40s and 50s will likely make up a significant portion of those hospitalized during a delta surge, he said. Fahn also noted he's hopeful COVID-19 patients will be less sick this time around since they may not fall in a vulnerable category and effective treatments are more widely available.

Vetter said the fate of the state will hinge on the late summer when students return to school and large groups begin gathering indoors.

“I think the next two months are going to be critical," Vetter said. "If we see (cases) starting to level off and come back down, (that’s) great. If it just continues to increase over the next four to six weeks, then I think there could be more of an issue in the early fall.”

Fahn said he thinks the state's hospitals are "fairly well-prepared" for a surge in COVID-19 cases, though he notes the health care systems " may get stretched." He said his Bismarck hospital never really let its guard down against the virus, so it's not too much trouble to reinstitute processes from last year.

Vetter said medical personnel have more institutional knowledge of how to treat patients with the virus than they did a year ago. He added "it's a blessing" that North Dakota hospitals have gotten bits of information on how to deal with the delta variant from other countries and states that have already been smacked by the strain.

One problem is that hospitals are running above normal capacity because many patients who delayed medical care during the height of the pandemic are seeking treatment, Vetter said.

A shortage of nurses remains the biggest challenge in handling a spike in cases, and traveling nurses are likely even scarcer than they were last year because many are helping in other states or left the profession due to burnout, Vetter said. Fahn agreed that staffing would be the most significant concern in his hospital, noting that equipment shortages haven't really been an issue.

If the wave of cases severely strains hospital capacity, Vetter and Fahn said they could suspend elective surgeries, though Fahn noted "nobody wants to do that" since putting off procedures like hip replacements or kidney stone removals can be bad for patients' wellbeing.

The doctors recommend that North Dakotans continue or resume mask-wearing, social distancing and hand-washing measures to limit the spread of the virus, but more than anything, they urge residents to get vaccinated .

"If we can learn a lesson from other states, it’s get out there and get vaccinated," Fahn said.

Sanford Health Chief Physician Dr. Jeremy Cauwels said in a statement that "t he vaccine is the answer" that will continue to save lives.

"The more people who get vaccinated will result in less COVID hospitalizations," Cauwels said. "The science at this point is undeniable. Nearly all new COVID-19 cases, hospitalizations and deaths are among unvaccinated people."