Coronavirus pandemic will overlap with flu season starting this fall, challenging health systems

Essentia clinic CORONAFALL.JPG
Nurse practitioner Tiffany Pickard examines Bella Mahoo’s ear during a well child check at Essentia Health. Both are wearing appropriate personal protective equipment for COVID-19. Clinics are doing a lot of pediatric wellness checks before school begins in the fall. Special to The Forum / Essentia Health

FARGO — Health care providers are preparing for a fall and winter that could bring unprecedented challenges in treating respiratory illnesses when the coronavirus pandemic will coincide with cold and flu season.

Flu season starts in October, but typically intensifies in late December and continues through March, trailing off in April and May. When the pandemic struck earlier this year, in mid-March, flu season was beginning to wane.

Pandemic prediction models looking six to eight weeks into the future show coronavirus cases will continue to increase in the area, but at a rate that can be handled by normal hospital operations, said Dr. Bill Heegaard, president of Essentia Health’s West Market, based in Fargo.

“We will have increased cases, but nothing at this point that shows us going into the contingency phase or crisis phase,” he said. “That said,” he added, “the models become very unstable after six to eight weeks,” making predictions beyond that range difficult.

So far, despite record levels of active cases in North Dakota regularly exceeding 1,000 per day recently, Fargo hospitals have not been strained in treating patients with COVID-19, doctors said.


“We’re not being overwhelmed by COVID cases,” Heegaard said. “While we see increases, we’re not seeing any huge surge.”

The positivity rate in North Dakota and Minnesota has fluctuated around 5% recently, a level suggesting outbreaks should be manageable, he said. “We’re watching that closely.”

Fargo-Moorhead appears to be past its first peak, with other areas in North Dakota now experiencing their first peaks, said Dr. Avish Nagpal, an infectious disease specialist at Sanford Health.

“We typically lag behind the nation by two to four weeks,” he said. “It looks like it is plateauing now at the overall national rate, and it looks like it is plateauing here, too.”

In fact, Covid Act Now, a group that tracks the pandemic, on Thursday, Aug. 6, reduced the threat level for Cass County from “at risk” to “slow disease growth,” with cases growing in a “slow and controlled fashion.”

The county has an estimated infection rate of 0.81 — a rate less than one means the epidemic is declining — and a low rate of daily new cases, 8.5 per 100,000 population, according to the group’s metrics.

The threat level for North Dakota , however, remains in the “at risk” category, which covers almost half the states, including Minnesota. A few western states and many southern states are deemed by Covid Act Now to be a higher risk category, “active or imminent outbreak.”

North Dakota’s estimated infection rate is 1.04, suggesting COVID-19 will continue to spread “but in a slow and controlled fashion.”


Public models of the pandemic’s trajectory predict a continued gradual rise of cases in the fall. COVID-19 Projections predicts North Dakota’s deaths will increase to 210 by Nov. 1, while the University of Washington’s Institute for Health Metrics and Evaluation similarly predicts 215 deaths by Dec. 1 — a number that would decline to 147 with universal mask wearing.

As of Friday, North Dakota reported 110 deaths from COVID-19.

COVID-19 Projections estimates that 5.3% of North Dakota residents have been infected by the coronavirus, a rate it predicts will increase to 12% by Nov. 1, though it could reach as high as 26.6%.

North Dakota’s capacity of hospital beds, intensive care beds and ventilators appears adequate to withstand another wave, the forecasts agree.

“We are not worried about the capacity,” Nagpal said. “I think we have enough.”

With luck, coronavirus infections will decrease at the onset of flu season, a challenging period for the health care system, he said. “It is very likely that our flu and COVID cases coincide.”

Many recent cases involve younger patients who are less likely to require hospitalization or die, Heegaard and Nagpal said.

Although both Sanford and Essentia reported being well stocked with personal protective wear for their staffs and bed capacity has been adequate, both said maintaining coronavirus testing supplies and materials will be difficult.


“When there’s surges, there become real challenges in the supply chain,” Heegaard said.

Sanford faces the same challenges in maintaining testing supplies, and the challenge is apt to only intensify when the need for flu and COVID-19 testing overlaps, Nagpal said.

“What we are worried about is our testing,” he said. “Our testing supplies are kind of stretched. That’s what keeps us awake these days.”

Health care providers and public health officials continue to stress for people to take precautions, including wearing masks indoors when social distancing isn’t possible, maintaining at least six feet from others outside the home and frequent handwashing.

“Really, that’s the only preventive thing we can do at this point,” Heegaard said.

Immunization pic 1.jpg
Four-month-old Troy daSilva receives childhood vaccinations from a nurse as his mother, 4-month old Troy daSilva, comforts him at Sanford Health. Doctors stress the importance of getting children immunized so they are not susceptible to infectious diseases during the coronavirus pandemic. Special to The Forum / Sanford Health

What To Read Next
Get Local