FARGO — The rise in new coronavirus cases that have been creeping up in Fargo-Moorhead appears to be largely driven by infections among those who are younger than 18.

In recent days, active COVID-19 cases in Cass County have hovered between almost 440 and almost 480 — far below the November peak that surpassed 1,700 active cases, but well above the 100-plus trough reached in early February, according to figures from the North Dakota Department of Health.

The uptick coincides with increased cases nationally and in North Dakota as well as Minnesota in recent weeks and comes as restrictions are being eased, including the expiration of local mask mandates in Fargo and West Fargo.

Many of the new cases are coming from residents ages 10 to 22, said Brenton Nesemeier, a field epidemiologist for the North Dakota Department of Health who is based in Fargo.

“We’re seeing it in a population group, especially 10- to 18-year-olds, that didn’t really experience it before,” he said Monday, March 29.

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West Fargo Public Schools announced last week, for example, that they are seeing more cases, and Dilworth-Glyndon-Felton Public Schools announced last week that it is shifting to full distance learning through April 5 after seeing an increase in exposures, quarantines and cases.

These younger age groups have not been among those vaccinated, although as of Monday, North Dakota opened vaccination eligibility to all those 16 and older, a step Minnesota will take Tuesday.

Those seeking vaccinations from Clay County Public Health, however, should keep in mind that vaccines still are going to those in the priority groups, including those who are 65 or older, have high-risk medical conditions, or work in food processing or manufacturing, said Cheryl Sapp, the county’s COVID-19 vaccination manager and immunization coordinator.

Parents with children who are 16 or older should get them in to get vaccinated, Nesemeier said. “It’s their turn,” he said. “It’s not too late to get that group vaccinated.”

The timing of the increased cases appears to stem from a resumption of events, including athletic tournaments and travel during spring breaks, he said.

Also, Nesemeier and others said, people are growing tired of having to adhere to precautions, such as wearing masks and avoiding large gatherings, as the pandemic grinds on beyond a year.

“I think there’s definitely some COVID fatigue going on,” he said. “People are becoming more mobile. Many schools came off spring breaks.”

Rapid testing in Cass County has been running between 300 and 400 tests per day recently, and has picked up, Nesemeier said.

Despite the increase in cases, deaths and hospitalizations remain low.

Dr. Avish Nagpal, Sanford Health’s chief infectious disease doctor, said the most vulnerable populations are now well vaccinated. Between 70% and 75% of nursing home residents have been vaccinated, for example.

Also, he said, therapies such as monoclonal antibodies can help those susceptible to severe cases from having to be hospitalized.

“I think those two factors are combining to keep our hospitalizations low,” he said.

Nationally, another factor for the increase in cases that has been cited is the emergence of new variants of the coronavirus, some of which might elude protection from vaccines that were designed to protect against earlier strains.

In effect, there is a race between getting enough of the population vaccinated to achieve herd immunity, and the mutating virus.

“I won’t say the virus has the upper edge right now,” Nagpal said. “This rebound was kind of expected. We are heading in the right direction.”

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Still, hospitalizations are a lagging indicator. It often takes two weeks or more for an increase in cases to show up in hospitals. “I’ll hold my judgment for another couple of weeks,” Nagpal said.

The role new virus variants could be playing in the increase in cases isn’t well understood, Sapp said. Both the Minnesota Department of Health and the North Dakota Department of Health recently announced that they will increase surveillance testing to get a better idea of the prevalence of variants, Nagpal said.

Nagpal’s big worry is those who won’t get vaccinated because of unfounded fears, often based on misinformation circulating on social media.

“I think we are seeing a lot of hesitancy and a lot of misinformation,” he said. He’s concerned that only 50% to 60% of the population is willing to get vaccinated. “Then we’ll never get to herd immunity,” a threshold many experts believe requires 70% or more of the population to be vaccinated or to have recovered from infection.

“It will be a struggle between the virus and the vaccine, and the viruses are smart,” Nagpal said.

Dr. Richard Vetter, chief medical officer at Essentia Health in Fargo, estimates that about 30% of the population is hesitant to get vaccinated. Public education campaigns will strive to overcome that hesitancy.

Vetter, Nagpal and Nesemeier all stressed the importance of adhering to precautions, even as vaccines are being administered. Getting vaccinated and following guidance, such as wearing masks while indoors in public and avoiding large gatherings, will be the key to turning around the increase in cases, they said.

As of Monday, 25.3% of the population had been fully vaccinated and 39.1% had at least one dose in North Dakota. In Minnesota, 17.8% had been fully vaccinated and 28.9% had received a single dose.

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