BISMARCK — The highly infectious delta variant of COVID-19 is in North Dakota, but the state has so far avoided a surge in cases, hospitalizations and deaths. Experts say that luck could turn in the coming months if residents in low-vaccination communities continue to forgo the shot.

Lab officials have detected 20 cases of the delta strain in North Dakota, but the state only performs genome sequencing on a small percentage of positive tests, so it’s impossible to say how many residents have contracted the variant. State epidemiologist Grace Njau said “it would not be a reach to assume that (delta) is or is soon to be the dominant strain in North Dakota.”

The variant, first identified in India late last year, accounts for an estimated 83% of COVID-19 cases nationwide, said Centers for Disease Control and Prevention Director Rochelle Walensky on Tuesday, July 20. That’s up from 50% of genetically sequenced positives just three weeks ago.

The strain that battered India and the United Kingdom is now striking pockets of the U.S. with low vaccination rates. Delta-fueled outbreaks in Missouri and Arkansas have led to the highest case rates in months, pushing some hospitals to their limit. During an appearance on Face the Nation, Springfield, Mo., Mayor Ken McClure attributed his community’s troubling rise in infection to vaccine hesitancy and urged unvaccinated people across the state to seek the jab because “the surge is coming.”

With about 40% of its population fully immunized against COVID-19, North Dakota has a similar vaccination rate to Missouri and Arkansas, meaning the Peace Garden State is similarly vulnerable to a reemergence of the virus, said state vaccination coordinator Molly Howell.

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“I don’t see why North Dakota would be any different from those states,” Howell said. “Anywhere there are pockets of unvaccinated or undervaccinated individuals would be at risk of having a COVID-19 outbreak.”

It’s likely the more contagious strain hasn’t yet hit hard in North Dakota because it was introduced later than in more populous and well-traveled states, Howell noted. The earlier arrival of hot weather in the southern U.S. also may have driven residents inside where the virus spreads more easily, Howell said.

North Dakota has seen a “slight but noticeable increase” in cases and positivity rate over the last few days, but it’s too early to say a surge is on the horizon, Njau said.

Any outbreak caused by the delta strain in North Dakota probably wouldn’t be as severe as the peak of infections in the fall because most older residents have gained protection through vaccination, Howell and Njau agree.

However, vaccine hesitant groups create “susceptible pools of individuals” who risk severe illness and death if they come down with the virus, Njau said.

“While the progress in vaccine uptake is promising, it should concern us all when there are areas that may be at risk of severe outbreaks, hospitalizations and deaths,” Njau said in an email. “And it would also not be a reach to assume that the devastation caused by a surge would be felt more strongly in these communities, compared to those that have vaccinated successfully.”

Western North Dakota continues to lag behind the rest of the state in vaccination rate, though immunization efforts have largely stalled across the board.

Howell said residents should feel an urgency to get both doses of the Pfizer or Moderna vaccines to become fully vaccinated and best shielded from the virus before a surge hits the state.

According to new research, people under 50 are much more likely to catch the delta strain than those over 50, which highlights the risk of illness for everyone, not just vulnerable residents, said state disease control chief Kirby Kruger. The "randomness of the disease" means young people could have asymptomatic cases of COVID-19 or end up hospitalized with long-term health consequences, so it's critical to gain the protection offered by the vaccine, Howell added.

Raising the overall vaccination rate also decreases the likelihood of "breakthrough" cases in vaccinated people, which happen on rare occasion since the vaccines are not 100% effective against the virus, Howell said.