FARGO — The number of COVID-19 patients being treated by Sanford Health hospitals has increased as the delta variant surge continues with no sign of abating.

Dr. Doug Griffin, vice president and medical officer for Sanford in Fargo, said the number of inpatients with COVID-19, which had hovered around 35 in recent weeks, has climbed to 50.

Along with hospitalizations, the death toll continues to mount. On Monday, Oct. 4, three COVID-19 patients died at Sanford in Fargo, bringing the local health system's total number of patients who have died from the coronavirus to 340 since the pandemic began.

On Monday, Covid Act Now raised North Dakota’s risk level from very high to severe, the highest category. North Dakota’s positive test rate was 11.4%, which indicates that many infected people are being missed by testing.

The last time North Dakota reached Covid Act Now's severe risk level was in December, when the state was reeling from the record fall-winter surge. Covid Act Now is a private independent nonprofit group whose partners include Sanford Medicine and the Harvard Global Health Initiative.

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The Centers for Disease Control and Prevention continues to categorize North Dakota’s COVID-19 risk level as high.

Surveillance testing indicates that almost all infections in the area are caused by the highly contagious delta variant of the coronavirus, Griffin said. The delta surge likely will continue for a few weeks, he added.

The University of Washington’s Institute of Health Metrics and Evaluation forecasts that North Dakota’s peak in daily cases could arrive by mid-October, but peaks in hospital resource demand and deaths will follow in November.

So far, Sanford is treating its COVID-19 patients in two units, an intensive care unit and a medical-surgical unit. But past experience with the pandemic has demonstrated that cases can spike abruptly.

That means Sanford must be ready to open a new unit on short notice, Griffin said.

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Sanford’s three hospital campuses in Fargo remain “very full,” with a census as of Tuesday morning of 521, down from as high as 545 in recent weeks.

Hospital caregivers are “just very, very busy,” dealing not only with COVID-19 cases, but other respiratory illnesses, trauma and the full range of people requiring hospital care, Griffin said.

COVID-19 patients often have long hospital stays and place added pressure on intensive care units and intermediate care units.

“They’re with us for a long time,” Griffin said of COVID-19 patients. “It adds a significant burden in our ICU.”

After about three weeks, COVID-19 patients are no longer infectious and don’t require isolation, but still can be very sick and need a long time to recover, he said.

Staffing challenges remain significant. Sanford in Fargo has openings for more than 200 nurses. Sanford has recently been able to hire 70 traveling nurses, but they are only available for a few weeks, Griffin said.

Sanford is offering a variety of pay increases and incentives, including referral bonuses. But the strains on doctors, nurses and other caregivers continue to increase as the pandemic, now raging for more than 18 months, drags on.

“What we’re concerned about is that resiliency,” Griffin said. “Just people not being able to sustain that.”

So far, 91% of Sanford’s Fargo workforce has been vaccinated against COVID-19. Employees must be vaccinated or granted an exemption by Nov. 1 or be subjected to weekly testing for the virus.

“We anticipate that we’ll lose very few,” Griffin said of employees who refuse to be vaccinated. Sanford Health, which has about 30,000 employees systemwide, has granted exemptions to more than 3,000 employees, he said.

Asked whether that was a major gap, Griffin said “potentially,” adding that Sanford wants its employees to be vaccinated to prevent them from infecting patients. Those who aren’t vaccinated as of Nov. 1 will be tested, however, he said.

To be granted a religious exemption, employees must be able to demonstrate “firmly held religious beliefs, Griffin said.

Unvaccinated patients continue to account for the vast majority of COVID-19 patients in Sanford hospitals. As of Tuesday, unvaccinated patients represented 158 of 170 COVID-19 admissions, 41 of 44 COVID-19 ICU cases and 31 of 32 COVID-19 patients on ventilators.

Sanford expects a worse flu season than last year, which was “very mild,” likely because so many wore masks and practiced social distancing.

To help alleviate the pressures on hospitals, the best thing people can do is to get vaccinated to protect against COVID-19 and influenza, Griffin said. Also, he added, people should take precautions, including mask wearing, social distancing, hand washing and being careful to avoid accidents.

Essentia had 18 inpatients with COVID-19 as of Tuesday.