FARGO — North Dakota has been riding a bumpy plateau of the delta wave with coronavirus running stubbornly high as people are preparing to gather to celebrate Thanksgiving and the initiation of the holiday season.

Health care providers and public health officials fear the virus could begin spreading more rapidly during holiday gatherings , driving cases higher before they resume a gradual decline.

The delta wave, which started in North Dakota this summer, peaked at 4,604 active cases on Oct. 6 and since has generally edged down along a zig-zagging trend line. Active cases were as high as 3,904 on Nov. 10 but fell to 2,841 as of Sunday, Nov. 21, according to figures from the North Dakota Department of Health.

By contrast, the record wave of cases last fall, which peaked at 10,431 active cases on Nov. 13, 2020, declined sharply after reaching its apex.

Despite the persistence of the delta wave, Dr. Avish Nagpal, the chief infectious disease specialist at Sanford Health in Fargo, believes it’s likely numbers will probably continue to recede — but the holidays could spur an uptick.

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“Holidays always bring an unpredictable factor with them,” he said. “We may see cases go up again.”

Fortunately, antiviral pills under review by the Food and Drug Administration could become available soon. Also, another monoclonal antibody treatment could become available.

The medications can keep sick people out of the hospital and prevent fatalities, but they must be taken or administered just a few days after the onset of symptoms to be effective, Nagpal said.

“They are potentially game-changers,” he said, referring to the antiviral pills, which will require prompt testing to be useful. The antibody treatments, however, remain in short supply.

“Fortunately we haven’t had to turn anyone away,” Nagpal said, but the treatments are available only to high-risk patients who have been infected, not merely exposed to the virus.

Sanford has been treating about 60 hospital patients daily in recent weeks, Nagpal said. “It seems we’ve plateaued for some reason,” he said.

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Once past a holiday uptick, cases should continue to diminish as vaccinations gradually increase, including booster doses that are now available for all adults, he said.

“If anything, I’m a little more optimistic with every passing week,” Nagpal said. “I’m more optimistic than pessimistic.”

Dr. Stephen McDonough, a retired Bismarck pediatrician who is closely following the pandemic, said it’s still uncertain whether a winter COVID-19 surge will occur.

“Children are still getting hospitalized, and one has died recently,” McDonough said, noting that four were hospitalized on Monday.

“One Williston mom who recently delivered a baby is critically ill in Minnesota," he added

Although children ages 5 to 11 recently became eligible for vaccination, immunization rates remain “very low in children and low in adults,” with few people wearing masks in crowded indoor settings.

“So there is definitely a possibility of a surge in cases after Thanksgiving and Christmas holidays,” McDonough said.

The University of Washington’s Institute for Health Metrics and Evaluation predicts that COVID-19 cases will continue to decline in North Dakota.

The institute’s model estimates that North Dakota is seeing 617 daily infections, a number that is predicted to drop to 130 by the end of February under the most likely scenario.

North Dakota continues to lag behind most of the country in vaccinations, with 69.8% of adults receiving at least one dose, according to the Centers for Disease Control and Prevention.

After rapidly vaccinating 40% to 50% of adults, vaccinations have slowed to a trickle, said Kylie Hall, operations director of North Dakota State University’s Center for Immunization Research and Education.

“We’re not moving the needle as quickly as we had hoped,” she said.

North Dakota has trained 12 or 15 trainers who will fan out to give presentations about vaccine safety and effectiveness at clinics around the state in a campaign to promote vaccination, Hall said.

Booster doses have been given to many of the state’s most vulnerable, including residents and staff at nursing homes and other health care workers, Hall said.

Her sense of the future: “Optimistic but careful.”