ST. CLOUD – The St. Cloud area, which week after week in the spring had some of the state's lowest percentages of vaccinated residents, is now seeing a surge in new cases that is forcing its primary hospital to expand its intensive care unit and delay medical care for those dealing with other illnesses or emergencies.

The number of new COVID-19 cases in the central Minnesota counties of Stearns, Benton and Sherburne has grown about 12% since the end of June, when spread of the disease was waning and cases plateauing. Since that time, the area's death toll has increased from 418 to 450, with eight new deaths reported since Tuesday in the three counties.

"We are tired. We're having good nurses leave and we're having folks cut back on their hours," said Dr. Jacob Lyons, critical care specialist at St. Cloud Hospital, which is one of CentraCare's main health hubs. "We have a shortage. It's not physical beds or ventilators or supplies — things we worried about early in the pandemic — it's nurses to take care of the critically ill folks."

In the past two months, the number of inpatients being treated for COVID-19 at CentraCare and its subsidiary Carris Health has fluctuated from 50 to 70, according to Dr. George Morris, CentraCare's COVID-19 incident response commander. CentraCare is a health care system with eight hospitals and more than 30 clinics in central Minnesota, as well as Carris Health facilities in west-central and southwest Minnesota. On Monday, 62 inpatients were being treated for COVID-19. Of those, 57 were unvaccinated and five were not.

"Ninety percent of our patients with COVID are unvaccinated. And even the ones that were vaccinated, they're 65 and above and we know [those] were the cases where they tended to not have as strong of an immune response or as long of an immune response," Morris said.

The St. Cloud area has for months lagged behind the state in its COVID-19 vaccination rate and, at times, has had the lowest percentage of vaccinated residents.

Rates have improved in recent months — with about 52% of eligible residents in Stearns, Benton and Sherburne counties fully vaccinated — although the region remains significantly behind the statewide average of 68% of residents 12 and older who have completed the vaccine series.

An increasing number of patients are young and unvaccinated, Morris said, noting about 15 of the current inpatients are younger than 50 — a reversal from the early days of the pandemic when patients were mostly older with underlying health conditions. Morris said he remembers only two patients in the past six weeks who were vaccinated and under 65, which, to Morris, indicates the effectiveness of the vaccine.

"There's very little reason for someone who is otherwise healthy, under 50, to be in the hospital with COVID or any pneumonia," he said. "This is a case where you should be young and healthy — and COVID is making you young and sick."

The increase in patients has forced St. Cloud Hospital to open another intensive care unit. As of this week, about half of ICU patients — roughly 20 — have COVID-19. Eighteen of those need ventilators, Morris said.

"Because COVID has taken up so many ICU beds, we are now having a hard time placing people who have had car accidents or strokes or heart attacks," Morris said. "So even if you don't have COVID, your care is affected by the pandemic."

Meeting the need has taken a toll on health care workers, who have been dealing with the pandemic for 18 months.

"It's frustrating but it's also heartbreaking," Lyons said. "It all feels so very preventable — and that's the hard part of this."

The case surge affects CentraCare employees, too. Morris said there are well over 100 employees either out with COVID-19 or quarantining due to exposure. And recently, at least four employees required hospitalization for COVID-19, including treatment in the ICU.

"When the community has spread, we feel it," Morris said.

He attributes part of the surge to people ignoring medical advice and not tapping into that sense of community felt at the beginning of the pandemic.

"That may be a little blunt reality, but if all of these people were vaccinated, we would perhaps see ... 10% of the people admitted, which means we would have six people in the hospital with COVID, not 60," he said. "Our hospital is full because of unvaccinated COVID-related patients."

Lyons said he's seen multiple patients who say they didn't think COVID-19 was real or they didn't think they would get sick.

"We've decided opinion is equal to expertise. As a society, that's what we've decided," he said.

But for Lyons, it's important not to vilify unvaccinated people.

"They're not idiots. They're not bad people. They're not monsters. They're not trying to get sick," he said. "They've each come to their decision thinking they were doing the best for their families but they were unfortunately misinformed. They got bad advice from their friends or Facebook or a talk-show host."