COVID-19 cases might not be on the rise in Minnesota, but the ever-present pandemic is combining with the start of flu season to pressure hospitals.

Total inpatient bed usage statewide has risen above 8,000 on four separate days this month — a rough threshold for when the health care systems are near peak capacity, according to Thursday's weekly state pandemic update.

About 475 of those patients have been treated for COVID-19 on any given day in November. COVID-19 cases requiring intensive care reached 63 on Nov. 9 — the first time that number has been above 60 since March 4 — but other indicators of pandemic activity are relatively stable.

"The thing that I think is encouraging, at least so far, is that COVID is not adding a greater burden to what is turning out to be a really tough start to the influenza season," said Dr. Mark Sannes, an infectious disease specialist with HealthPartners. The Bloomington-based health system reported 170 COVID-19 inpatient cases across eight hospitals at this time last year compared to 64 now.

The state is identifying fewer than 800 new daily infections with the coronavirus that causes COVID-19 through testing at clinics and pop-up sites. The results exclude at-home tests results, but health officials said the numbers along with tracking viral load in wastewater provides adequate monitoring of pandemic trends.

State leaders this week encouraged Minnesotans to access more free at-home tests to identify any infections in their households ahead of holiday gatherings that could spread the virus.

Coronavirus loads in wastewater have held steady across Minnesota, with small increases in southeast and central regions of the state now leveling out, according to results through Nov. 13 published by the University of Minnesota.

The rising hospitalizations likely reflect the combined impact of COVID-19 along with early surges in RSV infections among infants and influenza cases among children and adults. Thursday's weekly state influenza report showed 439 flu-related hospitalizations in Minnesota already, which puts the state well ahead of the usual pace of the season.

In the severe 2017-2018 flu season, Minnesota didn't reach that many hospitalizations until around Christmas. Whether this year is a severe flu season or just an early one is unclear, but it is hitting children at unusually high rates.

Cases have risen recently among seniors — who are at greatest risk of severe complications — but the median age of hospitalized flu patients so far is 48. The median is usually 50 to 70 in a typical season.

The 195 flu-like outbreaks reported among schools in the week ending Nov. 12 is high for this early in the season. Such outbreaks are reported when schools have at least 5% of students absent or three children missing from the same elementary classroom with flu-like illnesses.

RSV levels remain elevated in Minnesota — another anomaly at this point in the year. Of the roughly 180 RSV-related hospitalizations in Minnesota last week, the vast majority involved children four and younger. But the small number involving children age 5 to 17 has increased.

Only five flu-related deaths have been identified in Minnesota so far, none among children.

Health officials urged Minnesotans to take precautions, including vaccinations against influenza as well as COVID-19 — which continues to produce a higher death rate, mostly among seniors.

Minnesota is reporting about seven COVID-19 deaths per day over the past month, a slight increase from earlier this summer and fall. Of the 81 COVID-19 deaths in Minnesota since Oct. 30, 73 involved seniors. Three COVID-19 deaths in November involved people 18 to 49.

Minnesota's death toll in the pandemic has reached 13,610.