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Thanksgiving is a time for families to come together. Yet the current holiday, coming amid another COVID-19 surge across Minnesota,finds many with cause for separation.

Thousands of Minnesotans who have tested positive in recent days during the latest pandemic spike have been advised to isolate.

Many are so sick they require hospital care, which means more health care workers will be on the job Thursday and separated from their families.

And perhaps the deepest divides are in families that don't agree on whether to be vaccinated against COVID-19. Some are choosing not to gather, while others will do so under a cloud — not sure whether or how to raise the topic of immunizations.

It all makes for a fraught holiday, not the fairly normal Thanksgiving that seemed likely just a few months ago.

"Many people missed last year's holidays, so they were so counting on this year," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "People weren't ready to say: This is going to be another year when there's going to be challenges. We have a vaccine – why do we have to worry?

"Well, we worry in part because we know a number of people won't get vaccinated — it just takes one in a family setting to be a challenge," Osterholm said. "Then there's the fact that, with breakthrough infections, how do you protect yourself? And then, we still have a lot of kids who either are not able to be vaccinated or haven't been vaccinated, and so the question becomes: What risk are they to grandma and grandpa if they go to a Thanksgiving Day event?

"I think there are a lot of questions that people thought would be addressed and answered by now, that would mean we can just go back to the way it was," he said.

The state Department of Health on Wednesday reported another 3,759 COVID-19 cases, a relatively low count in recent weeks. After setting another 2021 record for COVID-19 hospitalizations Monday, the latest data showed hospitals across the state on Tuesday were caring for 1,420 patients with the virus — down slightly from the previous day.

Health officials linked another 53 deaths to the pandemic, bringing the cumulative state count to 9,282 fatalities.

Thinking that families will be searching for ways to have productive conversations on vaccines this Thanksgiving, the Health Department launched a website and bought ads in Thursday newspapers across the state with strategies for talking about the issue during the holidays.

"They've become the new dinner table topic where families say, 'We don't talk about that,'" the website states. "But for those of us with friends and family who still have questions about or are resistant to the vaccine, having an empathetic conversation can be an incredibly effective way to bypass the heated public debate and purely appeal to someone you care about."

Doctors continue to stress the effectiveness of the COVID-19 vaccines, saying that while immunizations can't stop all infections, they help most patients avoid the worst of the virus. At Minneapolis-based Allina Health System, 56 of the 68 pandemic patients in the intensive care unit Monday were unvaccinated.

The number of serious illnesses in people who've been vaccinated is beginning to tick up, but that's a function of waning immunity, plus the simple fact that as more people get vaccinated there are more chances for breakthrough infections, said Dr. Frank Rhame, an infectious disease specialist at Allina.

Vaccination is key for controlling the pandemic, Rhame said, but he said he believes Minnesota's case surge in recent months stems from people not following public health recommendations.

"I think we have to look to changes in people's habits with masking and distancing and avoiding crowded spaces … [to] explain the volatility of the case rates," he said.

On a typical Thanksgiving Day before the pandemic, the beds at United Hospital in St. Paul would be about 80 to 85% full. This year, "we're probably going to be 100% full or close to it," said Erik Johnson, a nurse and director of the hospital's emergency department.

The hospital will staff to that higher need, Johnson said, so more health care workers will be on duty over the holiday. He said "COVID is the biggest driver" of hospital demand, both because of all those who've been sickened by the coronavirus as well as the many ways the pandemic has complicated health care for other conditions.

At Hennepin Healthcare's HCMC hospital in Minneapolis, staffing will be up about 26% compared with a pre-pandemic Thanksgiving Day. A team of some 20 doctors, nurses and respiratory therapists from the Air Force was scheduled to begin helping with patients at HCMC on Thursday, which will allow the hospital to create a unit to address emergency room backlogs.

"Demand for emergency and life-saving care has exceeded our capacity," Jennifer DeCubellis, the hospital's chief executive, said Tuesday.

The federal help, along with training announced this week for the Minnesota National Guard to support long-term care facilities, shows the pandemic is not over — even though that's not the impression from the crowded restaurants, bars, social events and concerts across the state, Osterholm said during a podcast posted Wednesday.

He stressed three take-home messages.

"One, the pandemic's not done," Osterholm said. "Two, we have to understand that that means what we do in our behavior still has everything to do with our risk of getting infected. And the fact is, vaccines still are a remarkable, remarkable tool — not perfect, but remarkable."