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When Medtronic executives said in late August that COVID-19 cases across the U.S. were on the verge of peaking, they'd been listening to a physician employee in New York whose surgery practice gives him first-hand experience with the pandemic.

Dr. John de Csepel is a vice president of medical affairs at Medtronic who also leads a group of clinicians that has been assisting the company's standing team for crisis and risk management.

While still working his primary job at Medtronic, he and other doctors and nurses have helped the medical device manufacturer manage everything from internal policies on masking and coronavirus testing to a company-wide push for vaccinations.

Because Medtronic's business depends largely on scheduled medical procedures that get postponed as hospitals care for COVID-19 patients, a key part of de Csepel's job centers on guiding top executives on what might be coming next with the pandemic.

"When we make these projections, we are not doing it with any degree of bravado," he said. "There's so much more to be learned about this virus."

Forecasting requires humility given the newness of the SARS-CoV-2 virus and the surprising twists and turns with the pandemic thus far, said de Csepel, who spends weekends performing surgery at a New York City hospital. That medical center was particularly hard hit when COVID-19 first arrived in the U.S., prompting de Csepel to pitch in with intensive care patients.

"It got so bad that they even asked a surgeon like myself to run a COVID ICU," he said.

"These patients are the sickest patients in the hospital, they need the most sophisticated critical care. But we opened up so many ICUs in the hospital — it seemed like every spare room in the hospital was turned into a COVID ICU — that they needed other physicians beyond those who are [specialized] in critical care to staff and manage those patients."

Medtronic is one of the nation's largest medical device manufacturers with more than 90,000 employees, including nearly 11,000 across Minnesota. Based in Ireland, the company has its operational headquarters in Fridley.

When developing its outlook, the Medtronic team considers forecasts that are generated from sophisticated pandemic models developed by academic groups, but doesn't rely on them exclusively, de Csepel said.

They also try to understand the pandemic through medical literature, government data sources and guidance from top exerts in the field.

Michael Osterholm, the director of the Center for Infectious Disease Researcher and Policy at the University of Minnesota, is a go-to source, de Csepel said, adding that he's listened to all 70 of Osterholm's pandemic podcasts.

"This is how we make our projections — it's not that we have some sort of secret model," de Csepel said. "It's more really trying to understand the epidemiology of COVID and the dynamics of this virus."

Trends in the U.K. tend to be a pretty good indicator for what might happen in the U.S., de Csepel said, because vaccination rates have been comparable in the two countries. The health systems generate somewhat similar patient outcomes, he added, and the population in both countries is similarly mixed across urban, suburban and rural areas.

Studying the experience this year with the delta variant in England, where cases rose for about two months before starting to fall, helped ground the team's guidance to chief executive Geoff Martha, who said during the earnings call that Medtronic expected COVID-19 infection rates to peak in the U.S. in early September. At the time, some stock analysts and academic models also were talking about an early September peak.

The key message for investors was that Medtronic expected medical procedures using the company's products to rebound within the company's second quarter, which ends in late October.

"We do think this is shorter-lived and easier managed than the prior waves," Martha said.

Three weeks later, the national numbers seemed to be lining up with de Csepel and his team's forecast, de Csepel said.

As of Sept. 21, the Centers for Disease Control and Prevention was reporting a seven-day average of 127,655 new cases per day across the U.S., down from the recent peak by that measure of nearly 160,000 new cases on Sept. 1.

The picture varies by state. New cases in Minnesota continue to climb, while Florida, which was one of the nation's COVID-19 hot spots in August, has been reporting steep declines for more than three weeks.

"We're seeing the states that were hit hardest in the southeast, where hospital capacities … were taken to extreme levels, now we've seen them coming down pretty markedly — not all, but in a number of the states," de Csepel said.

The projection stemmed from the observation that, in the United Kingdom, the delta variant peaked about eight weeks after first surfacing, de Csepel said. In the U.S., delta started driving case totals in early July, so a peak by Labor Day seemed reasonable.

The British pattern, however, is not always predictive.

During late 2020, England suffered from a surge of cases driven by an earlier variant of the virus. The influx delivered a major hit to hospitals and prompted Osterholm and some other experts to warn that the U.K. variant was like a powerful hurricane threatening to come ashore in the U.S.

In the end, though, it didn't cause the nationwide problems that were feared, though Michigan and, to a lesser extent, Minnesota saw surges. The experience illustrates how there's always uncertainty with projections about COVID-19.

"[Osterholm] would be the first to tell you that this virus is so humbling," de Csepel said. "And it's been absolutely humbling for us."

If the nationwide case count keeps falling while states like Minnesota — which was a little late to summer's delta surge — join places like Florida in seeing case declines, then what's next on the horizon with the pandemic?

It's getting harder to predict, de Csepel said, as students return to schools and adherence to public health guidelines slips. Even so, Martha told investors at a recent conference: "We expect headwinds from this latest wave to be transient. And we fully expect to recover and have a strong second half of our fiscal year."