BISMARCK — Twenty-four more people in North Dakota were reported dead from COVID-19 on Wednesday, Oct. 7, more than the number reported on any other day of the pandemic in the state.

That's more deaths reported in North Dakota on Wednesday than in the entire months of March, April, June or July each. And as the death toll has spiked over the last month in North Dakota, the state has also continued to report the most new cases per capita of any state in the country for multiple consecutive weeks, according to The New York Times.

In reporting the wave of the new deaths, the North Dakota Department of Health noted a significant lag time, specifying that six individuals reported Wednesday died between four and seven days ago. Eighteen of the new deaths reported have occurred since the start of this week.

In total, 304 people have died from complications related to the coronavirus in North Dakota since March, according to the Department of Health. Deaths have been spiking in North Dakota over the last five weeks, and the state reports that 116 people died during the month of September. In just the first seven days of October, another 41 people have died.

In an email, department spokeswoman Nicole Peske told Forum News Service that the state's reporting delay "can be due to a number of things." The state draws on several sources to aggregate COVID deaths — including family members, nursing homes and hospitals — and Peske said that irregular reporting to the department can contribute to a system backlog, as happened on Wednesday.

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These hold-ups can include "a lag in reporting from the facility, the case worker not finding out until the end of an infectious period, (or) the individual being released from public health monitoring and then passing away after that," she said.

The 13 men and 11 women reported dead Wednesday came from 11 different counties and all had underlying health conditions, according to the department. Five of the deaths came from Morton County, which sits west of the Missouri River from Bismarck. Four deaths came from rural Bottineau County, where a nursing home has suffered a massive outbreak.

The massive mid-week death toll comes as the North Dakota health system has experienced a shortage of hospital beds in the last two weeks. On Wednesday afternoon, there were 25 total ICU beds and 218 standard, inpatient beds available in the state, according to an internal tally by the North Dakota Department of Health. These numbers differ from what the department reports on the state's COVID-19 dashboard because the state publicly reports the number of licensed beds at hospitals, rather than the number of beds staffed by medical professionals, according to Peske.

And even as the strain on statewide hospital capacity seemed to ease at the beginning of this week, the situation remains very tight in certain local hot spots. The Fargo health system was down to nine ICU beds and 11 standard, inpatient beds on Wednesday, while the medical hub of Grand Forks has just four ICU beds and seven inpatient beds available.

Bismarck, Dickinson and Minot are also all managing heavy patient volumes, leaving just three ICU beds in Bismarck on Wednesday, one in Dickinson and two in Minot. And all three cities reported shortages of inpatient beds, with sixteen in Bismarck, five in Dickinson and seven in Minot.

The number of COVID hospitalizations remained stable between Tuesday and Wednesday at 116, a pandemic high.

The state's largest hot spot persists in Burleigh County, where 80 new cases were reported on Wednesday. Burleigh and the neighboring Morton County, which encompass Bismarck and Mandan, are reporting 883 active cases.

A hot spot in Cass County, which encompasses Fargo and West Fargo, continues to grow, reporting 134 new cases on Wednesday, more than any other county. Cass is reporting 621 active cases.

Hot spots have also been resilient in some smaller western counties. Sixteen new cases were reported in Stark County, which includes Dickinson, in Tuesday's report, for 256 active positives in the county. Meanwhile, Williams County, which encompasses Williston, has 240 active cases, and Ward County, which encompasses Minot, is managing 242.

North Dakota reported 495 new COVID cases on Wednesday, bringing the statewide active case total up to 3,706.

About 7.9% of the 6,260 residents tested as part of the latest batch received a positive result, and 13.8% of residents tested for the first time got a positive result.

North Dakota does not report a seven-day rolling average for positivity rate, but Forum News Service calculated the rate to be 7.3% for all residents tested and about 13.5% for tests taken on previously untested residents.

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Readers can reach reporter Adam Willis, a Report for America corps member, at