BISMARCK — North Dakota's COVID-19 outbreak, already among the nation's worst, continues to spiral out of control.

The state Health Department on Thursday, Nov. 5, reported a single-day record 29 deaths from COVID-19 and an unprecedented surge in cases. Gov. Doug Burgum said at a news conference Thursday marks "the worst day" of the pandemic in North Dakota from a statistical standpoint.

The deaths came from all over the state, including eight from Ward County, three from Grand Forks County, three from Burleigh County and three from Traill County. The youngest victim was in her 30s, while the oldest was more than 100 years old.

The department says 596 North Dakotans have succumbed to the illness since March, and deaths have been climbing at a rapid pace over the last three months. The state has averaged more than nine COVID-19 deaths per day in October and November.

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At least 342 of the state's deaths have come in nursing homes and other long-term care facilities. Seven facilities have more than 15 active cases in residents, including Trinity Homes in Minot, which has 58 infected residents.

There are now a record 9,224 North Dakotans known to be infected with the virus.

North Dakota has reported the most COVID-19 cases and deaths per capita in the nation over the last week, according to the Centers for Disease Control and Prevention. The whole region is experiencing a surge in cases, with South Dakota, Wisconsin, Iowa, Montana and Minnesota all seeing increasing cases.

Burgum has faced criticism from doctors and political opponents for refusing to issue a statewide mask mandate as cases and deaths continue to climb exponentially. The Republican governor reiterated Thursday that the state will rely on the "personal responsibility" of residents to wear masks and keep distance from one another.

"There's always the question we get every day: what is government going to do and should government be doing more?" Burgum said. "I think the answer is that question back to you: what are you as an individual going to do?"

The governor has frequently rejected mask mandates as an effective strategy, saying "we know masks work, we're not sure mask mandates work." However, he has trumpeted his support for mask requirements imposed by cities and counties across the state in recent weeks. Rural Nelson County, which lies west of Grand Forks, joined Fargo, Grand Forks, Bismarck and a handful of other cities, counties and Native American reservations when its board of commissioners voted to mandate masks in public areas.

In acknowledgement of the worsening outbreak, Burgum on Thursday moved eight counties up to "high risk" and 14 counties up to "moderate risk" on the state's color-coded COVID-19 gauge. The move means there are no counties in the two lowest risk levels, reflecting the increased prevalence of the virus in rural counties.

All of the state's largest counties, including Cass, Burleigh and Grand Forks, sit at the "orange" high risk designation, which comes with a recommendation for restaurants, bars and large event venues to limit capacity to a quarter of their normal levels. Among the new additions to the orange level is Stutsman County, which includes Jamestown. No county has been placed in the critical, or "red," designation that would come with business closures.

The number of hospitalized residents due to COVID-19 rose on Thursday to 231. Another 135 patients were initially hospitalized with some other ailment but later tested positive for COVID-19. Fifty-one residents with the virus are in intensive care.

The state's largest hospitals are under severe staffing crunches, and available hospital beds are scarce. While only about 20% of the patients hospitalized in North Dakota have COVID-19, hospital administrators say the strain is mostly due to the extra staff and resources that must go to patients with the virus.

There are just 14 available intensive care beds in the entire state, according to the latest figures reported by the North Dakota Department of Health. Most of the 159 open inpatient beds in the state are in rural hospitals, which often don't have the capability to care for patients with serious ailments.

Chris Jones, the director of the state Department of Human Services, said Thursday the stress on the hospitals is getting worse and could become even more intense if North Dakotans don't band together to limit the spread of the virus. He drew a direct line between the lack of mask wearing and social distancing in communities across the state and the struggles with hospital staffing.

The health department reported a single-day high 1,540 new cases of COVID-19 on Thursday. All but six of the state's 53 counties reported at least one new case.

Cass County, which includes Fargo, reported 266 new cases of COVID-19 on Thursday. The state's most populous county has 1,430 infected residents.

Ward County, which includes Minot, reported 221 new cases, bringing the county's active case count to 1,246.

Burleigh County, which encompasses Bismarck, reported 214 new cases Thursday. The county has the second most active cases in the state with 1,345. Morton County, which sits just west of Burleigh County and includes Mandan, reported 84 new cases and has 476 active cases.

Grand Forks County reported 101 new cases, bringing its active case count up to 1,048.

About 17.2% of the 8,982 residents tested as part of the latest batch received a positive result, but 27.9% 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 14.3% for all residents tested and 24.9% for tests taken on previously untested residents. Both rates are the highest since Forum News Service started tracking the figures at the beginning of August.

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