BISMARCK — The North Dakota Department of Health on Thursday, July 23, announced 128 new cases of COVID-19, including nearly 60 from the state's second largest metro area.

There are now 921 North Dakotans known to be infected with the virus, marking the highest point of the pandemic and an increase of more than 50 from Wednesday's previous all-time high. The state is also seeing a record number of residents hospitalized with the illness for the second straight day at 57, up five from Wednesday.

The department also announced Thursday that a Burleigh County man in his 70s has died from the illness. Like nearly every North Dakotan that has succumbed to the illness, the department reports that he had underlying health conditions.

The department says 97 North Dakotans have died from the illness, including 75 residents of Cass County, which includes Fargo and West Fargo. Sixty-four of the deaths have come in nursing homes and other long-term care facilities.

There are still four deaths that remain in a "presumed positive" category, which means a medical professional determined that COVID-19 was a cause of death but the person was not tested for the illness while he or she was alive. If those deaths are counted toward the official death count as they are in several other states like New York, there would be 101 victims of the illness who resided in the state.

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Gov. Doug Burgum said at a press conference Wednesday the state is "not heading in the right direction" with active cases, hospitalization and testing positivity rates increasing. Burgum pleaded with residents on Wednesday to wear a mask in public places to slow the spread of the virus, but he said he would not issue a statewide mandatory mask order like Minnesota Gov. Tim Walz.

Forty-eight of the new cases came from Burleigh County, which encompasses Bismarck. The county that has experienced a consistent rise in infections over the last month once again has the most active cases in the state with 211. Morton County, which sits just west of Burleigh County and includes Mandan, reported 11 new cases.

Nineteen of the new cases came from Cass County, which has seen infections growing after declining earlier this month. The state's most populous county now has 157 active cases.

Eleven new cases came from Ward County, which includes Minot. The county was thought to be a hotspot when the pandemic began, but it now only has 51 active cases.

Eight new cases came from Williams County, which encompasses Williston. The county has seen a dramatic increase in cases over the last two weeks after largely avoiding the worst of the pandemic for more than three months. The county now has 88 known active cases.

Twenty-one counties reported at least one case Thursday, including many small, rural counties.

About 3% of the 4,318 test results announced Thursday came back positive, but more than half of the tests were performed on those who had previously been tested for the illness. Johns Hopkins University, which calculates the rate of positives using only those tested for the first time, found that an average of 6.3% of North Dakotans tested over a weeklong period came back positive. The state does not regularly report a seven-day rolling average for positivity rate, but Burgum committed Wednesday to reporting a 14-day rolling average rate on the state's website.

Burgum said he did not think the state was artificially lowering the positivity rate by including test results from residents being retested and that adding re-tests to the equation was a necessary piece of information for policy-making.

A total of 5,493 North Dakota residents have tested positive, but 4,475 have recovered.

The state has announced the results of 275,255 tests, but many residents have been tested more than once.

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