BISMARCK — Active COVID-19 cases took a rare dip while virus hospitalizations jumped on Monday, Oct. 26, as North Dakota continues to lead the country in several key pandemic metrics.

The North Dakota Department of Health announced 527 new positive COVID-19 cases and nine hospitalizations in its latest report. Statewide active cases dropped to 6,446 while hospitalizations climbed to 173, adding to the state's already strained health care system.

And as the United States passed its third peak of the pandemic for average new COVID cases over the weekend, North Dakota continued to lead the country in cases and deaths per capita for the last week, according to The New York Times. The Upper Midwest has experienced a region-wide surge in cases in the last month, with South Dakota, Wisconsin, Iowa, Montana and Minnesota all identified by the publication as states where infections are "high and staying high."

North Dakota health officials confirmed five deaths due to the virus on Monday, adding to what has already been the deadliest month of the pandemic for the state. Since the start of October, 190 residents have died from COVID-19, over 40% of the state's 456 total virus deaths.

The deaths of a Burleigh County man in his 70s, a Cass County man in his 70s, a Ramsey County man in his 80s, a Williams County woman in her 80s and a Sioux County man in his 30s were reported on Monday.

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At least 280 of the state's deaths have come in nursing homes and other long-term care facilities, many of which have been badly affected by the virus in the last two months. At least three facilities have 15 or more infected residents, according to the Department of Health's dashboard.

The state is battling through a shortage of available hospital beds as COVID hospitalizations converge with strains on health care staffing and high noncoronavirus admissions. There are 25 available intensive care beds and 268 regular, inpatient beds in the whole state, according to the state's latest figures.

The situation is especially urgent in Bismarck, where the two hospitals have just one available ICU bed and six inpatient beds between them. Grand Forks has just one ICU bed and 15 inpatient beds, while Dickinson has two ICU beds and seven inpatient beds, and Minot has three ICU beds and 16 inpatient beds.

Fargo's three hospitals have carved out some breathing room following strained capacity in recent weeks, noting 14 open ICU beds and 41 inpatient beds in their latest report.

Of the 173 North Dakotans currently hospitalized with the virus, 29 are in intensive care, according to the department. North Dakotans who are transferred out of state for medical care are not tracked by the health department, spokeswoman Nicole Peske said.

All but 10 of North Dakota's 53 counties reported at least one positive on Monday, and every county in the state is reporting at least one currently active case.

The state's largest outbreak persists in Cass County, which includes Fargo, where the state reported 136 new positives of COVID-19 on Monday and 1158 active cases.

Burleigh County, which encompasses Bismarck, reported 89 new cases Monday. The county has the second most active cases in the state with 1040. The neighboring Morton County, which includes Mandan, reported 24 new cases and has 337 active cases.

Fifty-three new cases came from Grand Forks County. The county has the third most active cases in the state at 756.

About 8.3% of the 6,660 residents tested as part of the latest batch received a positive result, but 18.2% 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 11.7% for all residents tested and 20.9% 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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Readers can reach reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.