BISMARCK — North Dakota has been the nation's COVID-19 hotspot for more than a month as more North Dakotans continue to succumb to the illness.

Local officials are grappling with their growing case counts as state government looks on, encouraging them to do what is best in their communities to slow the pandemic's rapid spread.

With the pandemic showing no signs of abatement, the North Dakota Department of Health on Tuesday, Nov. 3, announced another 15 COVID-19 deaths.

North Dakota's death rate is staggeringly higher than the rest of the nation, with 1.5 deaths per 100,000 in the last seven days. The nationwide average is 0.3 deaths per 100,000 in the last seven days, according to the Centers for Disease Control and Prevention. More than 230,800 Americans have died from COVID-19 throughout the pandemic as of Tuesday.

The deaths announced Tuesday were all men and women in their 50s to 90s and included three women from Burleigh County, two residents of Towner County and two Ward County men. The others each were from Benson, Cass, Dickey, LaMoure, Pierce, Rolette, Stark and Wells counties.

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October was North Dakota's deadliest month by far with 275 deaths. More deaths are likely to be added to the state's official October toll as death investigations conclude. October has seen more than twice as many deaths as September so far.

At least 326 of the state's deaths have come in nursing homes and other long-term care facilities, many of which have seen skyrocketing cases among residents and employees in the last month.

COVID-19 hospitalizations statewide remained at a high of 215 residents Tuesday, and there are approximately 11% of staffed hospital beds available statewide.

Hospital capacity in the state's largest cities remained tight on Tuesday, with both Essentia Health and Sanford Health in Fargo reporting zero available staffed in-patient beds. Among the city's three hospitals, three staffed ICU beds were available and eight in-patient beds were only available in Fargo's VA hospital.

Bismarck reported six available staffed in-patient beds and two staffed ICU beds among Bismarck's two hospitals, according to the latest numbers from the North Dakota Department of Health.

Statewide, there are 12 available staffed ICU beds and 195 available staffed in-patient beds, according to the latest numbers from the North Dakota Department of Health.

On Oct. 3, the state reported 3,055 residents known to be infected with COVID-19. As of Tuesday, at least 8,396 residents were infected by the virus. This is a 175% increase in active COVID-19 cases in one month.

Grand Forks County recently surpassed 1,000 active cases for the first time and local health officials are warning that the worst is yet to come and urging the government at all levels to enact more stringent policies to help curb COVID-19 spread. The county reported an additional 218 positive cases on Tuesday.

Steele County enacted a mask mandate to protect citizens in the county, Steele County Public Health announced Tuesday. The county as a population of around 1,900 and it reported a 16% rolling positivity state for all COVID-19 tests in the last 14 days, according to the Department of Health.

Ward County, which encompasses Minot, reported an additional 182 positive COVID-19 cases Tuesday and now has the third-highest number of active cases among North Dakota's counties with 1,222 residents known to be infected with the virus.

Cass County, which includes Fargo and West Fargo, has 1,229 residents known to be infected with the illness — the most of the state's 53 counties. It announced an additional 176 cases Tuesday.

About 16% of the 7,615 residents tested as part of the latest batch received a positive result, but 24% 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 about 14% for all residents tested and about 24% for tests taken on previously untested residents.

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Readers can reach reporter Michelle Griffith, a Report for America corps member, at mgriffith@forumcomm.com.