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(NEXSTAR/AP) — Nearly 37,000 Americans died of COVID-19 in November, the most in any month since the dark early days of the pandemic, engulfing families in grief, filling newspaper obituary pages and testing the capacity of morgues, funeral homes and hospitals.

Amid the resurgence, states have begun reopening field hospitals to handle an influx of patients that is pushing health care systems — and their workers — to the breaking point. Hospitals are bringing in mobile morgues, and funerals are being livestreamed or performed as drive-by affairs.

As with the first wave, the rate of infections surged well before the death toll. As we turn the calendar to December, four states are seeing at least one in 100,000 residents die over the prior seven days, according to data from the Centers for Disease Control and Prevention.

Here are the death rates per 100,000 residents over the last week, according to the CDC.

South Dakota2.1
North Dakota1.3
New Mexico1.2
Rhode Island0.9

All other states have a death rate of .6 per 100,000 or lower over the prior seven days, as of Wednesday.

Even with the recent surge of deaths in the upper Midwest, the number of deaths per capita this year still remains lower in those states than in New York, New Jersey and Massachusetts, the states hit hardest in the initial wave of fatalities. New York state has seen 376 deaths per 100,000 so far this year. By comparison, North Dakota has lost 125 out of 100,000, according to the CDC.

Health officials fear the crisis will be even worse in coming weeks, after many Americans ignored pleas to stay home over Thanksgiving and avoid people who don’t live with them.

“I have no doubt that we’re going to see a climbing death toll … and that’s a horrific and tragic place to be,” said Josh Michaud, associate director of global health policy at the Kaiser Family Foundation. “It’s going to be a very dark couple of weeks.”

November’s toll was far lower than the 60,699 recorded in April but perilously close to the next-highest total of almost 42,000 in May, according to data compiled by Johns Hopkins University. Deaths had dropped to just over 20,000 in June after states closed many businesses and ordered people to stay at home.

The fast-deteriorating situation is particularly frustrating because vaccine distribution could begin within weeks, Michaud said.

“Hospitals all around the country are worried on a day-to-day basis about their capacity … and we’re not really even into winter season and we haven’t seen the impact of Thanksgiving travel and Thanksgiving gatherings,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

The number of hospital beds is just one concern. Many hospitals are scrambling to find enough staff to care for patients as the virus surges almost everywhere at once, Adalja said.

“You can’t just say we’ll have doctors and nurses from other states come because those other states are also dealing with COVID patients,” he said.

The virus is blamed for over 268,000 deaths and more than 13.5 million confirmed infections in the United States. A record 96,000 people were in the hospital with the virus in the U.S. as of Monday. The U.S. is seeing on average more than 160,000 new cases per day and almost 1,470 deaths — equal to what the country was witnessing in mid-May.

The Associated Press contributed to this report.

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