Alaska, already the state with the country’s worst COVID-19 recent case rate, now also holds one of the country’s highest rates of recently reported deaths.

The state reported another 21 deaths Monday after adding 44 virus-related fatalities — many from last month — to the total last week.

The delta variant and the state’s sub-average vaccination rate are driving a rapid surge in new infections and taxing a hospital system made vulnerable by Alaska’s isolation from other states and the challenges of caring for patients at farflung medical facilities in rural communities off the road system.

Eighteen of the deaths reported Monday involved Alaskans and three involved out-of-state residents, according to the Alaska Department of Health and Social Services. Most were in September, though some of the deaths occurred in August and July, a spokesperson said.

At least two additional deaths aren’t yet included in the state tally. The City and Borough of Juneau on Monday reported the death of a local woman in her 50s Sunday and local man in his 60s on Monday.

Alaska reported a dramatically high number of deaths Friday, when 44 people who died from COVID-19 were added to the total. State officials explained that the high numbers were due at least in part to data backlogs. Most occurred in August but some were even earlier.

Alaska reported 7.9 deaths per 100,000 over the past week, according to the Centers for Disease Control. Nationally, only one state had a worse rate: West Virginia, reporting 8.5 deaths per 100,000.

Many states report coronavirus deaths based on when they happened. Alaska’s reports are based both on date of death and reporting date. So the state’s relatively high recent numbers are partly the result of backlogged data rather than all the deaths occurring last week.

Alaska’s per capita death rate over the entire pandemic remains among the best in the country if evaluated since January 2020. Only Vermont and Hawaii are better.

But the sudden spike in cases here has changed the overall equation.

Alaska’s case rate per capita is the highest in the nation, according to the Centers for Disease Control. The state’s 7-day case rate per 100,000 is almost 785, far ahead of West Virginia at 752.

Continually high numbers of COVID-19 patients are straining health care facilities around the state. Hospitals in Anchorage, already understaffed, say the crush of extremely ill people with the virus is maxing out emergency rooms and ICUs at times.

Last week, state officials announced they were enabling hospitals to enact crisis standards of care if necessary. That step is considered a worst-case scenario that allows hospitals to ration care due to equipment, bed or staffing limitations.

Providence Alaska Medical Center shifted to crisis-care mode earlier this month.

State officials also announced last week the state has signed a contract to bring nearly 500 health care workers from the Lower 48 to provide some relief.

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The $87 million contract with a company called DLH Solutions promises to bring 470 contracted health care workers to facilities around the state beginning as soon as this week. The workers will come in phases, hospital officials say. Exactly how many positions will be filled, and on what timeline, remained unconfirmed Monday.

The state reported a near-record of 215 people hospitalized with the virus as of Sunday. Friday was the only day that number was higher, at 217.

Alaska hospitals say their numbers are likely an undercount of the true impact of COVID-19, since they don’t include some long-term COVID-19 patients who no longer test positive but still need hospital care.

Health officials also reported a total of 3,878 new infections in residents over a 3-day period between Friday and Sunday, including a near-record of 1,575 resident cases reported for Sunday. Another 147 cases were reported in people from outside the state who tested positive in Alaska.

State epidemiologists say the daily case counts don’t necessarily translate to real time because of reporting and other backlogs. They expect to see roughly 1,000 cases a day once the state is through its backlog.

A total of 532 residents and 21 nonresidents have died from COVID-19 since March 2020.

Most of the hospitalizations are in people who aren’t vaccinated for the virus. As of Monday, 20 of the 23 COVID-positive people at Soldotna’s Central Peninsula Hospital — nearly half the facility’s total patients — were not vaccinated.

The state does not regularly publish data on the vaccination status of new cases, hospitalizations or deaths. That information is published on a monthly basis. In July, breakthrough infections in vaccinated people accounted for about a third of new infections. August’s data is not yet publicly available.

Getting vaccinated remains the best defense against serious illness and death, health authorities say. The July report found unvaccinated Alaskans were 7 1/2 times as likely to be hospitalized as vaccinated people.

As of Monday, 62.9% of eligible Alaskans had received at least one dose of vaccine and 58.9% were considered fully vaccinated. Alaska ranked 30th in the country for vaccination rates, a slight uptick since last week.

Statewide, 9.18% of the tests conducted last week came up positive for the virus. Health experts say anything over 5% indicates there isn’t enough testing going on.

This is a developing story and will be updated.