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The rate of new COVID-19 cases statewide has gone up steadily since about mid-July, when the seven-day average dropped below 30. Despite some fluctuations over the past month, that upward trend has continued.

COVID cases are continuing their rise as New Hampshire heads deeper into the fall.

“As of now, unlike the rest of the country, we are not seeing a dip in our numbers in New Hampshire,” Dr. Aalok Khole, an infectious disease specialist at Cheshire Medical Center in Keene, said in an email Friday. “Locally, we see the case counts going up too.”

The rate of new cases statewide has gone up steadily since about mid-July, when the seven-day average dropped below 30. And despite some fluctuations over the past month, that upward trend has continued.

The state was averaging 534 new cases per day as of Friday, up from 461 on Sept. 16 — a 16 percent increase.

That compares to an average of 77 cases per day at this time last year, as the previous fall/winter surge ramped up.

Another indicator of community spread, the share of tests coming back positive, also remains relatively high. The statewide seven-day average was 6.5 percent as of Friday, compared to 4.6 percent at the beginning of this month.

This latest surge has been fed by the rise of the more contagious delta variant and lower-than-hoped vaccination rates. A little under 55 percent of New Hampshire residents are fully vaccinated, a number that has hardly budged since early summer.

“I think delta is the difference, in terms of why it’s happening to the degree it’s happening, with vaccinations being there,” Cheshire Medical CEO Dr. Don Caruso said in a Sept. 23 interview with The Sentinel’s editorial board. “ ‘Cause you can say, ‘Why did it happen when ... 54 percent of our state is vaccinated?’ And a lot of it is delta. It’s way more contagious, and that’s really why.”

Public health officials have long encouraged vaccination as the most effective way to end the pandemic, and the data from New Hampshire continue to show that vaccinated people are more protected against illness, hospitalization and death.

Between Jan. 1 and Oct. 13 of this year, only 3.4 percent of known COVID cases, 7 percent of hospitalizations and 7.8 percent of COVID deaths have occurred in fully vaccinated people, according to the state health department. (All of those deaths have been among people who were 60 years or older, an age group that’s at higher risk for serious complications.)

According to data from Cheshire Medical Center, unvaccinated people have accounted for about 72 percent of positive COVID-19 tests taken by the hospital since July 20.

‘Substantial’ spread across New Hampshire

The N.H. Department of Health and Human Services currently considers all of New Hampshire to have “substantial” community spread, based on infections, hospitalizations and the rate of positive tests.

Cheshire County added 364 new cases over the past two weeks and had 246 active cases as of Friday. (Sullivan County — despite a smaller population — saw 489 new cases in the same period.)

There are two separate sources of data for local test rates. The state health department’s numbers put Cheshire County’s positivity rate at 3.9 percent as of Wednesday, as measured by a seven-day average.

Cheshire Medical Center also tracks the positivity rate for the tests it does. The hospital reported an 8.9 percent positivity rate for the week ending Oct. 7.

Hospital officials have said they believe the state data don’t fully capture the level of community spread in the Monadnock Region, as they include large numbers of people affiliated with Keene State College or other institutions who get tested regularly. The hospital data include people who get tested after coming down with symptoms, as well as asymptomatic people entering the hospital for procedures.

“We think we’re actually getting a better cut of the community, because we’re not testing the same people over and over again,” Caruso said in the Sept. 23 interview, noting that the hospital’s testing statistics have tended to predict COVID patient caseloads two weeks later.

New Hampshire’s hospitals held 140 confirmed COVID-19 patients as of Friday, according to state data.

The state announced the deaths of 22 Granite State residents due to COVID-19 in the past week. None lived in Cheshire County.

Khole said it’s key that everyone keep safety in mind as the weather cools.

“Projecting is hard, given the variation between us and the rest of the country, but the weather is getting colder and we know people are going to move indoors for gatherings as the temperatures continue to drop,” he said.

“However, with the respiratory virus season upon us, if we don’t comply with masking and vaccination guidance, this situation has a possibility of getting worse — not only from a COVID perspective but also from other respiratory viruses, potentially flu and RSV.”