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States with the biggest nursing home outbreaks of COVID-19

States with the biggest nursing home outbreaks of COVID-19

More than 40% of all COVID-19 deaths in the U.S. have happened inside nursing homes. As much as 44% of those deaths could have been avoided had “cross traffic” among nursing home employees—those who work at multiple nursing homes—been curbed, according to research released at the end of July.

To examine nursing home outbreaks in different U.S. states, Stacker consulted a dataset from the COVID Tracking Project at the Atlantic, a volunteer project which compiles COVID-19 data from states’ public health departments. Forty-seven states and Washington D.C. currently report some form of data on outbreaks in nursing homes, assisted living facilities, and other long-term care facilities, according to the COVID Tracking Project’s Long-Term Care COVID Tracker.

Each state has a different reporting system and terminology for these outbreaks, which the COVID Tracking Project has standardized through consultation with public health experts. We have further standardized the dataset by compiling all nursing home and long-term care (LTC) cases into two figures: resident cases and staff cases. We have similarly compiled resident deaths and staff deaths. The 47 states and D.C. with available data are ranked here according to their total COVID-19 cases in long-term care facilities as of Aug. 20. Our story also includes the total numbers of COVID-19 cases, deaths, and tests conducted in each state as of Aug. 23, via the COVID Tracking Project’s main state dataset.

It is important to note that these rankings do not capture the full scale of the impact that COVID-19 has had on nursing home residents and staff in many states. State-reported data are often incomplete: while some states report cumulative cases and deaths from long-term care facilities, some only report those in current outbreaks, which are defined differently depending on the state. Also, some states only report total cases, some only report total deaths, and two (Missouri and Arizona) only report the number of outbreaks that have occurred in nursing homes. Montana, South Dakota, and Alaska do not report any data on COVID-19 in long-term care facilities.

New York state is one notable example of missing data: The state does not report the number of COVID-19 cases that have occurred in its nursing homes, so it is not ranked in this story. However, over 6,600 residents and staff of long-term care facilities have died of COVID-19 in the state—the second-highest LTC death toll of any state. And this number may be an undercount, according to reporting by the Associated Press. 

Keep reading to see which states have the biggest nursing home outbreaks of COVID-19.

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Editor's note: Betsy Ladyzhets, a research associate at Stacker who worked on this story, volunteers for the COVID-19 Tracking Project.

Arizona (not ranked)

State nursing home outbreaks as of August 20:
- Cases and deaths not available
- 499 outbreaks

Total state COVID-19 counts as of August 23:
- 198,103 cases (2,852 per 100,000 people, #3 highest)
- 4,771 deaths (68.7 per 100k, #9 highest)
- 1.2 million tests (16,567 per 100k, #12 lowest)

Missouri (not ranked)

State nursing home outbreaks as of August 20:
- Cases and deaths not available
- 427 outbreaks

Total state COVID-19 counts as of August 23:
- 75,075 cases (1,233 per 100,000 people, #17 lowest)
- 1,426 deaths (23.4 per 100k, #19 lowest)
- 914,833 tests (15,022 per 100k, #10 lowest)

New York (not ranked)

State nursing home outbreaks as of August 20:
- Cases not available
- 6,624 deaths (26.2% of all state deaths)
- 459 outbreaks

Total state COVID-19 counts as of August 23:
- 429,737 cases (2,190 per 100,000 people, #9 highest)
- 25,288 deaths (128.9 per 100k, #3 highest)
- 7.6 million tests (38,847 per 100k, #4 highest)

#45. Maine

State nursing home outbreaks as of August 20:
- 16 cases (0.4% of all state cases, 378 among residents, 245 among staff)
- 70 deaths (53.4% of all state deaths)
- 21 outbreaks

Total state COVID-19 counts as of August 23:
- 4,335 cases (325 per 100,000 people, #2 lowest)
- 131 deaths (9.8 per 100k, #7 lowest)
- 231,701 tests (17,384 per 100k, #17 lowest)

#44. Wyoming

State nursing home outbreaks as of August 20:
- 57 cases (1.6% of all state cases, 36 among residents, 21 among staff)
- 7 deaths (18.9% of all state deaths, 7 among residents)
- 5 outbreaks

Total state COVID-19 counts as of August 23:
- 3,579 cases (615 per 100,000 people, #7 lowest)
- 37 deaths (6.4 per 100k, #3 lowest)
- 64,892 tests (11,153 per 100k, #1 lowest)

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#43. Hawaii

State nursing home outbreaks as of August 20:
- 70 cases (1.1% of all state cases, 34 among residents, 36 among staff)
- 4 deaths (8.5% of all state deaths)
- 19 outbreaks

Total state COVID-19 counts as of August 23:
- 6,356 cases (447 per 100,000 people, #3 lowest)
- 47 deaths (3.3 per 100k, #1 lowest)
- 176,184 tests (12,390 per 100k, #3 lowest)

#42. Vermont

State nursing home outbreaks as of August 20:
- 176 cases (11.3% of all state cases, 108 among residents, 68 among staff)
- 32 deaths (55.2% of all state deaths, 32 among residents)
- 12 outbreaks

Total state COVID-19 counts as of August 23:
- 1,557 cases (249 per 100,000 people, #1 lowest)
- 58 deaths (9.3 per 100k, #5 lowest)
- 120,043 tests (19,208 per 100k, #25 lowest)

#41. West Virginia

State nursing home outbreaks as of August 20:
- 806 cases (8.7% of all state cases, 478 among residents, 328 among staff)
- 71 deaths (39.9% of all state deaths)
- 123 outbreaks

Total state COVID-19 counts as of August 23:
- 9,272 cases (507 per 100,000 people, #4 lowest)
- 178 deaths (9.7 per 100k, #6 lowest)
- 396,193 tests (21,661 per 100k, #17 highest)

#40. Washington D.C.

State nursing home outbreaks as of August 20:
- 1,051 cases (7.7% of all state cases, 707 among residents, 344 among staff)
- 169 deaths (28.0% of all state deaths, 162 among residents, 7 among staff)
- 18 outbreaks

Total state COVID-19 counts as of August 23:
- 13,590 cases (1,985 per 100,000 people, #14 highest)
- 604 deaths (88.2 per 100k, #7 highest)
- 266,046 tests (38,867 per 100k, #3 highest)

#39. North Dakota

State nursing home outbreaks as of August 20:
- 1,060 cases (10.7% of all state cases, 438 among residents, 622 among staff)
- 72 deaths (64.3% of all state deaths)
- 120 outbreaks

Total state COVID-19 counts as of August 23:
- 9,876 cases (1,313 per 100,000 people, #23 lowest)
- 112 deaths (14.9 per 100k, #11 lowest)
- 190,885 tests (25,377 per 100k, #13 highest)

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#38. Kansas

State nursing home outbreaks as of August 20:
- 1,382 cases (3.7% of all state cases)
- 197 deaths (47.0% of all state deaths)
- 102 outbreaks

Total state COVID-19 counts as of August 23:
- 36,856 cases (1,267 per 100,000 people, #19 lowest)
- 419 deaths (14.4 per 100k, #10 lowest)
- 366,315 tests (12,593 per 100k, #4 lowest)

#37. New Mexico

State nursing home outbreaks as of August 20:
- 1,522 cases (6.3% of all state cases, 881 among residents, 641 among staff)
- 259 deaths (34.9% of all state deaths, 255 among residents, 4 among staff)

Total state COVID-19 counts as of August 23:
- 24,302 cases (1,161 per 100,000 people, #16 lowest)
- 743 deaths (35.5 per 100k, #22 highest)
- 705,162 tests (33,701 per 100k, #6 highest)

#36. Wisconsin

State nursing home outbreaks as of August 20:
- 1,653 cases (2.2% of all state cases, 1,653 among residents)
- 403 deaths (37.0% of all state deaths, 403 among residents)
- 602 outbreaks

Total state COVID-19 counts as of August 23:
- 75,205 cases (1,301 per 100,000 people, #21 lowest)
- 1,089 deaths (18.8 per 100k, #15 lowest)
- 1.2 million tests (20,600 per 100k, #21 highest)

#35. Nebraska

State nursing home outbreaks as of August 20:
- 1,666 cases (5.2% of all state cases, 875 among residents, 791 among staff)
- 172 deaths (45.7% of all state deaths, 172 among residents)
- 216 outbreaks

Total state COVID-19 counts as of August 23:
- 31,780 cases (1,668 per 100,000 people, #23 highest)
- 376 deaths (19.7 per 100k, #16 lowest)
- 338,361 tests (17,764 per 100k, #19 lowest)

#34. Idaho

State nursing home outbreaks as of August 20:
- 1,668 cases (5.6% of all state cases)
- 138 deaths (45.1% of all state deaths)
- 137 outbreaks

Total state COVID-19 counts as of August 23:
- 29,662 cases (1,757 per 100,000 people, #19 highest)
- 306 deaths (18.1 per 100k, #12 lowest)
- 237,280 tests (14,058 per 100k, #7 lowest)

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#33. Delaware

State nursing home outbreaks as of August 20:
- 1,695 cases (10.0% of all state cases, 1,234 among residents, 461 among staff)
- 363 deaths (60.5% of all state deaths, 362 among residents, 1 among staff)

Total state COVID-19 counts as of August 23:
- 16,895 cases (1,779 per 100,000 people, #18 highest)
- 600 deaths (63.2 per 100k, #11 highest)
- 221,845 tests (23,365 per 100k, #14 highest)

#32. Oregon

State nursing home outbreaks as of August 20:
- 1,814 cases (7.3% of all state cases)
- 209 deaths (50.1% of all state deaths, , 1 among staff)
- 119 outbreaks

Total state COVID-19 counts as of August 23:
- 24,937 cases (611 per 100,000 people, #6 lowest)
- 417 deaths (10.2 per 100k, #8 lowest)
- 519,820 tests (12,735 per 100k, #5 lowest)

#31. Utah

State nursing home outbreaks as of August 20:
- 2,120 cases (4.3% of all state cases, 1,128 among residents, 992 among staff)
- 176 deaths (45.7% of all state deaths, 176 among residents)
- 363 outbreaks

Total state COVID-19 counts as of August 23:
- 49,115 cases (1,613 per 100,000 people, #24 highest)
- 385 deaths (12.6 per 100k, #9 lowest)
- 624,836 tests (20,518 per 100k, #23 highest)

#30. New Hampshire

State nursing home outbreaks as of August 20:
- 2,157 cases (30.4% of all state cases)
- 348 deaths (81.1% of all state deaths)

Total state COVID-19 counts as of August 23:
- 7,107 cases (529 per 100,000 people, #5 lowest)
- 429 deaths (31.9 per 100k, #25 lowest)
- 196,064 tests (14,592 per 100k, #8 lowest)

#29. Iowa

State nursing home outbreaks as of August 20:
- 2,355 cases (4.2% of all state cases)
- 544 deaths (52.5% of all state deaths)

Total state COVID-19 counts as of August 23:
- 56,275 cases (1,796 per 100,000 people, #17 highest)
- 1,036 deaths (33.1 per 100k, #24 highest)
- 581,976 tests (18,579 per 100k, #22 lowest)

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#28. Nevada

State nursing home outbreaks as of August 20:
- 2,515 cases (3.8% of all state cases, 1,517 among residents, 998 among staff)
- 207 deaths (17.3% of all state deaths, 202 among residents, 5 among staff)
- 124 outbreaks

Total state COVID-19 counts as of August 23:
- 65,601 cases (2,244 per 100,000 people, #8 highest)
- 1,197 deaths (41.0 per 100k, #20 highest)
- 574,229 tests (19,646 per 100k, #26 lowest)

#27. Oklahoma

State nursing home outbreaks as of August 20:
- 2,949 cases (5.5% of all state cases, 1,893 among residents, 1,056 among staff)
- 300 deaths (41.3% of all state deaths)
- 258 outbreaks

Total state COVID-19 counts as of August 23:
- 53,165 cases (1,357 per 100,000 people, #25 lowest)
- 726 deaths (18.5 per 100k, #13 lowest)
- 812,500 tests (20,737 per 100k, #20 highest)

#26. Rhode Island

State nursing home outbreaks as of August 20:
- 2,960 cases (14.1% of all state cases, 2,960 among residents)
- 800 deaths (77.7% of all state deaths, 800 among residents)
- 65 outbreaks

Total state COVID-19 counts as of August 23:
- 21,022 cases (1,990 per 100,000 people, #13 highest)
- 1,030 deaths (97.5 per 100k, #6 highest)
- 454,977 tests (43,060 per 100k, #2 highest)

#25. Arkansas

State nursing home outbreaks as of August 20:
- 3,021 cases (5.3% of all state cases, 1,794 among residents, 1,227 among staff)
- 184 deaths (26.8% of all state deaths, 182 among residents, 2 among staff)
- 156 outbreaks

Total state COVID-19 counts as of August 23:
- 56,574 cases (1,892 per 100,000 people, #15 highest)
- 687 deaths (23.0 per 100k, #18 lowest)
- 665,700 tests (22,259 per 100k, #16 highest)

#24. Minnesota

State nursing home outbreaks as of August 20:
- 4,193 cases (6.0% of all state cases, 4,193 among residents)
- 1,298 deaths (71.6% of all state deaths, 1,298 among residents)

Total state COVID-19 counts as of August 23:
- 69,584 cases (1,259 per 100,000 people, #18 lowest)
- 1,813 deaths (32.8 per 100k, #26 lowest)
- 1.1 million tests (19,183 per 100k, #24 lowest)

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#23. Mississippi

State nursing home outbreaks as of August 20:
- 4,578 cases (5.9% of all state cases, 4,578 among residents)
- 922 deaths (41.2% of all state deaths, 922 among residents)

Total state COVID-19 counts as of August 23:
- 77,894 cases (2,606 per 100,000 people, #4 highest)
- 2,240 deaths (74.9 per 100k, #8 highest)
- 534,248 tests (17,875 per 100k, #20 lowest)

#22. Kentucky

State nursing home outbreaks as of August 20:
- 4,800 cases (11.0% of all state cases, 3,020 among residents, 1,780 among staff)
- 515 deaths (58.5% of all state deaths, 510 among residents, 5 among staff)
- 287 outbreaks

Total state COVID-19 counts as of August 23:
- 43,529 cases (980 per 100,000 people, #11 lowest)
- 881 deaths (19.8 per 100k, #17 lowest)
- 749,731 tests (16,885 per 100k, #15 lowest)

#21. Tennessee

State nursing home outbreaks as of August 20:
- 5,033 cases (3.5% of all state cases, 2,607 among residents, 2,426 among staff)
- 382 deaths (24.4% of all state deaths, 382 among residents)
- 363 outbreaks

Total state COVID-19 counts as of August 23:
- 143,937 cases (2,164 per 100,000 people, #10 highest)
- 1,567 deaths (23.6 per 100k, #20 lowest)
- 2.0 million tests (30,750 per 100k, #7 highest)

#20. South Carolina

State nursing home outbreaks as of August 20:
- 6,018 cases (5.4% of all state cases, 4,026 among residents, 1,992 among staff)
- 895 deaths (35.7% of all state deaths, 885 among residents, 10 among staff)
- 330 outbreaks

Total state COVID-19 counts as of August 23:
- 111,988 cases (2,260 per 100,000 people, #7 highest)
- 2,504 deaths (50.5 per 100k, #16 highest)
- 892,336 tests (18,005 per 100k, #21 lowest)

#19. Washington

State nursing home outbreaks as of August 20:
- 6,090 cases (8.6% of all state cases)
- 951 deaths (51.2% of all state deaths)
- 571 outbreaks

Total state COVID-19 counts as of August 23:
- 70,595 cases (968 per 100,000 people, #10 lowest)
- 1,857 deaths (25.5 per 100k, #22 lowest)
- 1.0 million tests (13,993 per 100k, #6 lowest)

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#18. Colorado

State nursing home outbreaks as of August 20:
- 6,280 cases (11.4% of all state cases, 3,506 among residents, 2,774 among staff)
- 981 deaths (54.0% of all state deaths, 974 among residents, 7 among staff)
- 190 outbreaks

Total state COVID-19 counts as of August 23:
- 54,883 cases (992 per 100,000 people, #13 lowest)
- 1,815 deaths (32.8 per 100k, #25 highest)
- 930,152 tests (16,817 per 100k, #14 lowest)

#17. Alabama

State nursing home outbreaks as of August 20:
- 7,301 cases (6.3% of all state cases, 4,779 among residents, 2,522 among staff)
- 770 deaths (38.3% of all state deaths, 770 among residents)

Total state COVID-19 counts as of August 23:
- 115,060 cases (2,365 per 100,000 people, #6 highest)
- 2,013 deaths (41.4 per 100k, #19 highest)
- 921,669 tests (18,946 per 100k, #23 lowest)

#16. California

State nursing home outbreaks as of August 20:
- 7,811 cases (1.2% of all state cases, 22,571 among residents, 16,631 among staff)
- 822 deaths (6.8% of all state deaths, 3,826 among residents, 140 among staff)
- 1,506 outbreaks

Total state COVID-19 counts as of August 23:
- 663,669 cases (1,695 per 100,000 people, #22 highest)
- 12,134 deaths (31.0 per 100k, #24 lowest)
- 10.5 million tests (26,926 per 100k, #11 highest)

#15. Virginia

State nursing home outbreaks as of August 20:
- 8,964 cases (7.9% of all state cases)
- 1,311 deaths (53.1% of all state deaths)
- 368 outbreaks

Total state COVID-19 counts as of August 23:
- 112,966 cases (1,343 per 100,000 people, #24 lowest)
- 2,467 deaths (29.3 per 100k, #23 lowest)
- 1.5 million tests (17,482 per 100k, #18 lowest)

#14. Indiana

State nursing home outbreaks as of August 20:
- 9,889 cases (11.5% of all state cases, 6,984 among residents, 2,905 among staff)
- 1,719 deaths (53.4% of all state deaths, 1,719 among residents)
- 528 outbreaks

Total state COVID-19 counts as of August 23:
- 85,932 cases (1,295 per 100,000 people, #20 lowest)
- 3,220 deaths (48.5 per 100k, #18 highest)
- 977,802 tests (14,732 per 100k, #9 lowest)

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#13. Connecticut

State nursing home outbreaks as of August 20:
- 10,222 cases (19.8% of all state cases, 9,892 among residents, 330 among staff)
- 3,249 deaths (72.8% of all state deaths, 3,246 among residents, 3 among staff)
- 266 outbreaks

Total state COVID-19 counts as of August 23:
- 51,519 cases (1,438 per 100,000 people, #26 lowest)
- 4,460 deaths (124.5 per 100k, #4 highest)
- 1.0 million tests (28,546 per 100k, #10 highest)

#12. North Carolina

State nursing home outbreaks as of August 20:
- 10,849 cases (7.0% of all state cases)
- 1,216 deaths (48.0% of all state deaths)
- 293 outbreaks

Total state COVID-19 counts as of August 23:
- 155,113 cases (1,527 per 100,000 people, #25 highest)
- 2,531 deaths (24.9 per 100k, #21 lowest)
- 2.1 million tests (20,466 per 100k, #24 highest)

#11. Michigan

State nursing home outbreaks as of August 20:
- 12,251 cases (11.5% of all state cases, 8,042 among residents, 4,209 among staff)
- 2,109 deaths (31.7% of all state deaths, 2,088 among residents, 21 among staff)
- 442 outbreaks

Total state COVID-19 counts as of August 23:
- 106,808 cases (1,073 per 100,000 people, #15 lowest)
- 6,659 deaths (66.9 per 100k, #10 highest)
- 2.5 million tests (25,443 per 100k, #12 highest)

#10. Maryland

State nursing home outbreaks as of August 20:
- 14,742 cases (14.2% of all state cases)
- 2,091 deaths (56.7% of all state deaths)

Total state COVID-19 counts as of August 23:
- 104,102 cases (1,734 per 100,000 people, #20 highest)
- 3,691 deaths (61.5 per 100k, #13 highest)
- 1.2 million tests (20,537 per 100k, #22 highest)

#9. Florida

State nursing home outbreaks as of August 20:
- 14,916 cases (2.5% of all state cases, 9,985 among residents, 4,931 among staff)
- 1,351 outbreaks

Total state COVID-19 counts as of August 23:
- 600,571 cases (2,916 per 100,000 people, #2 highest)
- 10,462 deaths (50.8 per 100k, #15 highest)
- 4.4 million tests (21,500 per 100k, #18 highest)

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#8. Louisiana

State nursing home outbreaks as of August 20:
- 15,963 cases (11.2% of all state cases, 10,425 among residents, 5,538 among staff)
- 1,965 deaths (41.4% of all state deaths, 1,965 among residents)
- 446 outbreaks

Total state COVID-19 counts as of August 23:
- 142,943 cases (3,065 per 100,000 people, #1 highest)
- 4,746 deaths (101.8 per 100k, #5 highest)
- 1.8 million tests (37,821 per 100k, #5 highest)

#7. Ohio

State nursing home outbreaks as of August 20:
- 16,096 cases (14.0% of all state cases, 10,376 among residents, 5,720 among staff)
- 2,195 deaths (55.2% of all state deaths, 2,195 among residents)
- 960 outbreaks

Total state COVID-19 counts as of August 23:
- 114,802 cases (986 per 100,000 people, #12 lowest)
- 3,978 deaths (34.2 per 100k, #23 highest)
- 2.0 million tests (17,041 per 100k, #16 lowest)

#6. Georgia

State nursing home outbreaks as of August 20:
- 18,208 cases (7.2% of all state cases, 12,092 among residents, 6,116 among staff)
- 2,068 deaths (40.3% of all state deaths, 2,068 among residents)
- 625 outbreaks

Total state COVID-19 counts as of August 23:
- 253,949 cases (2,466 per 100,000 people, #5 highest)
- 5,132 deaths (49.8 per 100k, #17 highest)
- 2.2 million tests (21,091 per 100k, #19 highest)

#5. Texas

State nursing home outbreaks as of August 20:
- 23,974 cases (4.2% of all state cases, 23,974 among residents)
- 3,440 deaths (30.3% of all state deaths, 3,440 among residents)
- 1,584 outbreaks

Total state COVID-19 counts as of August 23:
- 577,537 cases (2,071 per 100,000 people, #12 highest)
- 11,370 deaths (40.8 per 100k, #21 highest)
- 4.7 million tests (16,740 per 100k, #13 lowest)

#4. Massachusetts

State nursing home outbreaks as of August 20:
- 24,551 cases (19.6% of all state cases)
- 5,693 deaths (63.8% of all state deaths)
- 379 outbreaks

Total state COVID-19 counts as of August 23:
- 125,360 cases (1,835 per 100,000 people, #16 highest)
- 8,921 deaths (130.6 per 100k, #2 highest)
- 1.6 million tests (22,747 per 100k, #15 highest)

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#3. Pennsylvania

State nursing home outbreaks as of August 20:
- 24,837 cases (19.2% of all state cases, 20,522 among residents, 4,315 among staff)
- 5,107 deaths (67.4% of all state deaths)
- 905 outbreaks

Total state COVID-19 counts as of August 23:
- 129,048 cases (1,009 per 100,000 people, #14 lowest)
- 7,578 deaths (59.2 per 100k, #14 highest)
- 1.6 million tests (12,141 per 100k, #2 lowest)

#2. Illinois

State nursing home outbreaks as of August 20:
- 25,921 cases (11.7% of all state cases)
- 4,305 deaths (53.2% of all state deaths)
- 742 outbreaks

Total state COVID-19 counts as of August 23:
- 221,595 cases (1,728 per 100,000 people, #21 highest)
- 8,089 deaths (63.1 per 100k, #12 highest)
- 3.7 million tests (28,900 per 100k, #9 highest)

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#1. New Jersey

State nursing home outbreaks as of August 20:
- 37,782 cases (19.9% of all state cases, 24,676 among residents, 13,106 among staff)
- 6,818 deaths (42.8% of all state deaths, 6,698 among residents, 120 among staff)
- 634 outbreaks

Total state COVID-19 counts as of August 23:
- 189,494 cases (2,133 per 100,000 people, #11 highest)
- 15,946 deaths (179.5 per 100k, #1 highest)
- 2.6 million tests (29,825 per 100k, #8 highest)

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