U.S. cases of the novel coronavirus were approaching 6 million on Sunday as many Midwest states reported increasing infections, according to a Reuters tally.
Iowa, North Dakota, South Dakota and Minnesota have recently reported record one-day increases in new cases while Montana and Idaho are seeing record numbers of currently hospitalized COVID-19 patients.
Nationally, metrics on new cases, deaths, hospitalizations and the positivity rates of tests are all declining but there are emerging hotspots in the Midwest.
Many of the new cases in Iowa are in the counties that are home to the University of Iowa and Iowa State University, which are holding some in-person classes. Colleges and universities around the country have seen outbreaks after students returned to campus, forcing some to switch to online-only learning.
Infections have also risen after an annual motorcycle rally in Sturgis, South Dakota drew more than 365,000 people from across the country from Aug. 7 to 16. The South Dakota health department said 88 cases have been traced to the rally.
More than eight months into the pandemic, the United States continues to struggle with testing, seeing the number of people tested fall in recent weeks.
Many health officials and at least 33 states have rejected the new COVID-19 testing guidance issued by the Trump administration last week that said those exposed to the virus and without symptoms may not need testing.
Public health officials believe the United States needs to test more frequently to find asymptomatic COVID-19 carriers to slow the spread of the disease.
While the United States has the most recorded infections in the world, it ranks tenth based on cases per capita, with Brazil, Peru and Chile having higher rates of infection, according to a Reuters tally.
The United States also has the most deaths in the world at over 182,000 and ranks 11th for deaths per capita, exceeded by Sweden, Brazil, Italy, Chile, Spain, the United Kingdom, Belgium and Peru.