Concerns over the rapid spread of COVID-19 in Minnesota keep building as the state on Saturday smashed the one-month record for deaths amid high case counts and pleas from health officials to curb the increase in cases so hospitals don’t become overwhelmed.

The state reported on Saturday another 51 deaths from COVID-19, pushing total fatalities reported in November to 744 — well beyond the previous one-month peak of 696 deaths in May.

Health officials say high counts for deaths and serious illnesses remain likely given the case surge in recent weeks. The state reported 6,265 new infections on Saturday, which resulted in the first decline in the seven-day average for new cases since Oct. 26, according to the Star Tribune’s coronavirus tracker.

A four-week shutdown of bars, restaurants, entertainment venues and fitness centers started Friday amid worries from health care leaders about the ongoing surge of patients. Hospitals are struggling because so many health care workers are either sick themselves, are out caring for someone at home or have been quarantined due to exposures in the community.

A recent survey suggests the number of hospital health care workers sidelined by the virus grew by about 11% over the past week, said Dr. Rahul Koranne, president of the Minnesota Hospital Association. November has seen a significant increase, he added, in the share of general hospital and ICU beds occupied by COVID-19 patients.

“Those three things add up to a very worrisome scenario if we don’t break the back of this virus now,” Koranne said.

Although numbers reported Saturday suggest some moderation in the recent growth rate for new hospital and ICU admissions, doctors say health care workers already are under significant stress.

“All the people working on the front lines have been doing that for nine months now,” Dr. Cindy Firkins Smith, co-CEO of Carris Health, said during a Thursday news conference with Gov. Tim Walz. “They’re sick of this virus ... just like everybody else and beyond that they’re exhausted.”

“And we don’t have anybody to replace them,” added Smith, whose health system includes hospitals and clinics in west-central and southwest Minnesota. “There’s no calling New York. There’s no calling Texas. There’s no calling the Twin Cities. There’s no calling anywhere to get help.”

North Dakota and South Dakota once again held the top two spots in the nation on Saturday for recent population-adjusted case growth followed by Iowa (No. 4) and Wisconsin (No. 7), according to a tracking website from Brown University.

Minnesota pushed ahead of Wisconsin in the ranking, moving up two spots from last Saturday to No. 6.

Colder weather, drier conditions and the movement of people indoors have fueled the spread of the virus across the Upper Midwest, said Dr. Jonathan Temte, an associate dean at the University of Wisconsin School of Medicine and Public Health. Recently expanded health measures and growing concern over the pandemic could slow the spread, Temte said, but any plateau in new cases likely would hold “at a very high rate here for the next few months.”

He worries about the potential for more spread with the coming holidays, even as health authorities recommend celebrating Thanksgiving just with the people you live with at home.

“Will everybody adhere to that? No, they won’t,” Temte said. “But if many people do, it has a big effect. The way to think about this is ‘What’s the average behavior, what’s the average contact people have?’ and if you can shift that average up or down it has some effect, particularly one or two weeks later.”

Minnesota has now reported 262,952 positive cases, 14,745 hospitalizations and 3,201 deaths since the pandemic arrived here in March. Of the deaths announced Saturday, 31 were residents of long-term care and assisted-living facilities, a group that’s seen 2,192 deaths since the start of the pandemic.

The state’s one-day count of 6,265 new cases came on a very high volume of about 52,025 newly completed tests. With the latest numbers, an average of about 13.5% of reported tests have been positive over the past week. That’s a high level, doctors say, but seven-day averages have leveled off over the past week or so after big increases in early November.