OMAHA, Neb. (AP) — The growth in the number of new COVID-19 cases in Nebraska has somewhat slowed down over the past week, but the number of people hospitalized with the virus remains high.

A total of 4,688 new cases of COVID-19 were reported in the state in the week that ended Thursday, according to the Omaha World-Herald’s analysis of data from the federal Centers for Disease Control and Prevention. Previously, the newspaper reported 4,707 new cases the week before and roughly 5,300 two weeks earlier.

Infectious disease Dr. James Lawler told the World-Herald that even though Nebraska might be seeing an overall decrease in the number of new cases, the federal data may not show the complete picture because the epicenter of the recent outbreak is shifting to rural areas where testing is not readily available.

“I think we’re going to see ups and downs and high levels of disease activity for many weeks forward,” he said. “It’s moving to places that haven’t experienced a big delta wave yet.”

The number of people hospitalized with the virus in the state hit 434 on Monday, according to the new state dashboard. That number has remained above 400 on all but two days since mid-September. Hospitalizations remain well below last November’s peak of 987, but hospital capacity is still strained because hospitals in the state are busy with non-COVID patients.

“The pandemic has not gone away,” said Lawler, who is one of the leaders of the University of Nebraska Medical Center’s Global Center for Health Security. “It’s still putting our hospitals under tremendous strain. The path out hasn’t changed — it’s vaccination first of all and continuing to implement (preventative measures) until we can reach an appropriate level of vaccination.”

Overall, 54.4% of Nebraskans are fully vaccinated, slightly below the national number of 55.3%. But vaccination rates vary widely across the state.

Many rural Nebraska counties report having fewer than 50% of their residents 12 and older vaccinated, and two counties — Logan and McPherson — say just 18% of their residents have been vaccinated. That compares with vaccination rates of 72% in Lancaster County and 71% in Douglas County in the state’s more urban cities of Lincoln and Omaha.