FARGO — The region’s rise in new coronavirus infections is straining testing capacity at Sanford Health, where specimens from lower-priority cases are being sent to outside laboratories for analysis.

Sanford is struggling to keep up with testing demand, and is sending Fargo specimens of less-urgent cases to labs run by the North Dakota Department of Health and Minnesota's Mayo Clinic.

“The demand has really been through the roof,” Dr. Avish Nagpal, an infectious disease specialist at Sanford, said Friday, July 17.

Last week, Sanford received 2,700 swabs per day for COVID-19 testing, a number exceeding its in-house testing capacity of 1,600 per day at its hubs in Fargo, Bismarck, Sioux Falls, S.D., and Bemidji, Minn.

North Dakota reported 124 new coronavirus infection cases on Friday, including 37 in Cass County and 25 in Burleigh County. North Dakota has reported 4,792 cases, 799 of which remained active, a new record.

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Among the new cases reported Friday, 3% of tests administered were positive, according to state figures.

Also Friday, North Dakota reported its 90th death from COVID-19, a woman in her 80s from Morton County.

Despite the steady rise in cases and the record number of active cases, the state remains at low risk from the coronavirus, according to the North Dakota Department of Health. That risk level allows businesses to stay open, with certain restrictions, including capacity reductions.

But Covid Act Now, a coronavirus pandemic modeling group, has determined that North Dakota is at high risk of an outbreak. The group estimates that each person in the state who is infected by the coronavirus transmits the virus to an average of 1.26 others, which the group deems a high infection rate.

“As such, the total number of active cases in North Dakota is growing at an unsustainable rate,” according to Covid Act Now, a partnership with Georgetown University Center for Global Health Science and Security, Stanford University Clinical Excellence Research Center and Grand Rounds. “Caution is warranted.”

North Dakota’s cumulative positive testing rate is 5.5%, a medium risk, and its intensive care unit utilization rate is estimated at 10%, a low level, indicating the state likely would withstand a new wave of cases, according to Covid Act Now.

North Dakota was one of nine states listed by The New York Times on Friday where coronavirus cases are rising the fastest.

Most of Sanford’s tests are analyzed by high-capacity machines at its central reference lab in Sioux Falls, but centers in Fargo, Bismarck and Bemidji also have smaller machines for rapid test results, Nagpal said.

The spike in test demand stems from multiple factors, including the surge in infections throughout most of the country, the presentation of patients who have symptoms similar to COVID-19 but are caused by other viruses, and routine preoperative testing.

“All of these factors have contributed to increased testing demand,” Nagpal said.

Sanford recently received two more high-capacity test-analyzing machines that were ordered in April. Technicians are preparing the machines, including testing to validate that results are accurate, and they should be ready for use by the end of the month, he said.

The new machines, located in Sioux Falls, will double Sanford’s testing capacity.

“We’re trying to ramp up our capacity,” Nagpal said. Testing turnaround times, now averaging three to four days, are expected to decrease when capacity increases, he said.

Both Sanford and Essentia Health use in-house labs for rapid test results, which are available in 45 minutes, for symptomatic patients in the emergency room or admitted to a hospital.

“At Essentia Health we are currently using in-house labs in each of our hospitals to perform rapid tests for those facilities,” said Tara Ekren, an Essentia spokeswoman.

“While we are able to keep up with demand for these tests, testing supplies for these platforms are in short supply nationally,” she said. “Our supplies are on allocation from the vendor and do not have a consistent delivery schedule.”

For other routine coronavirus tests, Essentia sends specimens to Mayo Clinic. “The turnaround time for these tests is currently running about five days due to the increased demand on Mayo,” Ekren said.

Sanford’s testing supplies are adequate so far, Nagpal said.

Testing companies are working on tests that will enable the same specimen to be analyzed for both the coronavirus and influenza, which will help expedite diagnoses when the pandemic will overlap with flu season, Nagpal said.