JUNEAU, Alaska (AP) — Alaska is facing “one of the sharpest surges” in COVID-19 in the country, the state epidemiologist said Thursday, adding that it’s not clear when the situation might stabilize.

“A lot of it’s going to depend on vaccination coverage rates” and measures such as masking, distancing and avoiding crowds, Dr. Joe McLaughlin told reporters.

Health officials said hospitals are stressed, with staffing and capacity issues. The state health department reported about 20% of patients hospitalized in Alaska have COVID-19.

McLaughlin said COVID-19 cases “really started to go up in early July, and we’re still on the upward trajectory.”

In late June, the state health department reported increasing statewide transmission following a period of daily case counts in the double-digits, though the test positivity rate remained low, at 1.2%.

Currently, most areas of the state are considered at high alert status, based on reported cases per 100,000 people over the past seven days. The average percentage of daily positive tests for the previous seven days was reported Thursday at 9.7%.

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McLaughlin said Alaska has one of the highest case rates in the nation right now.

The department, in a weekly COVID-19 report released Thursday, cited several factors as likely contributing to the current surge, including the highly contagious delta variant; the level to which people are masking, distancing or engaging in other mitigation efforts; vaccination rates and waning immunities, “both vaccine-induced and infection-induced immunity.”

Statewide, about 57% of residents 12 or older are fully vaccinated, according to the health department.

On Thursday, the Alaska Chamber announced the first winners of a weekly drawing intended to encourage people who haven’t been vaccinated to get vaccinated. The adult winner, Carin Kircher of Valdez, will get a $49,000 cash prize and the youth winner, Ethan Benton of Kodiak, will receive a $49,000 scholarship account, according to the chamber. Opportunities to enter continue through October.

There also will be a drawing for people who were vaccinated before Sept. 2. The deadline to enter for that is Oct. 30.

Alaska Gov. Mike Dunleavy, speaking to reporters on the last day of the special legislative session Tuesday, said he encouraged Alaskans to get vaccinated. On social media the next day, he said the state will continue fighting COVID-19 “on many fronts. However, my Administration will likewise ferociously defend the fundamental rights of every Alaskan.”

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On Thursday, Alaska Attorney General Treg Taylor joined with the attorneys general of 23 other states in a letter to President Joe Biden. Biden has directed the federal Occupational Safety and Health Administration to write a rule requiring employers with at least 100 workers to mandate that employees get vaccinated against COVID-19 or test weekly.

The attorneys general call the plan illegal and “likely to increase skepticism of vaccines.” If Biden doesn’t change course, they vowed to pursue legal options.

Biden, in response to threatened lawsuits, last week said: “Have at it.”

Meanwhile, Bartlett Regional Hospital in Juneau announced that as a condition of employment, staff must be vaccinated against COVID-19 by Dec. 15. The hospital, in a statement, said the terms apply to all employees and contract workers on the hospital campus.

According to the statement, 71 of the hospital’s 799 employees and medical staff are unvaccinated.