JOHNSTON, Iowa (AP) – Iowa reported 143 nursing homes with coronavirus outbreaks on Tuesday, and thousands of residents have tested positive for the virus.

More than 4,500 residents of care centers are infected with the virus, according to the state Department of Public Health. State data shows 1,008 residents of long-term care facilities have died with COVID-19 in the past eight months.

The deteriorating situation for nursing homes is reflective of overall virus trends in Iowa, which on Tuesday reported 18 additional deaths. More than 500 people with COVID-19 have died in Iowa so far this month and 2,224 overall.

In the past 24 hours as of Tuesday morning, there were 3,860 additional confirmed cases.

The seven-day rolling average of daily deaths in Iowa has risen over the past two weeks from 15 deaths per day on Nov. 9 to more than 30 deaths per day on Nov. 23, according to researchers at Johns Hopkins University.

More than 1,350 people continue to be hospitalized in Iowa with the virus.