Pennsylvania’s coronavirus hospitalizations and new daily cases are the highest they have been since January, with the number of hospitalized patients increasing nearly 10% in a week and ICU beds getting increasingly full.

With heightened rates in central and western areas, still driven by the delta variant, Pennsylvania had the highest daily average number of coronavirus hospitalizations in the country Wednesday. Philadelphia and its suburbs are doing the best of all counties in the commonwealth — but still, Philadelphia is seeing its highest daily case totals since the spring.

More than 4,300 people statewide were hospitalized with the virus, and one county, Montour — home to Geisinger Medical Center — had the highest hospitalization rate in the United States on Wednesday.

Hospital beds in the county are at capacity, and “the post-Thanksgiving fallout” has exacerbated a death rate that was already on the rise, said Montour County Coroner Scott E. Lynn.

In the last week alone, 21 people there died of the virus — ranging in age from 2 days to 85 years old. Lynn and his staff processed their bodies at the county’s COVID-19 morgue — a mobile unit on the Geisinger campus that Lynn had hoped “would be gone by this point.”

“So far, the patterns are starting to mirror those patterns last year,” he said Wednesday. “It appears to us [to be] a tenuous period.”

With cases already on the rise before Thanksgiving, public health officials expected a spike after the holiday, driven by indoor gatherings. The current increases appear to be driven by the delta variant, Pennsylvania and New Jersey officials said. While the omicron variant has been found in both states, officials said it doesn’t make up a significant portion of new cases yet.

“It becomes quite obvious that we have experienced, as we expected and predicted, a post-Thanksgiving spike,” New Jersey Gov. Phil Murphy said. “There’s no other way really to look at these numbers. The combination of colder weather, going indoors, and then layering on top of that a uniquely American holiday — we believe that combination is driving what we’re seeing here.”

New Jersey has seen a smaller rise in hospitalizations but is recording its highest level since May and was up to 1,400 patients on Wednesday. Though it has lower case and hospitalization rates than many other states, average daily cases have increased 84% since two weeks ago, making it the state with the third-largest increase, according to New York Times data analysis.

Both states’ seven-day average numbers of new cases have been climbing since early November, state data show. Pennsylvania’s was 7,730 on Tuesday, the highest since mid-January, when most people hadn’t been vaccinated. New Jersey averaged 3,852 new daily cases on Tuesday, the highest level since April.

Nationwide, a handful of states are seeing sharper increases, particularly in the Northeast and Midwest. The case rate per 100,000 people for the United States was 36 on Tuesday, lower than New Jersey at 43 and Pennsylvania at 60, according to the Times data.

People who are not fully vaccinated — in Pennsylvania, about 40% of residents — have made up the majority of those hospitalized or dying, but vaccinated people can also get sick with breakthrough cases. Pennsylvania has no data available on what portion of the cases in the last month are among vaccinated residents, but in Montour County, the coroner said most deaths were of unvaccinated or partially vaccinated people.

“We believe an increase in cases will continue, not just because of Thanksgiving, but because of the roll into the next holiday, which includes shopping, parties, social gatherings, and family gatherings,” said Chester County health director Jeanne Franklin.

‘A lot of concern’

Montour, Northumberland, and Columbia Counties had the highest hospitalization rates in the country Wednesday, according to New York Times data analysis, and many Western Pennsylvania counties were within the top few dozen.

In Northumberland County, Sunbury officials closed their city offices last Friday to prevent the spread of the virus after a few employees tested positive, said City Administrator Derrick Backer.

“Our local hospitals are at capacity right now,” he said Wednesday. “There’s a lot of concern — if we don’t mitigate the spread within the community and the county, we [could] burden our hospitals even more so than they already are.”

Though rates in this region are lower, cases around Philadelphia have also been increasing.

“The trends are unsettling,” said Delaware County medical director Lisa O’Mahony.

Philadelphia has been reporting more than 450 cases a day on average, a high for the summer and fall, health department spokesperson James Garrow said Tuesday.

Aside from gatherings, other factors also likely contribute to the spike, including less masking or social distancing, the possibility that some people delayed testing until after Thanksgiving, or the possibility that people who have not had boosters are experiencing waning immunity, a Pennsylvania Department of Health spokesperson said Wednesday.

Garrow, Murphy, and others stressed that the threat remains delta, which has caused, on average in the last week, more than 11,000 new cases and more than 100 deaths a day combined in Pennsylvania and New Jersey.

In New Jersey, the percent positivity is highest in South Jersey, where more than 11% of tests are coming back positive, health officials said, and hospital staffing remains a concern due to a number of factors, including burnout.

State health officials are concerned by the increase, Pennsylvania Department of Health spokesperson Mark O’Neill said Wednesday. The “overwhelming majority” of cases have been linked to the delta variant, putting people who have not had two or three vaccine doses at a much higher risk, he said.

» READ MORE: Omicron has fueled even more COVID-19 misinformation as scientists wait to learn more

Hope for boosters

So far, the holidays, employer mandates, and concern about omicron have helped drive a slight increase in vaccinations, according to the region’s health department directors.

The vaccines’ effect in mitigating the winter spread is also being seen, officials said. Last year, when the vaccines weren’t available, the post-Thanksgiving spike was much higher.

Montgomery County medical director Richard Lorraine said both the rate of spread is slower and the number of cases is lower, possibly showing the effect of increased population immunity due to both vaccination and natural immunity.

Still, officials say they’d like to see more come to vaccine clinics — particularly as early information emerges about the omicron variant. On Wednesday, Pfizer-BioNTech said a booster of its vaccine appears to protect against the variant, after a study provided evidence that omicron may be able to evade the immune protection that comes with only two vaccine doses.

» READ MORE: All adults should get boosters, CDC says amid omicron worries. Here’s how to tell if it’s time for an appointment.

For now, officials believe the exponential case spread is likely to continue. They’ve urged caution as the world waits to learn more about omicron and have said taking precautions now could help tamp down case counts in the coming weeks.

“If everyone in Philadelphia gets vaccinated, wears their mask, and limits their exposure to others,” Garrow said, “we are confident that we will avoid” more severe spikes.