DES MOINES, Iowa (AP) — Iowa opened coronavirus vaccination to everyone age 16 and older on Monday, as the state dealt with increasing spread of the virus and a seven-day death rate that was among the highest in the nation.

State public health officials reported 68 more deaths on Sunday. Many of those people died weeks earlier because there is a delay between when someone dies and when the the National Center for Health Statistics processes the death certificate, attributes the death to COVID-19 and gets the information to Iowa.

The high figure on Sunday reflected a number of year-end reports received by the state, said Sarah Ekstrand, a spokeswoman for the Iowa Department of Public Health.

Iowa has seen 5,822 people die of COVID-19 and has the nation's 16th-highest overall coronavirus death rate at 184 deaths per 100,000 since the pandemic began, according to the U.S. Centers for Disease Control and Prevention.

In the last seven days, Iowa’s 104 deaths equated to 3.3 deaths per 100,000, the second-highest rate in the U.S. behind West Virginia’s 3.5 rate, according to the CDC.

State health officials reported 119 new confirmed positive cases in the previous 24 hours on Monday morning for a total of 381,926 cases. Iowa has the seventh-highest COVID-19 case rate in the nation at 11,184 cases per 100,000, according to the CDC.

The state positivity rate rose to 5.1% after remaining below 5% for most of the past few weeks.

State data indicates that 27% of the positive cases identified in the previous seven days were among young adults ages 18 to 29.

Iowa Department of Public Health Director Kelly Garcia last week attributed part of the increase to spring break travel and more contagious variants.

Nationally, public health officials are warning that a new surge could be coming and encouraged people to maintain social distancing in public places and to wear a mask.

Iowa Gov. Kim Reynolds has lifted state restrictions and seemed less concerned than CDC Director Rochelle Walensky and other national experts during her weekly news conference last Wednesday.

“Even now that virus activity in our state is as low as it's been in several months, while we have monitored a slight uptick in positivity rate, we've not seen evidence to suggest it's leading down a concerning path,” she said.

In Iowa, nearly 673,000 people, or 21.3% of the population, has been completely vaccinated. Iowa is 10th in the U.S., tied with Minnesota and New Jersey, for the percentage of total population vaccinated.