SIOUX FALLS, S.D. (AP) — South Dakota health officials on Sunday confirmed 23 deaths in the last day due to complications from the coronavirus.

The update lifted the total number of fatalities to 168 in January and 1,656 since the start of the pandemic. The death toll is the 40th highest in the country overall and the fifth highest per capita at about 185 deaths per 100,000 people, according to Johns Hopkins University researchers.

Six of the deaths reported Sunday were from Pennington County, in western South Dakota. There were three deaths confirmed in both Minnehaha and Brown counties and two in Lawrence County.

The state reported 266 positive tests since Saturday, for a total of 94,557 confirmed cases statewide. South Dakota ranks 39th in the country for new cases per capita over the last two weeks. One in every 371 people in South Dakota tested positive in the past week, researchers said.

Health officials say the state had administered 56,625 doses of the COVID-19 vaccine to 46,79 people as of Sunday.

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.