Window Rock, Ariz. • Navajo Nation health officials on Monday reported 213 new COVID-19 cases and 15 more deaths.

In all, the tribe has now reported 18,163 cases and 682 knows deaths since the pandemic began.

The Navajo Department of Health now has identified 77 communities with uncontrolled spread of COVID-19 from Nov. 20 to Dec. 3.

Tribal officials said nearly all intensive care unit beds on the reservation are being used as coronavirus cases surge.

They warn that the tribe is nearing a point where health care workers will have to make difficult decisions about providing care with limited hospital resources.

Navajo Nation President Jonathan Nez said Sunday evening that there are few options to transport patients to other regional hospitals that are near full capacity.

“This second wave of COVID-19 is much more dire and much more severe than the first wave we had in April and May,” Nez said in a statement.

The tribe has extended its stay-at-home order though Dec. 28 in an attempt to stop the spread of the virus. The extension took effect Monday morning.

Officials have set up isolation sites at hotels where people who test positive for the virus can be housed and get clinical monitoring.