The number of people hospitalized with COVID-19 in Maine on Monday dropped below 200 for the first time in 18 days, a small sign that the delta variant-fueled surge may be receding.

Of the 192 who are currently in a hospital with the virus, 61 are in critical care, the lowest total in a month, and 21 are on ventilators, the lowest since mid-August.

Although hospitalizations have decreased steadily from a pandemic peak of 235 on Sept. 25, they remain at a high level and many hospitals across the state are still strained.

Nevertheless, Maine Center for Disease Control and Prevention Director Dr. Nirav Shah said Monday that the decrease could be a sign of better days ahead. He said many states that were ravaged by the delta variant earlier in the summer have seen signs of improvement.

The number of hospitalizations nationwide has dropped to about 76,000 on average, down from slightly more than 100,000 this time last month, according to the New York Times.

Cases have started to come down as well. As of Saturday, the seven-day average for new cases in the U.S. was just over 100,000, a 28 percent decrease from 138,000 on average two weeks earlier, according to the U.S. CDC.

“Let’s hope that easing works its way to Maine,” Shah said on “Maine Calling,” Maine Public’s call-in radio show.

But Shah also stressed that Maine still has a high degree of control over what happens, and he said the “biggest factor is how many people get vaccinated.”

Hospital leaders in Maine aren’t cheering the decrease just yet.

Dr. David McDermott, vice president of medical affairs for two Northern Light hospitals in Piscataquis County, said the small decrease in COVID-19 hospitalizations has him, “cautiously optimistic but not yet breathing a sigh of relief.” The reason for that, he said, is that the official numbers don’t tell the whole story.

“We’re still seeing tremendous demand for hospital based care,” McDermott explained. “We have patients here who are in the hospital and were hospitalized with COVID but are no longer considered active cases. Even though they aren’t counted in our number, they are too weak to return to a boarding home level care. They need either skilled rehab or a nursing home and there simply aren’t any homes taking patients. That creates a bottleneck here.”

John Porter, a spokesman for MaineHealth, the parent organization of Maine Medical Center in Portland and seven other hospitals in Maine, said that while hospitalization numbers are down slightly, the big unknown for the winter is whether cases and hospitalizations will go down this winter, or if there will be another spike like there was last winter.

“It’s moderated a little bit right now, but it’s not a clear downward trend yet,” Porter said.

In both the MaineHealth and Northern Light Health systems, unvaccinated individuals have been more likely to be hospitalized and far more likely to need intensive care, although the numbers fluctuate somewhat from week to week. State officials have said that in MaineHealth hospitals all but two of the 28 people now in critical care are unvaccinated. In Northern Light’s system, eight of 16 people in critical care are unvaccinated, while just three weeks ago, 25 of 27 were unvaccinated.

McDermott said in nearly all cases, fully vaccinated people who end up in the hospital with COVID-19 are older and have other health conditions.

Despite the recent decline in cases and hospitalizations, the United States recently reached grim milestone: 700,000 deaths attributed to the virus since it reached the country in early 2020. Among those are 1,026 Maine residents. The state has one of the lowest per capita totals in the country.

The Maine CDC reported two additional COVID-related deaths over the weekend, including a resident of Cumberland County and a resident of Kennebec County. One was a woman and one was a man. One was between 50 and 59 years old and one was age 80 or older.

New COVID-19 case counts for Maine were not available Monday because the state no longer processes tests over the weekend. On Tuesday, the Maine CDC will release the number of new cases detected on Saturday, Sunday and Monday. The CDC also has been dealing with a significant backlog of tests in recent weeks that has made it challenging to determine how many new cases there are on any given day.

As of Saturday, the seven-day daily case average stood at 612, which is close to the state’s peak average set in mid-January during the winter surge, before most people were eligible for vaccinations. Two weeks ago, the average number of daily cases was 485, and this time last month, it was 370.

Shah said as the delta variant has worked its way through the country. “Unfortunately, the Northeast is taking its turn in the hot seat,” he said. However, he also noted that Maine’s positivity rate – the percentage of all COVID-19 tests that come back positive – has declined to 4.3 percent from 4.75 percent two weeks ago.

Some nearby states already are seeing cases start to fall. In Massachusetts, the seven-day average has decreased from 1,966 to 1,538 in two weeks, according to the U.S. CDC. In Connecticut, cases have dropped from 777 on average to 476. Among New England states, only Maine and New Hampshire are still seeing cases increase.

Shah was asked Monday why Connecticut, where the vaccination rate is similar to Maine’s, is seeing its cases come down more rapidly. He explained that Connecticut’s rate of vaccination doesn’t vary much from region to region. In Maine, however, many rural counties have vaccination rates that are far lower than in Cumberland County, for instance.

Staff Writer Joe Lawlor contributed to this story