OMAHA, Neb. — The economy continues improving in nine Midwest and Plains states but business leaders are less optimistic after the latest surge in coronavirus cases in the region, according to a new monthly survey released last week.

The overall index for the region suggests strong growth even though it dipped to 64.1 in December from November’s 69. Any score above 50 on the survey’s indexes suggests growth, while a score below 50 suggests recession.

Creighton University economist Ernie Goss, who oversees the survey, said the manufacturing sector has been growing steadily since restrictions related to the virus started to be relaxed in the spring, but current activity still remains below the level it was at before the pandemic began.

Goss said that the survey’s confidence index suggests business leaders are worried about the economy after the recent growth in virus cases across the region. The confidence index dipped into negative territory at 45.8 in December from November’s neutral score of 50.

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Companies were hiring last month, but the pace of job growth slowed. The employment index declined to 57.7 in December from November’s 63.1. Goss said the region has 4.7% fewer jobs now than when the pandemic began — a decrease of about 655,000 jobs.

The monthly survey covers Arkansas, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma and South Dakota.

Iowa’s Business Conditions Index remained above growth neutral for December, though the reading declined to 64.7 from 74.6 in November. Components of the overall December index were: new orders at 66.2, production. or sales at 62.5, delivery lead time at 83.0, employment at 55.6, and inventories at 57.7.

Since the onset of COVID-19 in February, the Iowa economy has lost a net of 78,000 nonfarm jobs, or 4.9%, according to the U.S. Bureau of Labor Statistics. Top performing industry for 2020: financial activities.