SIOUX FALLS, S.D. (AP) — A small hospital serving the Cheyenne River Sioux Tribe has sent two coronavirus patients to an out-of-state hospital in recent days, the tribe’s health department said Wednesday, even as South Dakota’s top health officials insist the state has plenty of hospital capacity for COVID-19 patients.

The Cheyenne River Sioux Health Department reported that it tried to find better-equipped hospitals to transfer coronavirus patients, but that 14 facilities said that they were also diverting COVID-19 patients. Eventually, the tribal health department found a hospital in Burnsville, Minnesota, that would accept patients.

Gov. Kristi Noem has made the state’s hospital capacity the bottom-line of her coronavirus response strategy. But as hospitals feel the squeeze of a rising number of cases and hospitalizations, the state’s hospital systems have seen ripple effects from the largest hospitals that boast hundreds of beds down to the eight beds at the Cheyenne River Health Center, an Indian Health Services Facility.

The state’s number of coronavirus-related hospitalizations again rose to an all-time high on Wednesday with 273 patients statewide.

Danette Serr, the Director of Nursing at the Cheyenne River Sioux Health Department, is helping keep track of five hospitalizations among tribal members. The tribe depends on larger facilities when infections worsen.

“We’re a very, very basic hospital,” Serr said. “We can’t do much here.”

The Cheyenne River Sioux Tribe’s chairman, Harold Frazier, has said the limited number of beds and remoteness of the facility is part of the reason the tribe enacted strict lockdowns and coronavirus checkpoints to minimize outbreaks on the reservation. But as the coronavirus surges statewide, the tribe and its health department have not been able to keep the virus completely at bay.

Nonetheless, the South Dakota Department of Health reports that the state’s hospital capacity remains in good shape. The Department’s spokesman Derrick Haskins called any assertion that the state didn’t have the needed hospital capacity “totally inaccurate.”

“Diversions can happen for a variety of reasons including the level of care needed for a patient,” Haskins said. “We have followed up with the IHS facility, and that is exactly what happened with the patients.”

Secretary of Health Kim Malsam-Rysdon said hospital diversions and transfers are part of the way that hospitals share the burden of patients and make sure they get needed medical care.

There are currently 37 South Dakota facilities caring for COVID-19 patients, including 10 with intensive care units and three using ventilators, according to Malsam-Rysdon. She said the large number of facilities handling COVID-19 patients shows the state’s hospitals have prepared for the pandemic.

Native Americans have been disproportionately affected by the coronavirus, accounting for nearly a quarter of hospitalizations statewide despite making up roughly 9% of the population. About 19% of the 258 people who have died from COVID-19 in South Dakota have been Native American.

Serr said that for the Cheyenne River Sioux Tribe’s Health Department, the pandemic is worsening.

“Just recently, it’s been the most difficult,” she said.

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