SIOUX FALLS, S.D. (AP) — Hospitalizations from COVID-19 in South Dakota reached new heights for the fourth straight day on Wednesday.

The number of daily new cases also set a record, with 1,270 people testing positive for the virus. The virus has surged in the state and region, sending South Dakota to the nation’s second-worst ranking in new cases per capita over the last two weeks. Johns Hopkins researchers report that one out of roughly every 77 people in the state has tested positive in the last two weeks.

The wave of cases has resulted in 412 people who are currently hospitalized with the virus. Health officials also reported nine new deaths. October has become the state’s deadliest month of the pandemic, with 189 deaths so far.

The outbreak has been particularly severe in the state’s prisons, where one out of roughly every three people incarcerated statewide has an active coronavirus infection.

Gov. Kristi Noem has made it clear she will not issue any requirements to wear masks in public. She has cast her approach to the pandemic — foregoing government restrictions to keep economic activity humming — as an example of Republican leadership. She spent the day at several Trump campaign events in Maine and New Hampshire.

Meanwhile, South Dakota health officials attempted to offer some hope to the state’s virus outlook, saying they will be ready by the middle of next month to distribute coronavirus vaccinations. But it is not clear when coronavirus vaccinations will receive regulatory approval and actually arrive in the state.

Health experts are hoping that several candidates for vaccines could be ready for distribution by year’s end, maybe sooner. President Donald Trump has pushed for a faster timeline.

South Dakota Secretary of Health Kim Malsam-Rysdon said she is following federal instructions to have a vaccine distribution system in place by Nov. 15.

“If the vaccine shows up at our doorstep on that day, it will be getting out to folks immediately,” she said.

South Dakota’s plan prioritizes health care workers and people who are vulnerable to the virus before vaccines are made widely available to the public.

The Food and Drug Administration has pledged that any vaccine it approves will meet clear standards for its safety and effectiveness.

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