SIOUX FALLS, S.D. (AP) — South Dakota on Wednesday broke its record for COVID-19 hospitalizations and new cases, and the state has already had more deaths from the disease less than halfway through October than it had in any other month.

Despite the grim prognosis — South Dakota had the nation’s highest rate of positive tests over the last 14 days, according to the COVID Tracking Project — Republican Gov. Kristi Noem has resisted pressure to step up the state's response to the disease, explaining Tuesday that the surge in case numbers was “expected” because the state was conducting more tests.

Secretary of Health Kim Malsam-Rysdon said she thinks the state is doing a good job conducting enough tests to detect outbreaks.

However, South Dakota's 14-day average positivity rate of nearly 24% is more than four times the national average of 5.1%, according to the COVID Tracking Project.

State Epidemiologist Josh Clayton said that the increase in testing led to more positive cases being identified. But he also acknowledged that infections are spreading in communities across the state.

“If you take all of that put together, we are seeing a fair bit of COVID-19 transmission,” he said.

The state's hospitals are feeling the effects, reporting that they are caring for 303 COVID-19 patients. As hospitals see patient increases from COVID-19 and other medical issues, some have experienced backups. Roughly 34% of general care beds and 39% of intensive care units statewide remain available, according to the Department of Health.

Noem said she is focused on making sure the state has enough hospital capacity.