(NEW YORK) — South Dakota has one of the highest rates of COVID-19 spread in the country, several reports show, as the Midwest experiences a surge in cases.

The state ranked second in the country for both rates of new cases and test positivity in the latest report from the White House Coronavirus Task Force. According to the report, dated Sept. 27, both numbers increased over the last week amid greater testing, “indicating increasing transmission.”

South Dakota leads in testing positivity in another survey of COVID-19 transmission. According to Johns Hopkins University, as of Tuesday, the state’s seven-day average testing positivity rate was 26% — the highest in the country.

After months of somewhat steady numbers, daily new cases and hospitalizations in the state have surged in recent weeks. South Dakota reported a record number of daily new cases on Sept. 26, with 579. The next day, it reported a record number of current hospitalizations, with 216, according to the COVID Tracking Project.

The records came several days after Gov. Kristi Noem said on Twitter that the spread of the virus had “peaked” in the state.

The increase in cases and hospitalizations come as COVID-19 is raging in the Midwest. Since Sept. 26, Minnesota, Wisconsin and Kansas have also reported record numbers of new cases, and the Midwest leads the nation in regional cases per one million people, according to the COVID Tracking Project.

Idaho and Wisconsin are currently seeing positivity rates at 20% or higher, Johns Hopkins University data shows. In the latest White House Coronavirus Task Force report, South Dakota’s neighbor to the north, North Dakota, had the highest rate of new cases in the country.

Additionally, three Midwestern states — North Dakota, South Dakota and Wisconsin — have the highest risk level for COVID-19 in the U.S., according to the Harvard Global Health Institute.

Testing is “key to achieving epidemic control” in South Dakota, the White House Coronavirus Task Force recommended. State health officials said that’s what they’re focusing on.

“We are very much working towards increasing testing volume across the state,” Department of Health Secretary Kim Malsam-Rysdon said during a coronavirus briefing earlier this week. “That will continue to be a priority for us.”

Malsam-Rysdon did not share details of the state’s plans to increase testing during the briefing, though she said that “it takes efforts from providers across the state to work towards that testing volume.”

Health officials said they have heard anecdotally of people avoiding testing, and they are encouraging people who show symptoms of COVID-19, or are asymptomatic but have had close contact with someone who is a confirmed case, to seek testing. They are also stressing that residents quarantine and isolate as necessary if they have a confirmed case or come into contact with someone who does.

After hovering around the high 70s earlier this month, hospitalizations due to COVID-19 have been above 200 since Sept. 27 in South Dakota, according to the COVID Tracking Project. Officials have stressed that hospital capacity in the state is not currently a concern, though they warned that a large number of hospitalizations can be expected for the time being.

As of Wednesday evening, hospital bed capacity was at 57% and ICU bed capacity at 75%, according to state data.

Dr. Joshua Clayton, the state epidemiologist, has emphasized “individual precautions,” such as mask-wearing and social distancing, when it comes to reducing the spread of COVID-19 in the state. South Dakota is among a minority of states to not have issued a statewide mask mandate during the pandemic, and it never issued a stay-at-home order.

The rising cases come as Gov. Noem has been promoting tourism in her state. Earlier this month, her administration announced it was using federal coronavirus relief funds to pay for a $5 million tourism ad campaign.

Last month, South Dakota hosted a massive motorcycle rally that had at least 100 COVID-19 cases in eight states traced back to it.

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