SIOUX FALLS (AP) – Gov. Kristi Noem has insisted South Dakota is excelling in its handling of the pandemic, even though the state surpassed 9,000 active coronavirus cases on Thursday and matched an all-time high for deaths reported in a day.

The state ranks second in the country in new infections per capita over the last two weeks, according to Johns Hopkins University data. There were about 1,036 new cases per 100,000 people in South Dakota, meaning that about one in every 97 people in the state has tested positive for the virus in the last two weeks. Health officials on Thursday also reported an all-time high of 973 new cases.

But the Republican governor has used her refusal to issue mandates to vault to nationwide relevance among conservatives. She told Fox News on Wednesday night: “We’re doing really good in South Dakota. We’re managing COVID-19, but also our economy is thriving.”

Health officials reported Thursday that the number of people hospitalized with COVID-19 reached a record high with 355 in hospitals, including 75 in Intensive Care Units. The state matched its record of 14 deaths in a day.

Noem has said COVID-19 hospitalizations account for a relatively small percentage of total hospital capacity and that hospitals are still handling an influx of patients for other health issues. Currently, 35% of general-care hospital beds and 36% of Intensive Care Units remain open, according to the Department of Health.

However, both of the state’s largest hospital systems have altered the logistics of some elective procedures to free up space and staff to handle the virus surge. Without a statewide mask mandate in place, the hospital systems have also urged people to wear masks when they are around people outside of their households.

The hospital systems got support on that message from Sioux Falls Mayor Paul TenHaken, who earlier this week put it bluntly: “Wear a dang mask.”

But Noem has made it clear she will not institute a mask requirement and doubts the usefulness of the recommendation from the nation’s top health experts that widespread masking helps prevent infections from spreading.

In an opinion article published Wednesday, the governor pointed to doctors who say it is not clear how effective masks are in preventing infections. She said places with mask mandates have still seen case growth, but conceded that masks are “appropriate” in hospitals or when caring for someone with COVID-19 symptoms.

Noem’s opinion piece also included a link to an article on masks from a conservative medical group called Association of American Physicians and Surgeons. The group has a history of staking out unorthodox positions on medical issues, including calling mass vaccinations “equivalent to human experimentation” and opposing Medicare, the government-funded health insurance for older people.

More recently, the group has spoken out against lockdowns to prevent the spread of the virus and encouraged treating COVID-19 with hydroxychloroquine, a malaria drug that President Donald Trump pushed before the Food and Drug Administration revoked its emergency-use authorization. Noem also sponsored a statewide trial of the drug.

The governor has stuck to a “freedom-first” strategy during the pandemic, at times downplaying its danger while emphasizing the state’s economic outlook. South Dakota reported that new unemployment claims inched down during the week ending Oct. 17. A total of 4,146 people in South Dakota were receiving unemployment benefits, according to the latest available report on Oct. 10. That represents 1% of all eligible employees.

Noem has also pointed out that South Dakota has one of the lowest death rates in the country. The state currently has the 17th lowest rate of deaths per capita, with roughly 38 deaths per 100,000 people, according to Johns Hopkins.

But October has been the state’s deadliest month of the pandemic, a trend that has lagged behind much of the country. There were 124 COVID-19 deaths this month, bringing the state’s death toll to 347.