SIOUX FALLS, S.D. — Leaders of South Dakota's two largest health systems asked the public to take personal responsibility to reducing the spread of COVID-19 to ease the pressure on their hospitals, as the state ends its worst month of the virus pandemic thus far.

In a Sioux Falls news conference on Monday, Nov. 2, representatives of both Sanford Health and Avera Health called on the public to step up well-known ways to reduce the spread of COVID-19: social distancing, mask wearing, hand-washing. The state has no statewide masking mandate or other COVID-19 restrictions.

"We're not asking you to do anything difficult. We're not asking you to give up your freedom," said Dr. Mike Elliot, chief medical officer of Avera McKennan hospital. "Exercise that freedom and make the right choice. Make the choice that is going to protect you, that is going to protect your loved ones, your colleagues, that is going to help flatten this curve, keep people out of the hospital.

"Please, please do that."

October was South Dakota's deadliest month yet during the pandemic, as the virus swept largely uncontrolled through most of the state's counties. There were 202 South Dakotans who died due to COVID-19 last month and record highs regularly set for number of new positive cases, daily active cases and hospitalizations.

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On Nov. 2, state Department of Health officials reported one additional fatality due to COVID-19 and another 526 people who have tested positive for the virus, a relatively limited number compared to previous days but in line with reduced testing numbers coming out of the weekend. The state's COVID-19 death toll stands at 438.

The state on Monday marked its third-highest daily count of active cases at 13,325, while hospitalizations slipped to 403. The number of those hospitalized with COVID-19 in the state has remained above 400 for six days, nearly double the number seen a month ago.

The growing number of COVID-19 patients, many of whom need intensive care, is taxing the state's hospitals. Elliot and Dr. Michael Wilde, chief medical officer at Sanford USD Medical Center, described hospitals as stressed by the ongoing influx of COVID-19 patients, largely in terms of staff needed to care for them all.

Elliot described his hardworking staff as "bone weary" and said they experience a "horrible disconnect" as they walk from the hospital out into the public.

"Then they go out in the community, and they watch people gathering in masses of 100-200 people, not wearing their masks, not seeming to understand that this is real, folks," Elliot said. "People are dying from this. And our staff just does not understand where that huge disconnect is coming from. It's incredibly frustrating."

The mayor of South Dakota's largest city sounded a similar note of alarm as he pointed to a state map filled with circles indicating the growing spread of COVID-19 in every county in the state.

'I'd like everyone to behave as if you have COVID. Assume you have COVID. And if that's the case, how would you act?" Said Mayor Paul TenHaken. "Behave as if you have COVID right now — use that mindset. We need you to do that for the next couple of weeks, which would really help our healthcare partners tremendously."

TenHaken said he extending the masking requirement for city workers through the end of the year, and he's encouraging business owners to follow suit.

The Sioux Falls City Council is set to consider a mask mandate in a meeting on Tuesday, Nov. 3. TenHaken, who would cast a tie-breaking vote if the council is deadlocked, said he wouldn't support a masking mandate.

TenHaken said the mandate is unenforceable, a deeply political question, not useful since it would only cover the city, not the region and not suggested by local healthcare systems.

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