hospitalizations here at monument health, and that is worrying. this is a trend that is a warning to us, a dire warning that we could be at capacities that we never imagined. >> reporter: none of the covid patients in the icu today, an icu that has had to be expanded, have been fully vaccinated. throughout this pandemic, the governor of south dakota, kristi noem, has refused to implement basic covid health and safety precautions used in other states. >> my people are happy. >> reporter: although she does say she is vaccinated. while south dakota isn't at the top of per capita covid deaths, it is comfortably in the top half at 20. in neighboring minnesota, which has had a full complement of covid precautions, has a death rail about 26% lower than south dakota. monument health doesn't rely on the governor to be the chief covid safety spoke. >> we've been the main spokesperson. it's been left to the health system, to the doctors, to the