South Dakota’s largest hospitals are at or above their capacity to care for critically ill COVID-19 patients, forcing some of the sickest patients to be flown out of state to receive care.

The strain of a months-long surge in coronavirus cases has reduced hospital capacity to care for those with severe symptoms, making it increasingly uncertain whether the sickest South Dakotans will be able to get treatment in the state, health providers say. Meanwhile, ICU space is quickly evaporating in neighboring states as well.

Both the Sanford USD Medical Center and Monument Health Rapid City Hospital have reported that their Intensive Care Units are out of space. On Dec. 2, Avera McKennan reported that 6.7% of its ICU beds were available for use. Statewide, the number of available ICU beds has been steadily declining as coronavirus cases have continued to climb.

Major hospitals are still taking patients when they can, but some sick South Dakotans are being sent out of state, forced to use expensive urgent transportation systems to get care hundreds of miles away from their families.