SIOUX FALLS, S.D. (AP) — With coronavirus cases running rampant in the Dakotas and elected leaders refusing to forcefully intervene, the burden of pushing people to take the virus seriously has increasingly been put on the families of those killed.

The ranks of those who know what it means to lose someone they love to COVID-19 are on the rise. North Dakota and South Dakota have the nation’s worst rate of deaths per capita over the last 30 days. Despite advances in treating COVID-19 patients, hundreds more people have died in recent weeks than during any other period — a grim exclamation point on the virus outbreak slamming the northern Plains and Upper Midwest.

In the Dakotas, the virus has shown few signs of slowing down. With winter approaching and hospitals scrambling to make room for COVID-19 patients, medical experts worry that virus deaths will continue to climb in a region where people have been slow to adopt mitigation measures like wearing masks. The Republican governors of both states have derided government orders to help halt the outbreaks, leaning on ideals of limited government.

The deaths have increasingly hit closer to home among many tight-knit communities: a priest in the Roman Catholic Diocese of Fargo; a former school principal in De Smet; an elementary school employee in Sioux Falls; a North Dakota state legislative candidate.

“Sometimes I think it’s not true,” said Chris Bjorkman, who lost her husband, John Bjorkman, 66. “Sometimes I think he’s going to walk through the door, but he hasn’t yet, so I just keep waiting.”

Bjorkman’s family, who live in De Smet, a town in eastern South Dakota where Laura Ingalls Wilder once had a homestead, decided to publicly share his struggle with the virus because he loved serving the community. After a career as a teacher and school administrator, Bjorkman was a well-known figure, remembered for his fun-loving ways and care for children.

“I want people to know what COVID can do and how serious it is.” Chris Bjorkman said.

The family experienced the crunch facing the health care system, as John Bjorkman was flown to a hospital in Minnesota after his condition worsened. The family posted regular Facebook updates as he was transferred to an intensive care unit bed in Sioux Falls and placed on a ventilator.

Doctors are unsure how many more cases like Bjorkman’s that they can handle.

“At this time, we’re headed in a direction of overwhelming our health care systems and I think that’s closer than what people understand,” said Dr. Michael Pietila, a critical care physician at the Yankton Medical Clinic.

The hospital systems in the Dakotas are an intricate network of critical access facilities in rural areas and small hospitals that depend on transferring patients to a handful of large hospitals in the region.

The rush of virus patients has dialed up the emotional and physical stress on hospital staff, even as they try to stay free from infections. During an interview with The Associated Press, Pietila was interrupted by the ping of an email notifying him that a number of hospital employees had tested positive for the virus.