SIOUX FALLS, S.D. — South Dakota Gov. Kristi Noem declared a statewide day of prayer for Wednesday, April 8, as the coronavirus death toll in the state rose to six.

Noem's declaration on Tuesday comes even as she has repeatedly rebuffed calls from medical, county and city leaders across the state for stricter statewide measures, choosing instead to issue a stay-at-home order for high-risk individuals in two counties Monday -- her harshest curb so far on the state's residents.

South Dakota was at a "critical point in time" as it faces the widening spread of the coronavirus, she said. The number of confirmed coronavirus cases has risen to 320, nearly tripling the case total in a week.

"To pray for success in the fight of this disease, to pray for comfort for those who have lost someone, to pray for strength for all of those who continue to fight, both in South Dakota and around the world, I would ask that all of us in this state take this opportunity to join together and pray," she said.

The state still lacks the hospital beds and life-saving ventilators it will need for the mid-June peak of the virus forecast by state and health system officials, although Noem has said state and health system officials have a plan to meet the state's needs by the expected surge.

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Noem remained vague when she was asked how she would enforce her stay at home order for those over the age of 65 and those with chronic medical conditions in Minnehaha and Lincoln counties, despite repeated questions over multiple days from journalists, saying she hasn't see any instances of people defying her direction.

"We will deal with that when it is necessary," she said.

Noem on Monday asked K-12 schools to close for the remainder of the school year, and she extended her social distancing guidelines for the state through May 31 and strengthened the language in her recommendations, changing all uses of the word "should" to "shall."

South Dakota is one of only eight states without a stay at home or shelter-in-place order, the New York Times reported. Noem's relatively hands-off approach to curbing the spread of the virus has coalesced calls from local and medical leaders in the state for her to take stronger measures.

On Friday, the South Dakota State Medical Association called for Noem to issue a statewide stay at home order. On Monday, about 160 city and county community leaders sent Noem a letter asking her to approve a public health emergency declaration. She has previously resisted calls for both moves.

"I have said many times I would use every tool that I have available to me at the appropriate time," she said Tuesday.

State officials said the two new COVID-19 fatalities were in McCook and Minnehaha counties, but they have regularly declined to provide additional information on individual deaths beyond age ranges for all fatalities combined, citing privacy concerns.

The four previously known fatalities are:

State officials say 23 diagnosed individuals have ever been hospitalized and 98 have recovered.

State, private and in-hospital labs have processed 6,270 tests from the state. The state is ranked 18th among U.S. states for per-capita testing, said Kim Malsam-Rysdon, secretary of the state Department of Health.

State health officials said Tuesday an employee at the Walmart Pharmacy in Yankton had tested positive for COVID-19. The employee had worked on March 25 and March 30. Anyone who visited the pharmacy on those days should monitor themselves for symptoms for 14 days after their visit, the officials said.

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