SIOUX FALLS, S.D. (AP) — South Dakota Gov. Kristi Noem hit the campaign trail on Thursday in New Hampshire, making appearances without wearing a mask, even as her state witnessed a new highpoint for coronavirus cases.

Active cases of the COVID-19 virus on Thursday topped 7,000 for the first time in South Dakota and hospitalizations inched to a new high for the third-straight day. With the virus surging across the state, the Department of Health reported 797 new cases, bringing the number of people with active infections to 7,132.

The Republican governor has vaulted to national prominence among conservatives who have praised her hands-off approach to the pandemic. She is now working as a surrogate for President Donald Trump. But as she made numerous campaign stops in New Hampshire, considered to be a proving ground for presidential hopefuls, the health crisis in her home state continued to escalate.

Health officials reported one of the highest single-day death tolls of the virus to date — 13 new deaths. Roughly halfway through October, the state has already had more deaths from COVID-19 than it has any other month. Health officials reported 81 people died this month so far, bringing the total number to 304.

The governor has defended her decision to continue campaigning despite the virus surge.

“If we do not focus on the election as well, and President Trump is not in office, there are consequences to that for our state of South Dakota,” she said this week. “We will be back facing regulations.”

She said that President Donald Trump's rollback of environmental and workplace safety regulations, as well as tax cuts, have helped the state.

Noem appears eager to follow in Trump's footprints. In a photo tweeted by Nina McLaughlin, communications director for the Maine GOP, Noem chose the same seat at the Red Arrow Diner in Manchester, New Hampshire, as Trump did in 2016. She was also sitting across from the same man — senior Trump advisor Corey Lewandowski.

Lewandowski has been advising the governor, helping orchestrate her national rise.

Noem has yet to be seen wearing a mask on the campaign trail — a move that has frustrated doctors in South Dakota. On Thursday, she appeared in a photo alongside two people wearing masks who appear to be restaurant workers.

Medical experts say that wearing a mask helps protect other people from catching the virus if the person wearing a mask has an infection, but the benefits of wearing a mask for personal protection are unclear. Noem has repeatedly cast doubt on a wide consensus among medical experts that wearing masks can help prevent infections from spreading.

The governor's spokesman Ian Fury said, “She's taking appropriate precautions.”

Noem also blamed the record case numbers on an increase in testing, but hospitals in the state bear evidence of the surge in infections. They are caring for 304 COVID-19 patients, the highest number reported to date.

Hospitals are also handling an increase in patients who have health needs besides COVID-19. About 32% of hospital beds and 41% of intensive care units statewide remain available.

Both of the largest hospital systems said they are adjusting their elective procedures to prepare for a possible surge in patients. Sanford Health will not be scheduling elective procedures next week that require an overnight stay. Avera Health relocated some surgeries to another facility after it faced a shortage of staff.

Avera spokesman Jake Iversen said, “What we are really trying to stress is that we are trying to push masks as much as possible.”