Coronavirus spikes in Midwest.

The coronavirus tightened its grip on the American heartland, with infections surging in the Midwest, some hospitals in Wisconsin and North Dakota running low on space.

Midwestern states are seeing some of the nation’s highest per capita rates of infection, and while federal health officials again urged some governors in the region to require masks statewide, many Republicans have resisted.

Like other states, health officials in Wisconsin had warned since the pandemic began that COVID-19 patients could overwhelm hospitals. That’s now happening for some facilities as experts fear a second wave of infections in the U.S.

A record number of people with COVID-19 were hospitalized in Wisconsin. Of those 737 patients Wednesday, 205 were in intensive care, with spikes in cases in northern parts of the state driving up the numbers. The state also reported its highest singleday number of deaths — 27 — raising the toll to 1,327.

Officials at ThedaCare, a community health system of seven hospitals, said they have exceeded capacity in the COVID-19 unit at their medical center in Appleton, about 100 miles north of Milwaukee. It’s started sending patients to other hospitals some 40 miles away.

Wisconsin health officials reported 2,319 new infections, bringing the total number to 122,274.

In North Dakota, hospitals are adding extra space amid concerns from employees about capacity. Nearly 678 COVID-19 infections per 100,000 people have been diagnosed over the past two weeks, leading the country for new cases per capita, according to the COVID Tracking Project.

A new Sanford Health hospital unit opened in the capital of Bismarck to add 14 more beds, with nearly half of those for intensive care patients. The space isn’t exclusively for coronavirus patients but could be used to treat them if needed.

Overall, North Dakota has reported 21,846 infections and 247 deaths. There are 89 people now hospitalized.

The upswing has been seen throughout the Midwest. Iowa also reported a spike in people hospitalized with the virus, to 390. Last week, the state had the nation’s sixth-highest rate of coronavirus infections per 100,000 people, according to a White House coronavirus task force report dated Sunday. It again recommended Iowa require masks statewide, which Republican Gov. Kim Reynolds has said is unnecessary.

Similarly, Oklahoma Gov. Kevin Stitt, a Republican, has said he won’t impose such a requirement. The task force report found his state is among the worst in the United States for positive coronavirus tests per 100,000 people, up 15% from a week ago.