The number of people infected in a wide-scale North Dakota Hepatitis C outbreak has risen, state health officials say.

The two new cases involve resident from Somerset Court, an assisted living facility in Minot, while the rest of the residents were at an HCR ManorCare facility, The Associated Press reported. Hepatitis C is spread through blood-to-blood contact and can be fatal.

Theories have abounded over how many residents were infected, as the number of those in the outbreak makes up one-fourth of all hepatitis C infections in the nation since 2008. Residents have filed suit against HCR ManorCare, which has sued its contracted podiatry company, Trinity Health. The latter company has said it would be “impossible” for the disease to be spread that virulently, according to AP.

“Based on the magnitude of this outbreak, there is absolutely no physiological, statistical or epidemiological way possible for hepatitis C to be spread through either phlebotomy or podiatry services,” said a Trinity spokesman. “Spreading this kind of thing over this length of time to this number of people through some kind of a sloppy needle use, even if you tried to, you couldn’t do it.”