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Rural Midwest hospitals struggling with COVID surge

Dr. Tom Dean poses at his clinic in Wessington Springs, S.D., on Friday. Oct. 16, 2020. Dean is one of three doctors in the county, which has seen one of the nation's highest rates of coronavirus cases per person. He writes a column in the local newspaper
Dr. Tom Dean poses at his clinic in Wessington Springs, S.D., on Friday. Oct. 16, 2020. Dean is one of three doctors in the county, which has seen one of the nation's highest rates of coronavirus cases per person. He writes a column in the local newspaper

'All of a sudden it hit, and as it does, it just exploded.'

Posted: Oct 17, 2020 11:14 AM

WESSINGTON SPRINGS, S.D. (AP) — Rural Jerauld County in South Dakota didn't see a single case of the coronavirus for more than two months stretching from June to August. But over the last two weeks, its rate of new cases per person soared to one of the highest in the nation.

“All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.

As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Dean took to writing a column in the local weekly newspaper, the True Dakotan, to offer his guidance. In recent weeks, he's watched as one in roughly every 37 people in his county has tested positive for the virus.

It ripped through the nursing home in Wessington Springs where both his parents lived, killing his father. The community’s six deaths may appear minimal compared with thousands who have died in cities, but they have propelled the county of about 2,000 people to a death rate roughly four times higher than the nationwide rate.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins researchers. In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak — and the toll hits close to home in tight-knit towns.

“One or two people with infections can really cause a large impact when you have one grocery store or gas station,” said Misty Rudebusch, the medical director at a network of rural health clinics in South Dakota called Horizon Health Care. “There is such a ripple effect.”

Wessington Springs is a hub for the generations of farmers and ranchers that work the surrounding land. Residents send their children to the same schoolhouse they attended and have preserved cultural offerings like a Shakespeare garden and opera house.

They trust Dean, who for 42 years has tended to everything from broken bones to high blood pressure. When a patient needs a higher level of care, the family physician usually depends on a transfer to a hospital 130 miles (209 kilometers) away.

As cases surge, hospitals in rural communities are having trouble finding beds. A recent request to transfer a “not desperately ill, but pretty" sick COVID-19 patient was denied for several days, until the patient's condition had worsened, Dean said.

“We’re proud of what we got, but it's been a struggle," he said of the 16-bed hospital.

The outbreak that killed Dean's dad forced Wessington Springs' only nursing home to put out a statewide request for nurses.

Thin resources and high death rates have plagued other small communities. Blair Tomsheck, interim director of the health department in Toole County, Montana, worried that the region’s small hospitals would need to start caring for serious COVID-19 patients after cases spiked to the nation's highest per capita. One out of every 28 people in the county has tested positive in the last two weeks, according to Johns Hopkins researchers.

“It's very, very challenging when your resources are poor — living in a small, rural county,” she said.

Infections can also spread quickly in places like Toole County, where most everyone shops at the same grocery store, attends the same school or worships at a handful of churches.

“The Sunday family dinners are killing us," Tomsheck said.

Even as outbreaks threaten to spiral out of control, doctors and health officials said they are struggling to convince people of the seriousness of a virus that took months to arrive in force.

“It’s kind of like getting a blizzard warning and then the blizzard doesn’t hit that week, so then the next time, people say they are not going to worry about it,” said Kathleen Taylor, a 67-year-old author who lives in Redfield, South Dakota.

In swaths of the country decorated by flags supporting President Donald Trump, people took their cues on wearing masks from his often-cavalier attitude towards the virus. Dean draws a direct connection between Trump's approach and the lack of precautions in his town of 956 people.

“There’s the foolish idea that mask-wearing or refusal is some kind of a political statement,” Dean said. “It has seriously interfered with our ability to get it under control.”

Even amid the surge, Republican governors in the region have been reluctant to act. North Dakota Gov. Doug Burgum said recently, “We are caught in the middle of a COVID storm" as he raised advisory risk levels in counties across the state. But he has refused to issue a mask mandate.

South Dakota Gov. Kristi Noem, who has carved out a reputation among conservatives by foregoing lockdowns, blamed the surge in cases on testing increases, even though the state has had the highest positivity rate in the nation over the last two weeks, according to the COVID Tracking Project. Positivity rates are an indication of how widespread infections are.

In Wisconsin, conservative groups have sued over Democratic Gov. Tony Evers mask mandate.

Whether the requirement survives doesn't matter to Jody Bierhals, a resident of Gillett who doubts the efficacy of wearing a mask. Her home county of Oconto, which stretches from the northern border of Green Bay into forests and farmland, has the state's second-highest growth in coronavirus cases per person.

Bierhals, a single mother with three kids, is more worried about the drop in business at her small salon. The region depends on tourists, but many have stayed away during the pandemic.

“Do I want to keep the water on, or do I want to be able to put food on the table?” she asked. “It’s a difficult situation.”

Bierhals said she thought the virus couldn't be stopped and it would be best to let it run its course. But local attitudes like that have left the county's health officer, Debra Koniter, desperate.

Konitzer warned that the uncontrolled spread of infections has overwhelmed the county's health systems.

“I’m just waiting to see if our community can change our behavior," she said. "Otherwise, I don’t see the end in sight.”

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 447349

Reported Deaths: 6007
CountyCasesDeaths
Hennepin929301478
Ramsey39917738
Dakota32945340
Anoka30935364
Washington20116227
Stearns17847187
St. Louis13658241
Scott1193296
Wright11598104
Olmsted1045075
Sherburne820665
Carver693436
Clay651680
Rice605268
Kandiyohi553671
Blue Earth539933
Crow Wing482574
Otter Tail456367
Chisago452032
Benton419586
Winona388046
Douglas373966
Nobles369646
Mower364729
Goodhue346858
Polk328256
McLeod324745
Morrison311544
Beltrami309947
Lyon301136
Becker284639
Itasca284543
Isanti282441
Carlton279443
Steele27279
Pine266613
Freeborn244621
Todd231730
Nicollet224036
Brown214734
Mille Lacs214046
Le Sueur209415
Cass207623
Meeker199433
Waseca188916
Wabasha17023
Martin169926
Roseau165416
Hubbard149238
Redwood139627
Renville137239
Houston135613
Dodge13434
Chippewa131032
Cottonwood127018
Fillmore12315
Wadena119916
Rock110112
Sibley10847
Aitkin108033
Watonwan10638
Faribault105716
Pennington99215
Kanabec97418
Pipestone94023
Yellow Medicine93714
Murray8815
Jackson85310
Swift83418
Pope7385
Marshall70315
Stevens7018
Clearwater68514
Lac qui Parle65716
Lake63615
Wilkin6249
Koochiching59510
Lincoln4831
Big Stone4563
Unassigned44168
Grant4298
Norman4238
Mahnomen4107
Kittson37219
Red Lake3164
Traverse2503
Lake of the Woods1931
Cook1140

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 304391

Reported Deaths: 4270
CountyCasesDeaths
Polk45574448
Linn17742274
Scott15414163
Black Hawk13696236
Woodbury12968175
Johnson1207549
Dubuque11348150
Pottawattamie8959112
Dallas885171
Story865434
Webster468271
Cerro Gordo464768
Sioux454456
Clinton449461
Warren440738
Marshall426561
Buena Vista392329
Muscatine388477
Des Moines381041
Plymouth349768
Wapello342398
Jasper321258
Lee315830
Marion303852
Jones270649
Henry263830
Carroll253934
Bremer242648
Crawford229422
Boone217017
Washington216831
Benton209244
Mahaska191836
Jackson191431
Tama186657
Dickinson185026
Delaware173036
Kossuth172143
Clay167319
Wright163624
Fayette161122
Buchanan159123
Hamilton158729
Winneshiek155219
Harrison154862
Hardin154429
Cedar152519
Clayton151348
Butler147324
Page144215
Floyd138836
Cherokee138427
Mills136216
Lyon134832
Poweshiek132424
Hancock129824
Allamakee127627
Iowa124322
Calhoun12209
Grundy120526
Jefferson120124
Madison11999
Winnebago118729
Mitchell116134
Louisa114730
Cass112841
Chickasaw110912
Sac110915
Emmet110431
Appanoose110138
Union108222
Humboldt105319
Guthrie102924
Shelby102126
Franklin101718
Unassigned9230
Palo Alto9049
Keokuk84926
Montgomery84822
Howard83119
Monroe80918
Clarke7927
Pocahontas77611
Ida74130
Davis69121
Greene6917
Adair68720
Lucas6488
Monona64016
Osceola6389
Worth6063
Taylor5919
Fremont5086
Van Buren49612
Decatur4824
Ringgold4289
Audubon4158
Wayne41421
Adams2953
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