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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.

Confirmed Cases: 128152

Reported Deaths: 2354
CountyConfirmedDeaths
Hennepin33024980
Ramsey13609355
Dakota9467136
Anoka8324150
Stearns554641
Washington539968
Scott326534
Olmsted315930
St. Louis279765
Wright233214
Nobles219516
Clay215343
Blue Earth20037
Carver17247
Kandiyohi16395
Sherburne160621
Rice15929
Mower149915
Winona122518
Crow Wing94721
Lyon9416
Chisago9202
Waseca9199
Benton8827
Beltrami8397
Otter Tail7896
Todd7525
Steele7342
Nicollet70017
Itasca69617
Morrison6578
Freeborn6494
Douglas6323
Martin60216
Le Sueur5985
McLeod5764
Watonwan5724
Polk5574
Goodhue54211
Becker5193
Pine5190
Isanti5115
Chippewa4153
Carlton4031
Dodge3790
Mille Lacs37613
Hubbard3462
Cass3445
Wabasha3430
Pipestone33616
Meeker3183
Brown3113
Rock3113
Yellow Medicine2715
Cottonwood2650
Unassigned26553
Murray2643
Redwood26011
Fillmore2450
Sibley2423
Renville23711
Faribault2210
Roseau2160
Wadena2082
Jackson2041
Kanabec19410
Swift1931
Houston1861
Stevens1741
Lincoln1720
Pennington1711
Koochiching1644
Aitkin1592
Pope1520
Big Stone1310
Lac qui Parle1303
Wilkin1274
Lake1110
Norman1050
Mahnomen1041
Marshall971
Grant924
Clearwater880
Red Lake662
Traverse540
Lake of the Woods431
Kittson370
Cook110

Iowa Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 111117

Reported Deaths: 1587
CountyConfirmedDeaths
Polk18419283
Woodbury697994
Johnson571730
Black Hawk535098
Linn5245129
Dubuque489654
Scott421037
Story391018
Dallas336944
Pottawattamie309144
Sioux234314
Buena Vista222512
Marshall195936
Webster178914
Plymouth159426
Wapello149462
Clinton140926
Muscatine139358
Crawford133712
Des Moines13059
Cerro Gordo130423
Warren11856
Carroll107212
Jasper105534
Henry10075
Marion95710
Tama91837
Lee90710
Delaware72912
Dickinson7117
Wright7071
Boone6969
Mahaska65924
Bremer6389
Washington62711
Harrison6238
Jackson5583
Benton5381
Lyon5287
Louisa50715
Clay5044
Hamilton4613
Winnebago45818
Winneshiek4559
Hardin4495
Kossuth4460
Poweshiek44111
Floyd42411
Jones4223
Cedar4205
Buchanan4194
Emmet41517
Iowa3948
Cherokee3832
Franklin37818
Sac3774
Guthrie37615
Clayton3753
Page3740
Shelby3601
Mills3551
Butler3542
Fayette3543
Cass3512
Madison3512
Allamakee3438
Chickasaw3381
Clarke3283
Humboldt3083
Hancock2984
Palo Alto2982
Grundy2895
Calhoun2854
Howard2619
Osceola2610
Monroe25111
Mitchell2380
Monona2361
Taylor2302
Union2194
Appanoose2173
Pocahontas2172
Jefferson2121
Lucas1976
Fremont1881
Ida1842
Greene1820
Van Buren1662
Davis1634
Montgomery1616
Adair1481
Keokuk1481
Decatur1430
Audubon1381
Worth1340
Wayne1133
Ringgold832
Adams700
Unassigned140
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