In rural Jerauld County, South Dakota, there was not a single case of the coronavirus for more than two months, which spanned June through August. In the past two weeks, however, the number of new cases per person has risen to one of the highest in the nation.
“Suddenly it hit and exploded,” said Dr. Tom Dean, one of only three doctors working in the county.
As the bulk of the virus has moved to the upper Midwest and northern plains, focus has shifted to the severity of the outbreaks in rural communities. Doctors and health officials in small towns fear that infections could overwhelm communities with limited medical resources. And many say they are still encountering attitudes about wearing masks that have hardened politically and the misconception that rural areas are immune to widespread infections.
Dean began writing a column on the local weekly True Dakotan to offer his guidance. In the past few weeks, he has seen one in about 37 people in his county test positive for the virus.
It ripped through the Wessington Springs nursing home where both of his parents lived, killing his father. The parish’s six deaths may seem minimal compared to the thousands who died in cities, but they have led the county to a death rate of roughly 2,000 people roughly four times the statewide rate.
According to researchers at Johns Hopkins University, rural counties in Wisconsin, North Dakota, South Dakota and Montana are among the top cases per capita nationwide in the past two weeks. In total, the nation topped 8 million confirmed coronavirus cases in the university’s census on Friday. The real number of infections is believed to be much higher as many people have not been tested.
In counties with only a few thousand inhabitants, the number of cases per capita can increase even with a small outbreak – and the toll in close-knit cities near home.
“One or two people with infections can have a really big impact when you have a grocery store or a gas station,” said Misty Rudebusch, medical director of a network of rural health clinics in South Dakota called Horizon Health Care. “There’s such a ripple effect.”
Wessington Springs is a hub for the generations of farmers and ranchers who work the surrounding land. The residents send their children to the same schoolhouse they attended and have received cultural offerings such as a Shakespeare garden and an opera house.
You trust Dean, who has been looking after everything from broken bones to high blood pressure for 42 years. Usually, when a patient needs a higher level of care, the GP will need a transfer to a hospital that is 209 kilometers away.
Hospitals in rural communities have trouble finding beds. A recent application for the transfer of a “not desperately ill but handsome” sick COVID-19 patient was denied for several days until the patient’s condition worsened, Dean said.
“We’re proud of what we got, but it was a struggle,” he said of the 16-bed hospital.
The outbreak that killed Dean’s father forced Wessington Springs’ only nursing home to make a nationwide request for nurses.
Thin resources and high mortality rates have plagued other small communities. Blair Tomsheck, interim director of the Health Department in Toole County, Montana, feared the area’s small hospitals would have to care for serious COVID-19 patients after cases rose to the highest per capita in the country. According to researchers at Johns Hopkins, 1 in 28 people in the county have tested positive in the past two weeks.
“It’s very, very challenging when your resources are poor – living in a small, rural county,” she said.
Infection can also spread quickly in places like Toole County, where almost everyone shops at the same grocery store, goes to the same school, or prays in a handful of churches.
“Sunday family dinners are killing us,” said Tomsheck.
Even as outbreaks threaten to spiral out of control, doctors and health officials struggle to convince people of the severity of a virus that has taken months to enter into force.
“It’s like getting a blizzard warning and then that week the blizzard doesn’t hit. Next time people say they won’t worry about it,” said Kathleen Taylor, a 67-year-old writer living in Redfield, South Dakota.
In large parts of the country, which were adorned with flags that supported President Donald Trump, people orientated themselves in wearing masks to his often carefree attitude towards the virus. Dean makes a direct link between Trump’s approach and the lack of precautionary measures in his city of 956 residents.
“There’s the stupid idea that wearing or refusing to wear a mask is some kind of political statement,” Dean said. “It seriously affected our ability to get it under control.”
Even amid the boom, Republican governors in the region were reluctant to act. North Dakota Governor Doug Burgum recently said “We are in the middle of a COVID storm” as he increased the risk of counseling in the state’s counties. However, he refused to grant a mask mandate.
South Dakota Governor Kristi Noem, who made a name for himself with Conservatives for not banning bans, blamed the surge in cases on test increases even though the state had the highest rate of positivity in the nation in the past two weeks for COVID- Tracking project. Positivity rates are an indication of how widespread infections are.
In Wisconsin, conservative groups have sued Democratic governor Tony Evers’ mask mandate.
Whether the request survives doesn’t matter to Jody Bierhals, a Gillett resident, who doubts the effectiveness of wearing a mask. Her home community of Oconto, which stretches from the northern border of Green Bay into forests and farmland, has the second highest growth in the state in coronavirus cases per person.
Bierhals, a single mother with three children, is more concerned about the downturn in business in her small salon. The region is dependent on tourists, but many have stayed away during the pandemic.
“Do I want to hold the water 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 was best to let it go. But such local attitudes have left the county health officer, Debra Konitzer, desperate.
Konitzer warned that the uncontrolled spread of infections had overwhelmed the county’s health systems.
“I’m just waiting to see if our church can change our behavior,” she said. “Otherwise I don’t see the end in sight.
Corrected this story to correct the spelling of Konitzer in one case.