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Midwest rural hospitals are struggling to find beds amid a surge




WESSINGTON SPRINGS, SD Rural Jerauld County in South Dakota did not see a single case of coronavirus for more than two months ranging from June to August. But over the past two weeks, the rate of new cases per person has risen to one of the highest in the country.

All of a sudden it hit, and as it does, it just exploded, said Dr. Tom Dean, one of only three doctors working in the county.

As the heavy burden of the virus has been shed in the Upper Midwest and the northern plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections could overwhelm communities with limited medical resources. And many say they are still opposing attitudes to wear masks that have been tightened along political lines and a false notion that rural areas are immune to widespread infections.

Dean tried to write a column in the local weekly newspaper, The True Dakotan, to provide his guidance. In recent weeks, he has seen one in almost every 37 people in his county who tested positive for the virus.

She ransacked the nursing home in Wessington Springs where both his parents lived, killing his father. The six deaths of communities may seem minimal compared to the thousands who have died in cities, but they have brought the county of about 2,000 people to a death rate roughly four times higher than the level across the country.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana stand among the best in the country for new cases per capita over the past two weeks, according to Johns Hopkins researchers. In counties with only a few thousand people, the number of cases per capita may increase even with a small explosion and the number of strokes near homes in closely related cities.

One or two people with infections can really make a big impact when you have a grocery store or gas station, said Misty Rudebusch, 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 generations of farmers and ranchers working the surrounding land. Residents send their children to the same school where they attended and have maintained cultural offerings like a Shakespearean garden and opera.

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 GP usually depends on transfer to a hospital 130 miles away.


Kids try candy during a return home parade on Friday in Wessington Springs, SD The parade had to be postponed due to a coronavirus outbreak that killed five residents of the local nursing home. Stephen Groves / Associated Press

As cases increase, hospitals in rural communities have trouble finding beds. A recent request to transfer a not-so-sick but fairly ill COVID-19 patient was rejected for several days, until the patient’s condition worsened, Dean said.

“We were proud of what we got, but it was a difficult fight,” he said of the 16-bed hospital.

The blast that killed Dean’s father forced the only Wessington Springs nursing home to make a nationwide request for nurses.

Cash resources and high death rates have plagued other small communities. Blair Tomsheck, interim director of the health department in Toole County, Montana, was concerned that small hospitals in the region would have to start caring for serious COVID-19 patients as cases went to the highest level per capita in the country. One in every 28 people in the county has tested positive in the past two weeks, according to Johns Hopkins researchers.

Summer is very, very challenging when your resources are poor living in a small, rural county, she said.

Infections can also spread quickly to places like Toole County, where most everyone buys at the same grocery store, attends the same school, or worships in several churches.

“Sunday family dinners are killing us,” Tomsheck said.

Even as the outbreaks threaten to spiral out of control, doctors and health officials say they are trying to convince people of the seriousness of a virus that took months to take effect.

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

In the country ponds adorned with flags supporting President Trump, people took their suggestions to keep masks out of his often cavalier stance on the virus. Dean draws a direct link between Trump’s approach and the lack of precautionary measures in his city of 956 people.

There is the stupid idea that wearing a mask or refusing is a kind of political statement, Dean said. It has seriously interfered with our ability to take it under control.

Even in the midst of the tide, Republican governors in the region have been reluctant to act. North Dakota Governor 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 masked mandate.

South Dakota Governor Kristi Noem, who has carved a reputation among conservatives from the above blockades, blamed rising cases on rising testing, even though the state has had the highest level of positivity in the country over the past two weeks , COVID Tracking Project. The degree of positivity is an indicator of how widespread the infections are.

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

Whether the claim survives does not matter to Jody Bierhals, a Gillett resident who doubts the effectiveness of wearing the mask. Its home county of Oconto, which stretches from Green Bay’s northern border to forests and farmland, has the state’s second-highest increase in coronavirus cases per person.

Bierhals, a single mother with three children, is most concerned about the collapse of the business in her small salon. The region depends on tourists, but many have stayed away during the pandemic.

Do I want to keep the water running, 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 could not be stopped and it would be best to let it run its course. But local attitudes like those have left county health official Debra Coniter in despair.

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

“I’re just waiting to see if our community can change our behavior,” she said. “Otherwise, I do not see the end being seen.

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