WESSINGTON SPRINGS, S.D. — 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 University researchers. Overall, the nation topped 8 million confirmed coronavirus cases in the university’s count on Friday; the true number of infections is believed to be much higher because many people have not been tested.
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 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.
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.