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 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 started 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.
High per capita toll
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. 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 school 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 toward 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 forgoing 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.
A mask doubter
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.
Koniter 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."
WHO Reports Record 3 Million New COVID-19 Cases in a Week
The World Health Organization says a record 2.8 million new COVID-19 cases have been reported globally over the past seven days ending Tuesday, including 40,000 new deaths.
The U.N. health agency says Europe accounts for the greatest proportion of reported new cases for the second consecutive week with more than 1.3 million, an increase of 33% compared to the previous week. The region accounted for nearly half of the new COVID-19 cases during the seven-day period.
The figures also show that cases are also increasing in the Americas, Eastern Mediterranean and African regions, while declines continue to be reported in Southeast Asia. The Western Pacific region also showed a slight decline in new cases and deaths over the seven-day period.
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WHO said the countries reporting the highest number of cases over the past week are India, the United States, France, Brazil and Britain — the same countries as the previous three weeks.
The virus has even affected operations at the U.N.’s main headquarters in New York. General Assembly President Volkan Bozkir canceled all in-person meetings Tuesday after five staffers with Niger’s mission to the world body tested positive for COVID-19.
The United States has posted a record 502,828 new COVID-19 cases over the past week, according to data compiled by Johns Hopkins Coronavirus Resource Center, an average of more than 70,000 new cases. The previous record of 481,519 new cases was just recorded for the week ending October 24.
White House coronavirus task force member Admiral Brett Giroir said Wednesday on NBC’s "Today" show that the surge in the U.S. is not just due to more testing, contradicting President Donald Trump’s assertion that more testing has revealed more cases.
Giroir, who Trump put in charge of testing, said the proof of the increase in infections is more hospitalizations and COVID-19 deaths throughout the United States. The U.S. leads the world with more than 8.7 million total COVID-19 cases, including nearly 226,700 deaths, according to Hopkins statistics.
Giroir said the U.S. has reached “another critical point” in the response to the coronavirus crisis and urged people to wear masks, wash hands and engage in social distancing. He also said a safe and effective vaccine is “around the corner.”
The U.S. Midwest has experienced a high number of new COVID-19 cases, including in the state of Illinois, where Gov. J.B. Pritzker has imposed a new round of restrictions, particularly in Chicago, the nation’s third-largest city. The governor on Tuesday announced a ban on all indoor service in bars and restaurants beginning Friday at midnight.
Farther west of Chicago, Mayor Michael Hancock of Denver, Colorado, has ordered restaurants and other businesses to limit the number of patrons from 50% to 25%, as the state capital posted a one-day record of 327 new coronavirus cases on Sunday.
Among the new U.S. cases is Justin Turner of Major League Baseball’s Los Angeles Dodgers, who was pulled from Tuesday’s World Series game against the Tampa Bay Rays after officials learned he had tested positive for the disease.
Turner was pulled late in the game before the Dodgers defeated the Rays 3 to 1 to win the league’s season-ending championship.
In the effort to develop a new coronavirus vaccine, U.S. pharmaceutical company Pfizer said its large, late-stage trial of its experimental vaccine it is developing with Germany's BioNTech has not reached a key milestone, making it unlikely that it will be released before the upcoming November 3 U.S. presidential election.
The company said fewer than 32 COVID-19 infections among its 44,000 volunteers have occurred, a necessary benchmark to determine whether the drug is safe and effective.
Indonesia’s Pandemic Response: A Law to Create Millions of Jobs
A landmark law passed this month in Indonesia will open the populous, impoverished country to labor-intensive industry like many of its Southeast Asian neighbors despite a hit to worker rights, people on the ground say.
The 905-page Omnibus Bill on Job Creation bill will give millions of young people chances to work, including in formal jobs that can be hard to find because older Indonesian laws discouraged foreign investors from setting up factories, analysts believe.
Indonesians are struggling to earn income during an unrelenting COVID-19 outbreak that prompted shutdowns from April. The nation with nearly 400,000 infections reported a sharp drop in retail sales from April through August and a fall in exports over the three months ending in September.
“With this new law, it is expected that the investment would come not only to the Indonesian economy, but also come to the labor-intensive part, and by getting more investment in that area it is expected that more jobs will be created, and those jobs are more of the quality jobs, not only informal jobs,” said Yose Rizal Damuri, economics department head with the Center for Strategic and International Studies research organization in Jakarta.
Indonesia’s government and House of Representatives passed the bill ahead of schedule on October 5, the Jakarta Post reported. The bill aims to cut bureaucracy and make it easier for investors to create jobs, said Richard Borsuk, S. Rajaratnam School of International Studies adjunct senior fellow in Singapore.
President Joko Widodo’s government sees this bill as part of his “legacy” to stimulate the 270 million-person country's economy, Rizal said. Minerals, oil and farming make up much of Indonesia’s $1 trillion-plus GDP today. “Labor-intensive” industry players find Indonesia too expensive now, Rizal said, explaining why that sub-sector makes up just 2% of the country’s total investment.
Foreign manufacturers of garments, shoes and textiles normally pick other low-cost Southeast Asian countries, such as Vietnam, over the past decade because of stiff pro-labor laws, economists say. Foreign investment eventually raises the living standards, as witnessed in China and eventually Vietnam.
“It’s probably something that will be a long-term benefit, if this does go through,” said Rajiv Biswas, senior regional economist with IHS Markit, a London-based analysis firm.
“It creates a better environment for foreign multinationals to hire, because from the perspective of foreign multinationals, it’s very restrictive labor laws there,” Biswas said. “They’re worried about hiring because it’s very hard to reduce the workforce later on.”
Foreign investors will consider the law a “step in the right” direction for making Indonesia friendlier, forecast Song Seng Wun, an economist in the private banking unit of Malaysian bank CIMB.
“This Omnibus Bill is part of something that Jokowi [was] looking to see how they can help sort of improve the investment landscape to make it a little bit more attractive in Indonesia, just to make sure Indonesia doesn’t get pushed down the investible list of countries,” Song said, using the Indonesian president’s nickname.
But the law sparked staunch opposition. Some governors have asked Widodo to revoke the law and other people protested in the streets over three days, sometimes violently, Borsuk’s study says.
The law effectively eliminates the power of labor unions, said Paramita Supamijoto, an international relations lecturer at Bina Nusantara University in greater Jakarta.
The October bill would roll back legal support for fair wages, safe working conditions and excessive overtime, U.S.-headquartered human rights advocacy group Amnesty International said in a statement in August. It called the bill’s preparation process “opaque.”
Severance pay for laid-off workers will also slip, Damuri said.
For workers, the law means that “whatever you do, your life will be determined by your employers,” Supamijoto said.
But the law could stoke enough investment to stop people from migrating overseas in search of work, she said. “Under our current president’s administration, they prefer to invite the investors rather than sending workers abroad, so it’s better to invite you to come here to spend money, to invest your money, then to help us to build the infrastructure,” she said.
Iran Parliament Speaker Contracts Virus as Deaths Surge
Iran's parliament speaker said that he has tested positive for the coronavirus, joining a growing list of infected Iranian officials as the country again shattered its single-day death record with 415 new fatalities reported Wednesday.
Mohammad Bagher Ghalibaf tweeted that he received the news after one of his colleagues tested positive for the virus. He said he would continue to carry out his duties from self-quarantine. Earlier this month, he was on state TV visiting a coronavirus ward in one of capital's overwhelmed hospitals to show support.
"I decided to appear in the hospital to see problems from a close distance," Ghalibaf told local media from the ward in Tehran. "Supervising is the main duty of parliament."
Iran has for months wrestled with the worst outbreak in the Middle East, and on Wednesday the daily death toll hit a new high for a second consecutive day. Wednesday's count pushes Iran's total death toll past 33,700 — the highest in the region. Public health officials have repeatedly stressed that the true number of deaths is likely 2.5 times higher.
The government, desperate to salvage an economy reeling from severe American sanctions, has been loath to order business closures even as infection rates reach new heights.
In a clear sign of the outbreak's scale, dozens of top officials have fallen ill. At least 30 lawmakers have tested positive in recent months, according to local media, and a senior adviser to the country's supreme leader has died. Earlier this month, the head of the country's atomic energy organization and the vice president in charge of budget and planning both contracted the virus.
Iran's former parliament speaker, Ali Larijani, tested positive for the virus in April and returned to work after convalescing for three weeks. Ghalibaf took over his post in early June.
As infections surge, filling the country's hospitals and driving up its death toll, Iran's parliament has continued to hold regular sessions. Lawmakers wear masks but tend not to practice social distancing. When President Hassan Rouhani decided to skip a parliamentary vote this fall out of concern for his health, he faced intense backlash from hard-line lawmakers who demanded he attend regardless.
The timing of the pandemic has proved disastrous for Iran's economy, which is buckling under U.S. sanctions re-imposed in 2018 after the Trump administration withdrew from the nuclear deal between Iran and world powers.
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