President Biden‘s announcement that there will be enough vaccines for all adults by May is raising hopes for a return to normal soon.
But the next few months in the pandemic are critical. Concern is growing over moves by some states to lift restrictions already, while new variants of the virus are on the rise in the U.S. Experts warn that actions taken now risk delaying getting back to some semblance of normal.
Health officials are urging restrictions to remain in place for the final stretch, saying that it will not be much longer before the situation markedly improves, and it does not make sense to lift all restrictions when widespread vaccinations are in sight.
Biden on Wednesday issued his most forceful comments to date, calling out the governors of Texas and Mississippi for lifting their states’ mask mandates and all capacity limits on businesses.
He noted that vaccinations for all adults are on the horizon.
“The last thing we need is Neanderthal thinking that in the meantime everything’s fine, take off your mask, forget it,” he said. “It still matters.”
Estimates differ on when exactly the country might return to something like “normal,” though many say they expect this summer will be much better.
Former Food and Drug Administration Commissioner Scott Gottlieb said on CNBC on Wednesday that he thinks even as soon as April will be “profoundly better,” given that vaccine supply will have ramped up significantly, allowing vaccine availability to be “wide open” by then.
Centers for Disease Control and Prevention Director Rochelle Walensky on Wednesday put the time frame at three months until the country could be vaccinated.
“The next three months are pivotal,” she said.
Thomas Tsai, a researcher at the Harvard T.H. Chan School of Public Health, said that by summer, “I think we can have a much more, I don’t want to say normal, but at least a ‘new normal’ summer.”
But experts warn that the return to normal could actually be delayed if restrictions are lifted too soon, causing a new spike in cases in the near term.
Tsai likened the current situation to the seventh inning stretch of a baseball game. “Progress has been made; it’s OK to take stock of that,” he said. “How we play the next two innings determines if this is a single game or turns into a doubleheader.”
Maintaining restrictions as people get fatigued and see the end in sight could be a challenge, though, particularly in red states that were skeptical of instituting health restrictions from the start.
Texas Gov. Greg Abbott and Mississippi Gov. Tate Reeves, both Republicans, pointed to the ongoing vaccination campaign in saying that the time has come to end restrictions.
“With the medical advancements of vaccines and antibody therapeutic drugs, Texas now has the tools to protect Texans from the virus,” Abbott said Tuesday. “We must now do more to restore livelihoods and normalcy for Texans by opening Texas 100 percent.”
Responding to Biden’s criticism on Wednesday, Reeves added: “Mississippians don’t need handlers.”
“As numbers drop, they can assess their choices and listen to experts,” he added. “I guess I just think we should trust Americans, not insult them.”
Gottlieb argued for a middle ground, saying that public health officials risk having the public simply ignore all guidance if they do not provide a “realistic glide path to a better future,” though March is “a little bit premature” to lift all restrictions.
“March really is a difficult month,” he said. “It sits between two worlds. February was a raging epidemic, it was very clear we needed to have measures in place. I think April’s going to be profoundly better, and March is sitting in the middle.”
Variants of the virus also pose a threat that adds another degree of uncertainty. The most common variant spreading in the US, known as B117, or the United Kingdom variant, responds well to vaccines, but is more infectious.
“The B117 hyper-transmissible variant looms ready to hijack our successes to date,” Walensky said.
Variants first identified in Brazil and South Africa also pose a risk of reducing the effectiveness of the vaccines, though the extent is not fully clear, and vaccine manufacturers are preparing backup plans to provide booster shots or updated vaccines if necessary.
“We are at a critical nexus in the pandemic,” Walensky said. “So much can turn in the next few weeks.”
After weeks of declines, both cases and deaths are ticking up. According to CDC data, the seven-day average of new cases per day, at 66,000, is up 3.5 percent from the past week, and deaths, at just over 2,000 per day, are up 2.2 percent.
Barbara Alexander, president of the Infectious Diseases Society of America, issued a statement Wednesday calling on people to continue wearing masks, distancing from others, and avoiding large gatherings.
“All of these measures together will bring us closer to ending the pandemic,” she said. “Abandoning them now will postpone the day we can put COVID-19 behind us.”
Still, the declines in past weeks and the increasing pace of vaccinations is offering some hope after a long year.
“I’m more optimistic than I have been in the last year,” Tsai said.
In recent weeks, U.S. coronavirus case data — long a closely-watched barometer of the pandemic’s severity — has sent some encouraging signals: The rate of newly recorded infections is plummeting from coast to coast and the worst surge yet is finally relenting. But scientists are split on why, exactly, it is happening.
Some point to the quickening pace of coronavirus vaccine administration, some say it’s because of the natural seasonal ebb of respiratory viruses and others chalk it up to social distancing measures.
And every explanation is appended with two significant caveats: The country is still in a bad place, continuing to notch more than 90,000 new cases every day, and recent progress could still be imperiled, either by new fast-spreading virus variants or by relaxed social distancing measures.
The rolling daily average of new infections in the United States hit its all-time high of 248,200 on Jan. 12, according to data gathered and analyzed by The Washington Post. Since then, the number has dropped every day, hitting 91,000 on Sunday, its lowest level since November.
A former director of the Centers for Disease Control and Prevention endorsed the idea that Americans are now seeing the effect of their good behavior — not of increased vaccinations.
“I don’t think the vaccine is having much of an impact at all on case rates,” Tom Frieden said in an interview Sunday on CNN’s “Fareed Zakaria GPS.” “It’s what we’re doing right: staying apart, wearing masks, not traveling, not mixing with others indoors.”
However, Frieden noted, the country’s numbers are still higher than they were during the spring and summer virus waves and “we’re nowhere near out of the woods.”
“We’ve had three surges,” Frieden said. “Whether or not we have a fourth surge is up to us, and the stakes couldn’t be higher.”
The current CDC director, Rochelle Walensky, said in a round of TV interviews Sunday morning that behavior will be crucial to averting yet another spike in infections and that it is far too soon for states to be rescinding mask mandates. Walensky also noted the declining numbers but said cases are still “more than two-and-a-half-fold times what we saw over the summer.”
“It’s encouraging to see these trends coming down, but they’re coming down from an extraordinarily high place,” she said on NBC’s “Meet the Press.”
Researchers at the University of Washington’s Institute for Health Metrics and Evaluation, publisher of a popular coronavirus model, are among those who attribute declining cases to vaccines and the virus’s seasonality, which scientists have said may allow it to spread faster in colder weather.
In the IHME’s most recent briefing, published Friday, the authors write that cases have “declined sharply,” dropping nearly 50 percent since early January.
“Two [factors] are driving down transmission,” the briefing says. “1) the continued scale-up of vaccination helped by the fraction of adults willing to accept the vaccine reaching 71 percent, and 2) declining seasonality, which will contribute to declining transmission potential from now until August.”
The model predicts 152,000 more covid-19 deaths by June 1, but projects that the vaccine rollout will save 114,000 lives.
Nearly 40 million people have received at least their first dose of a coronavirus vaccine, about 12 percent of the U.S. population. Experts have said that 70 percent to 90 percent of people need to have immunity, either through vaccination or prior infection, to quash the pandemic. And some leading epidemiologists have agreed with Frieden, saying that not enough people are vaccinated to make such a sizable dent in the case rates.
A fourth, less optimistic explanation has also emerged: More new cases are simply going undetected. On Twitter, Eleanor Murray, a professor of epidemiology at Boston University School of Public Health, said an increased focus on vaccine distribution and administration could be making it harder to get tested.
“I worry that it’s at least partly an artifact of resources being moved from testing to vaccination,” Murray said of the declines.
The Covid Tracking Project, which compiles and publishes data on coronavirus testing, has indeed observed a steady recent decrease in tests, from more than 2 million per day in mid-January to about 1.6 million a month later. The project’s latest updateblames this dip on “a combination of reduced demand as well as reduced availability or accessibility of testing.”
“Demand for testing may have dropped because fewer people are sick or have been exposed to infected individuals, but also perhaps because testing isn’t being promoted as heavily,” the authors write.
They note that a backlog of tests over the holidays probably produced an artificial spike of reported tests in early January, but that even when adjusted, it’s still “unequivocally the wrong direction for a country that needs to understand the movements of the virus during a slow vaccine rollout and the spread of multiple new variants.”
Where most experts agree:The mutated variants of the virus pose perhaps the biggest threat to the country’s recovery. One is spreading rapidly and another, known as B.1.351, contains a mutation that may help the virus partly evade natural and vaccine-induced antibodies.
Fewer than 20 cases have been reported in the United States, but a critically ill man in France underscores the variant’s potentially dangerous consequences. The 58-year-old had a mild coronavirus infection in September and the B.1.351 strain reinfected him four months later.
No matter what’s causing the current downturn in new infections, experts have urged Americans to avoid complacency.
“Masks, distancing, ventilation, avoiding gatherings, getting vaccinated when eligible. These are the tools we have to continue the long trip down the tall mountain,” Caitlin Rivers, an epidemiologist at Johns Hopkins University, said on Twitter. “The variants may throw us a curve ball, but if we keep driving down transmission we can get to a better place.”
The Centers for Disease Control and Prevention (CDC) on Friday released long-awaited guidance on safely reopening schools, emphasizing the importance of having schools open as long as proper safety precautions are followed.
The guidance states it is “critical for schools to open as safely and as soon as possible,” given the benefits of in-person learning.
The top recommendations for doing so safely are universal wearing of masks by students, staff and teachers as well as distancing so that people are six feet apart.
Vaccination of teachers should be prioritized, the agency said, but “should not be considered a condition” of reopening schools.
Schools can adjust whether they are fully in-person or hybrid depending on the level of spread in the surrounding community and mitigation measures in place.
Schools are encouraged to use “podding” to separate students into smaller groups to help make contract tracing easier.
Tucked in the shadow of the Tetons, the town of Jackson, Wy., and surrounding Teton County is home to less than 25,000 fulltime residents, but annually hosts over 2.5 million visitors. The valley’s natural beauty attracts an influx of tourists, who in turn are responsible for roughly 30% of the region’s jobs and over $1 billion in annual revenue, but this year, visitors came with an unwelcome price tag for locals: “Every time in this pandemic that we’ve had an influx of visitation, whether that’s second homeowners, or people just coming for a weekend, it follows with an uptick in cases and hospitalizations” says Dr. Jeff Greenbaum, medical director at the Emergency Department for St. John’s hospital and the Jackson Hole Mountain Ski Resort (JHMR) ski patrol.
With just one major hospital and eight emergency room physicians serving Teton County, any increase in COVID-19 cases is cause for concern. And in January, following the Christmas and New Year’s tourism rush, COVID-19 cases in Teton County skyrocketed to some of their highest levels since the pandemic began. Despite these developments, the ski resort, hotels, bars and restaurants remain open in the town. And Greenbaum remains optimistic that with the right strategies and precautions, the small hospital will not be overwhelmed by cases and skiing can stay open during the season for both visitors and locals. “The nightmare scenario is if the patients are stacking up in the emergency room and we don’t have enough personnel to treat them,” says Greenbaum. “But we’ll see that coming in advance, and we are not there yet.” The local hospital still has over 50% of its ICU beds unoccupied and has no COVID-19 patient on a ventilator. JHMR is similarly optimistic that it can stay open the entire season, trusting in the protocols it has put in place to protect both guests and staff.
Teton is the wealthiest county in the U.S., with a per capita income of over $250,000. At the start of the pandemic, a flurry of private jets landed at the Jackson Hole Airport, sometimes with a private ventilator in tow, as second homeowners and new buyers escaped to this rural paradise. Greenbaum posits that part of the reason why St. John’s hasn’t been overrun by cases is that many of the tourists that get COVID-19 in Teton County might not stay to get treatment in Teton County. At a time when millions of Americans are out of work, when daily infection rates are at an all-time high, and when thousands across the country are dying daily from the virus, should the wealthy indulge in an après ski, looking out onto the beautiful Teton mountains, all while potentially shuttling COVID-19 into and out of Jackson?
“This place is pretty much a gigantic country club, relying on second homeowners and tourism for its revenue,” says Jesse Bryant, a doctoral candidate in American Sociology at Yale University and creator of Yonder Lies, a podcast exploring the history of Jackson Hole. “But Jackson has to balance the ultra-wealthy with the real reality of people eking out a living here.” Teton County has the largest income gap of any county in the U.S., with the top 1% making almost 150 times more than the other 99%. From mountain guides to house cleaners to bartenders, much of the employment in Jackson cannot easily be transitioned to remote work, meaning that Jackson’s working class are among the most susceptible to unemployment from the pandemic. All across America the costs of the pandemic are being born by the poorest members of society; a Pew Research Center survey from September found that about 50% of low-income Americans say they or someone in their household has lost employment or had take a pay cut due to the pandemic, and similarly about 50% of low-income Americans reported having trouble paying their bills since the pandemic started.
During the spring and summer, the Coronavirus Aid, Relief, and Economic Security Act passed by the federal government at the start of the pandemic had provided $600 in additional unemployment payment per week, assuring many local and seasonal workers that their livelihoods were safe even if their jobs weren’t. But almost a year into the pandemic, Jackson’s working class are left with far fewer options: federal unemployment relief dropped to $300 and state unemployment benefits in Wyoming, although extended by 13 weeks, dry up after 39 weeks. “Many of the workers here don’t have a six-month buffer saved up,” said one restaurant worker who wished to remain anonymous for risk of losing their job, “so, while tourism presents a risk, we’re willing to take it to keep our paychecks coming in.”
This is the predicament that America has put herself in: a country with a limited safety net during the pandemic forces her workers to choose between the risk of getting sick, or losing their livelihoods. The mountain and the town are left trying to find a balance between keeping the economy open for tourists, and keeping COVID-19 out. As the second largest employer in Teton County, JHMR takes center stage in this unfolding drama. The resort is responsible for the livelihood of around 2,000 seasonal and local workers, and if the mountain were to shut down, many of the ancillary services in the town, like hotels, restaurants, rental shops, clothing stores and other retailers, would likely shutter their doors as well. In 2017, when the resort had to close for five days because of a power outage, the net economic impact to the local economy topped $5.5 million. “What’s happening in Jackson isn’t just a story of wealthy people coming into the rural west and getting the locals sick,” says Bryant. “This place has become more like a symbiotic relationship.”
One particularly vulnerable population is the Latino community, a significant number of which is undocumented, that lives in Jackson, and in the neighboring towns of Victor and Driggs. While it’s difficult to get exact numbers of their contribution to the economy, these workers keep Jackson running by filling jobs in all sectors, from house cleaners and construction workers to cooks and waiters.
“I’ve lived in Jackson for 25 years and used to go back to Mexico every winter because it was just too cold,” says Jorge, an undocumented construction worker in the town. “But then I got used to the cold and began skiing every single day.” Asked whether opening up the resort is worth the risk of bringing more COVID-19 into Jackson, Jorge says that by and large the Latino community welcomes the tourism with open arms, because it means job security. This lines up with findings from a survey undertaken by the Yale School of Environment this past summer, showing that Latino residents in the rural West had some of the highest rates of COVID-related unemployment in the country. “My wife and I work hard, her as a house cleaner, me in construction,” said Jorge. “The resort opening up and tourists coming to town is how many of us make our living.”
For its part, JHMR has been doing nearly everything within its power to keep COVID-19 from spreading on its slopes, iterating as the situation evolves to try to keep the 2021 season operating. In March of 2020, as the first wave of the pandemic was sweeping across the globe, the Wyoming State Health Officer shut down JHMR for the remainder of the season. The resort reopened in May, first for hikers and then mountain bikers—the summer tourists that in total are only about 10% the size of the winter tourist population. Before reopening for the summer crowd, it tested every single one of its staff members for COVID-19, and the resort’s human resources department transitioned into a contact-tracing team, coordinating with town officials whenever a case arose. While Wyoming didn’t issue a statewide mask mandate until Dec. 7, the resort instituted a mandatory mask policy during the summer. JHMR also learned to be more flexible in its operations: staff are now trained to perform a number of different functions, so they can sub in if there’s a shortage in a department, and shifts function as separate pods, meaning that if a person in one group has been exposed to COVID-19, another totally isolated pod can come in to take its place.
Over the summer and fall, tourists came in droves to Jackson, with as many as 40,000 total visitors in a day. According to the Jackson Hole Chamber of Commerce, both Yellowstone and Grand Teton National Parks—both within a quick drive from of Jackson—had about 50% more visitors in October of 2020 than they did for the same month in 2019. While many of the outdoor activities that bring people to Teton County during the summer—hiking, biking, climbing—have been deemed relatively safe during the pandemic, tourists also flocked indoors to the bars, restaurants and stores that remained open throughout most of the summer and fall. As a result, Teton County experienced large COVID-19 spikes in July and again at the end of October and into November.
Unsurprisingly, workers got sick. In response, Teton County’s Health Officer, Travis Riddell, sent out a series of recommendations pressing citizens to not gather with groups outside of their immediate family, avoid crowded indoor spaces and not congregate at trail heads, parks or other outside spaces. Still, most businesses stayed open as patrons kept coming. Riddell noted that the town had little choice: “Economic disasters are public health disasters,” Riddell said in an interview in July 2020 to National Geographic. “We know that when there are economic downturns, where there is an increase in poverty, an increase in uninsured numbers—that has direct health effects.”
Once JHMR opened for skiing the weekend after Thanksgiving, it was clear that demand for outdoor recreation would carry into winter; even with almost no international travel, JHMR expects demand during the 2021 winter months to be comparable to past years, at least. “If we just opened up [completely], the mountain would be packed, because demand itself is through the roof,” says LaMotte, “but we’ve imposed a maximum daily capacity for the mountain, to keep guests and staff safe.”
On a bluebird day near Christmas, the resort was sold out. It had snowed almost 15 inches the day before, and cars inched into the packed parking lot. Skiers and snowboarders waited in line for the lot shuttle bus, which, despite operating at 25% capacity, still felt uncomfortably full. The restaurants and bars looking out onto the sunny mountain were similarly capped at 25% capacity, and while masks and social distancing were required, patrons waiting for tables escaped the cold by standing shoulder to shoulder in the foyer.
At the resort, the socially distanced lines for the gondola were dangerously compressing. A resort worker cheerfully reminded guests from every corner of the U.S. to keep their distance and their masks above their noses. “We’re going to make it all the way through the season, without closing” yelled the worker, to cheers from the crowds. The lines moved slow—normally eight people fit onto the gondola, but under the new policies there was no mixing between groups, so often times the gondola ascends with just one or two passengers. At the top of the mountain, with views of the valley floor against the backdrop of the jagged Tetons, everyone breathed a bit easier.
Rob Kingwill and Emilé Zynobia, professional snowboarders based out of Jackson, stepped off the gondola into the cold Wyoming air, about 4,000 feet above the valley floor. Both sported COVID-19 masks made by Kingwill’s apparel company, Avalon 7. “I feel like this is almost an essential service, to give people the opportunity to be outside, said Kingwill. “We need this for our mental health.” When JHMR shut down in March of 2020, Kingwill strapped his snowboard to his backpack and hiked up Teton Pass’s infamous 1,300-foot Glory Boot Pack—every day for 77 days until all the snow had melted. But, he points out, most recreational skiers don’t have the knowledge and skills to navigate such technical terrain—and without the money those tourists bring in, Jackson’s working class would suffer. “It seems like the benefits outweigh the costs of keeping the resort open,” agreed Zynobia, as she and Kingwill strapped onto their boards. “Even though this is an activity skewed towards to wealthier people, it is helping a remote economy, and it is getting people outside at a time when we feel caged in.”
By the middle of January, Teton County’s COVID-19 cases were skyrocketing.Teton County currently has the highest caseload per capita of any county in the state of Wyoming and the highly contagious U.K. variant of COVID-19 was found to be circulating in the area. While the state of Wyoming had loosened COVID-19 gathering restrictions, the county reissued a series of guidelines on Jan. 25 that kept indoor gatherings capped at 25% and limited outdoor gatherings to 250 guests. At the resort, group ski lessons have been replaced by private lessons (at no extra cost), and the gondolas and lifts are ascending the mountain with minimal group mixing. Still JHMR can only control what happens on the mountain; “My main concern is not skiing itself,” says Greenbaum. “But rather I’m concerned about peripheral activity to skiing that lead people indoors, whether it’s a bar, a restaurant, a hotel lobby, a rental shop, a bus.”
Across the nation cases are surging, and other Colorado mountain towns like Telluride and Crested Butte have had similar spikes, likely due to an influx of winter tourism. The infection ratein Pitkin County, Colo., home to the Aspen and Snowmass ski resorts, was skyrocketing in the middle of January, with an incidence rate of about 3,500 per 100,000 people. In response, the county’s health department shut down all indoor dinning operations, but left the ski resorts open. The results were promising: in the past two weeks the COVID-19 rates for Pitkin County dropped by over 50%. “We’re on pace to be below 700 [cases per 100,000 people] in early February and I don’t think any of us thought that would happen so quickly,” said Josh Vance, the county’s epidemiologist, in an interview with the Aspen Times. “I’ll be honest—I think not having indoor dining plays a role.”
In Teton County, restaurants and bars remain open for indoor operations long as they follow social distancing guidelines. The reliance on the ultra-rich creates an undeniable risk to the livelihood of Jackson residents and workers. In the early days of the pandemic, ski resorts across Europe became super spreaders, with visitors transporting the virus like carry-on luggage, threatening other tourists and locals alike. As a result, resorts have been closed this winter across much of Europe, including in France, Germany and Italy. These precautions protect remote mountain towns from an influx of the virus, but there are other, massive costs associated with closing down. Without government support, there is little option for communities like Jackson but to stay open, follow existing public health guidelines and hope for the best. “When the pandemic first started coming to work felt like entering the lion’s den,” said the restaurant worker from Jackson who wished to remain anonymous. “But by now we’re all used to the risk, and really what choice do we have?”
The state has lost a greater share of its nursing home residents to COVID-19 than any other state this fall.
On October 9, an employee in the business office at Tieszen Memorial Home in Marion, South Dakota, tested positive for the coronavirus. She was sent home immediately, but three days later, a nursing aide and a housekeeper both tested positive.
Marion, a town of fewer than 1,000 residents, was experiencing a sharp uptick in cases — what scientists call community spread. It became more and more likely that the nursing home’s employees had become infected while, for example, grocery shopping.
On October 16, COVID-19 killed its first Tieszen resident. At that point, about thirteen of the home’s 55 residents had tested positive.
Nursing home administrator Laura Wilson called the days that followed the worst of her career.
“You almost feel like a battle zone,” she said. “We said, ‘You know, right now, we just need to survive.’”
South Dakota Republican Gov. Kristi Noem has taken a notably relaxed approach to the pandemic. This autumn, months deep into this pandemic, nursing homes there have seen a larger share of their residents die than any other state.
At Jenkin’s Living Center in Watertown, 24 residents have died from COVID-19 since the last week of October — about a fifth of the residents there — data submitted to the federal government show. Thirteen patients at Weskota Manor in Wessington Springs — more than a third of its patients — died from COVID-19 this autumn, most of them in one week. Walworth County Care Center in Selby, a 50-bed facility, saw COVID-19 kill 12 patients this autumn, an administrator said. Overall, more than 40 percent of South Dakota nursing homes have lost a tenth or more of their patients to the coronavirus, according to a Center for Public Integrity analysis of data from the federal Centers for Medicare and Medicaid Services.
Nationwide, more than 100,000 residents of long-term care facilities have died of COVID-19, making up 38% of the nation’s virus deaths, according to The Atlantic’s Covid Tracking Project, even though they represent less than 1 percent of the population.
The federal government has made protecting the elderly a priority, shipping millions of rapid tests to nursing homes across the country. Public health experts spent the first nine months of the pandemic perfecting strategies to keep the virus from spreading in close quarters. But, as researchers have learned, whether nursing home residents die from COVID-19 depends less on what happens inside than outside. Once COVID-19 permeates a town, there’s a limit to what nursing homes alone can do.
And that has made South Dakota an especially deadly place.
A LONG STRING OF DEATHS
During Tieszen’s outbreak, the nursing home was eerily quiet. On a normal day, “The Price is Right” might blare from a room, echoing down the hallways. But when the coronavirus hit, all the residents’ doors had to be closed to try to control the spread.
Before October, Tieszen had pandemic challenges but not mass tragedy. Wilson was forced to hunt for N95 masks on eBay, even though South Dakota is home to a 3M factory that makes them. She relied on her son, who works at Sam’s Club, to buy one pack of disinfecting wipes every day for the nursing home’s stockpile. Back when she was using lab-confirmed tests to screen her staff, she had trouble getting test results back within the time recommended by federal guidelines, as the Sioux Falls lab she had contracted with was swamped. And she says, like always, staffing was a problem: Tieszen told the federal government it was short on nurses and aides every week in October and November.
Wilson, who has worked at the nursing home for 42 years, said her staff did everything it could during the outbreak. Indeed, Tieszen, a small nonprofit that has earned five stars in the federal government’s nursing home quality rankings, passed three state inspections of its infection-control program between May and November, records show. It received roughly $70,000 in CARES Act incentive payments from the federal government in September based on good performance.
When the coronavirus hit, the nursing home dedicated two of its wings to COVID-19 patients, isolating them from other residents, until so many contracted the virus that they had to stay in their rooms. The entire nursing home, essentially, became a COVID ward. Wilson’s own 85-year-old father tested positive. Nurses worked overtime; Wilson put in 80-hour weeks and hired temporary help. Staff served residents’ meals on paper plates instead of dishes that might retain the virus. They conducted weekly audits of how often staff were washing their hands. They tested workers and residents at any sign of a sniffle, as well as regularly regardless of symptoms, using equipment shipped to the nursing home from the federal government. They followed up positive rapid test results with lab-confirmed PCR tests.
Despite all of these measures, the virus spread quickly.
The week after Tieszen’s first death on October 16, five more residents died, Wilson said. Among them was 89-year-old Maxine Ortman, a former teacher suffering from dementia whose husband would visit often, before the pandemic, from his home across the street.
The following week, seven more died.
In November, another seven died. They included 68-year-old Larry Johnson, a diabetic and former mechanic whose sense of humor and work ethic drew customers from all over northeastern South Dakota, his family wrote in his obituary.
And they included Randy Wieman, 64. He had Down syndrome, and died a week after testing positive for the virus, said his older sister, Carol Husby. He loved music, dancing and his many nieces and nephews. A normal December would find them celebrating Wieman’s birthday with chocolate cake.
“He would call me every morning to ask if I was up,” Husby said. “Randy was an amazing individual.”
In total, 20 residents died of the coronavirus — more than a third of those living at the Tieszen nursing home — in the space of five weeks.
Tamara Konetzka, a health researcher at the University of Chicago, has been studying the fate of nursing homes in the pandemic since the spring.
Her conclusion: “Nothing much has changed.”
Despite more testing and efforts to hone infection control practices, despite nine months of scientific study of the virus, nursing home residents are still at the mercy of their surrounding communities. “If they’re in virus hotspots, they’re going to be at risk,” Konetzka said. “The idea that we have found the secret to preventing nursing home cases and death is a little crazy.”
And this autumn, nearly all of South Dakota has been a hotspot. The state has ranked at or near the top of all 50 states in new coronavirus cases and deaths for months in reports issued to governors by the White House Coronavirus Task Force. During one week prior to Thanksgiving, South Dakota had 988 new coronavirus cases per 100,000 residents — more than double the national average. It had 19.6 deaths per 100,000 residents — the worst rate in the nation and more than six times the national average.
The state’s governor, Noem, is widely believed to have national political ambitions. She has proudly shunned strict measures to curb the virus. “Rather than following the pack and mandating harsh rules,” she wrote in The Wall Street Journal earlier this month, “we ask all South Dakotans to take personal responsibility for their health …. The state hasn’t issued lockdowns or mask mandates. We haven’t shut down businesses or closed churches.”
Many South Dakotans have refused to wear masks or socially distance. In September, Wilson spoke at a meeting of local business owners in Marion and urged them to take mask-wearing seriously. She was met with blank stares.
“When I left that meeting I had basically resigned myself to the fact that I am living in a different world, and they don’t get it,” she said. “I’d be the only person in the grocery store with a mask on.”
Though limiting community spread is the best way to protect nursing homes, researchers said, some measures — especially having enough staff — can affect the severity of outbreaks. Here is where the federal government failed spectacularly, experts said. “What they needed — damn it — they needed money for more staffing,” said Larry Polivka, executive director of the aging-focused Claude Pepper Center at Florida State University. “And they needed all of the PPE. They needed massive testing capacity as quickly as possible in the spring — they didn’t get it.”
Wilson said the South Dakota Department of Health was helpful when she called or emailed with questions. The state continued to inspect nursing homes for infection control practices, and just 14 South Dakota nursing homes were cited by inspectors for inadequate infection control between March and October, according to federal data. The state has a program to recruit retired nurses and doctors to help work in healthcare settings. The federal government sent a “strike team” to South Dakota in October to help nursing homes tackle the coronavirus, a spokesman for CMS said in an email, and federal officials have offered training and guidance.
But it’s unclear what else, if anything, South Dakota did to help nursing homes weather the brutal autumn. For nine weeks in October and November, on average, nearly a quarter of all nursing homes in South Dakota told the federal government they were short on nursing staff, far more than the 16 percent that did so nationwide. On average, more than 40 percent of South Dakota nursing homes reported shortages of aides, more than double the nationwide figure. And 13 percent of South Dakota nursing homes during that time reported shortages of PPE — roughly the same as did nationwide.
Policymakers of all stripes, even those who embrace a controversial “herd immunity” strategy and wish the virus to run free through the population, stress the need to protect long-term-care residents. Noem has not explicitly endorsed a herd immunity approach but has emphasized that the coronavirus is less likely to harm young people. She has acknowledged that the elderly face greater risks from the coronavirus.
Yet the governor’s spokesperson did not answer questions from the Center for Public Integrity regarding nursing homes or respond to requests for comment. Noem’s health secretary did not respond to a request for an interview. The South Dakota Department of Health declined to answer multiple emails sent by Public Integrity over multiple weeks. The state’s long-term-care ombudsman refused through an agency spokesman to answer questions. When pressed, the spokesman said he did not know the reason but was given orders to decline the interview.
Even supposed advocates for nursing homes are reluctant to speak about the toll the coronavirus is taking on South Dakota’s elderly. Two trade associations representing nursing homes in the state declined interviews. One of them, the South Dakota Health Care Association, recommended that a reporter speak to the state department of health instead. Another lobbyist, who wished to remain anonymous to avoid angering the Noem administration, said people fear upsetting the governor’s office, known for its guarded approach to dealing with the media.
The state also waited until September to decide how to spend nearly $600 million in CARES Act funding approved by Congress in March. Noem finally set aside $115 million for nursing homes and other local health providers. But nursing homes had to apply for the funding during an 11-day period in October and meet strict qualifications. Tieszen applied but was not granted funds. Documents from the South Dakota Legislature dated Dec. 7 show that 115 health care organizations applied for the funding, and 47 were approved. But just $1.9 million had been handed out as of Dec. 18. The state is now proposing another grant program to distribute the money to health organizations based on bed numbers.
But for many nursing homes, the money comes too late to save lives. South Dakota may be past the worst of this COVID-19 surge. New coronavirus cases in the state are on the wane; vaccines are perhaps weeks away for nursing home residents at Tieszen and elsewhere.
All told, the state lost roughly one out of every 10 nursing home residents to COVID-19, according to federal data.
“I don’t understand why people didn’t take it seriously right from the beginning,” Husby said. “It just breaks my heart because it didn’t have to be this way.”