BURKE -- Margaret Ann Bailey rarely left her hospital room bed for 15 days. She was alone, afraid and gasping for breath.

The 77-year-old Burke resident contracted COVID-19 in November after her husband, Rich, tested positive with mild flu-like symptoms. Initially, Bailey thought she had similar symptoms, but on the second day, her oxygen levels plummeted to 67 percent, well below the normal 95 percent.

Bailey was taken to Burke’s Community Memorial Hospital, not knowing she would not see her husband of 50 years for more than two weeks. After two days, she was rushed by ambulance to Sioux Falls for more aggressive treatment. There she laid, too weak to walk from the bed to a nearby chair.

A month later, Margaret Ann Bailey still feels weak and can only a few minutes of standing on the front porch is all that can be mustered. But the Baileys were lucky to avoid succumbing to a virus that has disproportionately impacted the elderly in Gregory County, which has a population of 4,185 people and where more than one-fourth of the residents are over the age of 65.

The county also has one of the highest death rates in the state, as 22 of 452 COVID-19 cases have ended in death, with 12 occurring since Nov. 2.

COVID-19 has hit the county harder than most in South Dakota, as the 4.9% death rate is higher than the state’s 1.2% and the percentage of hospitalization for those who contract the virus is 14.6%, compared to 5.6% statewide.

“I just can’t believe that people won’t adhere to the fact that it’s a virus and it’s dangerous and how stupid they are for not understanding you better wear a mask or stay home if you’re sick,” Bailey said. “I just don’t think people really get it. I nearly died and I don’t want anybody to go through this, but they just don’t understand.”

It took seven days on an oxygen machine for Bailey to regain her breath and she was able to avoid using a respirator. By the 11th day in the hospital, she began to gradually feel better as she was able to get out of bed for the first time since arriving.

The Baileys are once again reunited, but still confused by how they were both able to contract the virus. Margaret Ann knew she needed to be cautious prior to her illness, so she wore a mask and tried to stay home as much as possible. But she was still stunned by the aggressiveness of the virus, even two weeks removed from being discharged from the hospital.

“It completely takes all your strength,” Bailey said. “I can hardly get from my chair to the table. It’s getting better, but it’s pretty tough. It upsets me when I see people without masks, because they don’t even know. … You have no idea how you can be so weak and out of breath.”

Community spread causes pain

Less than 2% of South Dakota’s COVID-19 cases have come from people over the age of 70, but the same population accounts for 78% of the state’s deaths and 42% of hospitalizations.

A large percentage of those cases occur in nursing homes, as South Dakota has ranks third in the nation with 454.7 COVID-19 cases per 1,000 residents and fourth with 107.1 deaths per 1,000 residents, according to data submitted to the Centers for Medicare and Medicaid Services.

Nursing homes have been hit heavily in Gregory County, particularly Avera Rosebud Country Care Center in Gregory. On Sept. 13, ARCCC reported 35 current residents, with three COVID-19 cases to date. By Nov. 22, the number of occupied beds dropped to 22 after 22 cases and nine deaths due to COVID-19.

Representatives from Avera did not respond to a request for comment prior to the deadline for this story, while Gregory’s Silver Threads Assisted Living declined to comment. As an assisted living facility and not long-term care, Silver Threads is not required to publicly report COVID-19 data to CMS.

Details have also not been provided to Gregory County Commissioners, while advice health care experts has been frequently shunned by members of the community.

“If a medical professional talks to you about high blood pressure, you go on medication. If you have an infection, you take an antibiotic,” said Mistie Drey, Burke Community Memorial Hospital's administrator. “However, when it comes to wearing a mask -- our medical professionals across the board are telling people masking does make a difference, but that guidance doesn’t seem to be followed.”

On May 5, Gregory County Commissioners adopted a 21-point resolution that included food service businesses to operate at 50% capacity, with employees in direct contact with customers wearing face masks. Video lottery casinos and privately-owned gyms were also asked to have less than 10 people at one time, while cosmetologists in salons were to wear face masks.

The city of Burke also passed a resolution encouraging customers and employees to wear masks indoors, particularly during face-to-face contact. The city of Gregory also passed a resolution in April limiting food service businesses to half capacity, but did not mention face coverings.

But the resolutions have not gained significant traction. Meanwhile, the Gregory County Commissioners and the Burke City Council have struggled to create an ordinance to be enforced by law, not only finding pushback from the public but also failing to come to an internal consensus on the matter.

“Of those 20 people that died, I probably knew at least 15 of them,” Burke Mayor Tom Glover said. “It went through one of the nursing homes and now it’s in one of the assisted livings. That’s where a lot of those deaths occurred, but that’s no excuse for not taking precautions. It’s very frustrating. I don’t know what it’s going to take to convince people we should be doing more instead of less."

Seeking public cooperation

Like many counties in South Dakota, Gregory was compliant in taking precautionary measures early in the COVID-19 pandemic. But when the initial surge never came in March and the second surge never came in June, many balked at the notion more cases could come in the fall.

By the time the surge arrived during the fall, it was met with little resistance and precautions. This time, it hit hardest. The county, which has 68 active cases as of Dec. 4, has experienced more than half its deaths and 32 of its 66 hospitalizations since November.

Even restaurants that went against the resolution to remain open at full capacity are not seeing the normal foot traffic and now aid from government programs such as the CARES Act are gone. Gregory County Commissioner Kelsea Sutton proposed a plan for the county to cover businesses that want to close for a month due to COVID-19, but it did not gain large support.

“It couldn’t possibly be worse,” Sutton said. “It’s been so divisive, it’s caused so much community conflict and it’s caused family conflict. My perception is people are so tired of having the fight that they are just surviving in their day-to-day lives as best as they can. We are lucky to have truly excellent health care in our county. … It’s been really hard for them to have conversations with the community about what they need.”

Several lawmakers are frustrated with a perceived lack of leadership from Gov. Kristi Noem, as well as federal leaders. Anshutz has been a proponent of a mask mandate in Gregory, but the feeling among City Council members is that it would be impossible to enforce.

In October, Noem announced that $580 million would be distributed to health care organizations and non-profit businesses. Small businesses can apply for loans from a $400 million pool. But Noem has also downplayed the pandemic and offered encouragement differing from Centers for Disease Control and Prevention recommendations.

South Dakota is not one of 37 states with a statewide mask mandate and local lawmakers, as Noem has left governing on such issues to county and city governments.

“Without the state, us little towns are just hanging out here,” Gregory Mayor Scott Anshutz said. “Right now, I don’t have any police officers and the sheriff’s department is covering Gregory County. It’s tough to go to your friends and neighbors to make them wear a mask or shut down their business. With the leadership that we have -- federal and state -- we can’t make it happen. We’re too complacent.”

COVID-19 precautionary measures are being fought in a variety of different settings as people differ between health care concerns and personal freedoms.

“I feel strongly that it is fundamentally wrong that we have been left to fight amongst ourselves about these things in so many settings,” Sutton said. “We do not have the resources and training to do this work and deal with constant conflict. It’s exhausting and debilitating.”

Lawmakers and medical professionals have continued to implore people to take precautionary measures in Gregory County. Neighboring Charles Mix County has double the population size and number of cases, but 16 fewer deaths than Gregory County.

As of Dec. 4, Avera Gregory and Burke Community Memorial hospitals had a combined one ICU bed occupied due to COVID-19, but a small outbreak could overrun the small capacity numbers in both hospitals.

“Every day you try to make these people understand or believe what’s going on,” Glover said. “I’ve even heard from people that lost family members that still don’t think it’s that big of a deal. The cases are down now, but we don’t have a very big hospital. If we get a big influx, we could get overrun very easily.”