WESSINGTON SPRINGS — In a house set halfway up one of Jerauld County’s many rolling hills, Tom Dean can see nearly the entire city of Wessington Springs from his front porch.

Outsiders may think the term city is used loosely. There are no stoplights and yield signs are more prevalent than stop signs. City Hall, the school and a 125-year-old opera house still in operation are all on the same street.

Wessington Springs is the county seat of Jerauld County, one of South Dakota’s smallest in population and square miles. But with a population of 2,013, it has held the second-highest death rate for COVID-19 in the United States for months, despite being one of six counties in the state with mild or minimal spread.

As of Dec. 11, the South Dakota Department of Health has reported 258 cases, with 18 hospitalizations and 15 deaths due to COVID-19. Thirteen of those deaths occurred during an outbreak at Weskota Manor Avera, a long-term care facility in Wessington Springs. Since the start of the pandemic, Jerauld County has had 739 COVID-19 deaths per 100,000 people, second only Gove County, Kansas's 764.

Dean, a 75-year-old family medicine physician, lost both of his parents in the outbreak at Weskota, which saw 12 deaths between Oct. 4 to Oct. 25. Meanwhile, the facility has recorded 33 cases among residents — the facility held 34 residents at its peak during the pandemic — and more than half of 55-person staff contracted the virus.

“They went six months and were able to keep the virus out of the facility, even during a time when we had an outbreak in the community,” Dean said. “We know the virus was all around. The assumption is a staff member that was asymptomatic came in and brought the virus in, not knowing they were doing so. … But we’ll never know for sure.”

Prior to the onset of the pandemic, Harold and Betty Dean had limited communicative abilities. Betty was primarily unresponsive, while Harold — who was 100 years old — was limited, but physically active.

Once they contracted COVID-19, neither was able to fend off the virus for long and they died four days apart, as Betty died on Sept. 26 and Harold’s death on Sept. 30 came four days removed from his diagnosis, five months shy of their 77th wedding anniversary.

Before Weskota locked down the facility early in the pandemic, Dean visited his parents weekly. Weskota has allowed window visits, video chats and face-to-face interactions outdoors, where masks and 6 feet of separation were required. But Dean felt video chats would not have been worked well, given the mental state of his parents.

“Even before the outbreak (at Weskota), they had stopped all group activities, kept residents in their rooms rather than going to the dining room,” Dean said. “Nurses really found that difficult because it’s so hard on these frail old folks, so much of which are pretty confused and can’t figure out what’s going on. They miss the socialization with the other residents. From a medical point of view, it’s the right thing to do, but from a social standpoint, it’s very disturbing.”

Jerauld County experienced an outbreak over the summer at a diner in Lane — less than 10 miles from Wessington Springs — that resulted in at least 15 positive cases and at least one documented death.

Weskota managed to keep the virus out of the facility until Sept. 20, when the first three cases among residents appeared. The following week, there were 16 more confirmed cases. The next week, there were six more cases and three deaths. The most difficult period came on Oct. 25, when seven residents died due to COVID-19 in the span of one week.

As the outbreak worsened and staff members dwindled due to positive tests or close contacts, Weskota was forced to bring in temporary workers, while some nurses worked longer shifts. The facility also separated one wing of the facility to quarantine residents that were infected.

“Residents have that connection with their caregiver and the staff has that with the residents,” Weskota Administrator Nikki VonEye said. “It is tough when they do get sick or they pass away.”

COVID-19 penetrates locked-down buildings

COVID-19 has proven to be most lethal among the elderly community in South Dakota, with 955 of the state’s 1,210 deaths have come from people over the age of 70.

Nursing homes have offered a large chunk of those deaths as the virus tears through facilities like a burning building, leaving residents without a path to escape.

South Dakota’s long-term care facilities have accounted for 516 COVID-19 deaths, according to the latest data provided by the Centers for Medicare and Medicaid Services on Nov. 29.

Avera has screened employees since the onset of the pandemic and have begun providing rapid-result tests, with Weskota employees being tested twice per week. Those tests provide results within 15 minutes, and it has led to a decrease in cases across Avera facilities, as Weskota has had four new cases among residents since Oct. 18.

Still, it has been difficult to pinpoint how the virus enters facilities with such strict procedures, aside from most facility outbreaks coincide with significant spread within outside community members.

“Typically where we have seen outbreaks in long-term care facilities, there’s also a high positivity rate in the county where the facility is located,” said Doug Ekeren, Avera’s administrative lead for Avera’s long-term care strategic business unit. “We do have some movement of residents for medical purposes and provider visits. There’s a variety of ways it could happen, but we don’t know for certain.”

When an outbreak does occur in facilities, Avera notifies the family of each resident within 24 hours of a positive test. Dean was frequently in contact with Weskota nurses and was given updates on the condition of his parents throughout the pandemic.

“By being transparent with people, we got good questions on the front end when there was fear and uncertainty because we didn’t know as much,” Ekeren said. “We didn’t have all the treatment options that we administer in long-term care facilities now. … People trust us to take care of their loved ones and it’s not a time to pull back on information.”

The most talked about solution to subdue COVID-19 outbreaks in nursing homes has been the creation of a vaccine. State health officials are expecting 7,800 federal doses of a vaccine produced by Pfizer, while state Department of Health Secretary Kim Malsam-Rysdon announced 14,600 doses of a vaccine from Moderna would be distributed in South Dakota if approved on Dec. 17 . It is expected 11,000 long-term care residents are in line for the vaccine following frontline health care workers.

Still, Avera cannot mandate residents to take the two-dose vaccine when it becomes available.

“We would encourage it,” Ekeren said. “... Our medical experts are saying it is safe for people to take the vaccine. So, we are encouraging people to take the vaccine, but it is not required.”

Until a vetted vaccine arrives, Dean has been encouraging people to follow proper precautions to avoid further community spread, particularly from continuing to seep into nursing homes. Dean believes that compromise is essential and he believes explaining the benefits of wearing a mask will be more impactful on people than mandates.

“If you’re going to live in an organized society, we have to make some compromises,” Dean said. “You can’t drive 100 miles per hour down the highway, even though the weather may be good and you think you may be perfectly capable of doing that. You may not care if you get killed in a wreck, but you’re probably going to kill somebody else along with you and that becomes society’s problem.”