Late-night phone calls are common for Diane Kenkel.

But, as the COVID-19 pandemic intensified in November, the calls became increasingly more urgent for the Mitchell-based nurse practitioner. Hundreds of patients reported symptoms or were diagnosed with the virus ripping through Davison County.

One such patient of Kenkel’s is an active mother of four, who has been placed on oxygen in her home and has not been to work in more than a month as specialists struggle for a cure.

Kenkel has been a vocal advocate of the use of face masks during the pandemic and was an ardent supporter when Mitchell Mayor Bob Everson signed an executive order on Nov. 17 and the city council passed an ordinance with a fine on Nov. 23.

Nearly a month removed from the invocation of a citywide mask mandate, Davison County cases have plummeted. From Nov. 2 to Nov. 23, the county totaled 1,148 new cases — 52.2 per day — and 18 deaths. In the 21 days since, there have been 352 new cases and the average has dropped to 16.8 per day.

Among the 10 most populated cities in South Dakota on a per capita basis, Mitchell ranks ninth in total cases and last in total deaths since the beginning of the pandemic. But between Dec. 5 and Dec. 12, Mitchell ranked No. 2 in cases per 100,000 people, following Huron, which enacted a mask resolution on Nov. 16.

“I believe that it’s because we’re thinking about this,” Kenkel said. “We’re wearing masks, we’re being more cognizant of protecting the community around us. The mask is mostly to protect the people around you. I’m wearing mine for you and you’re wearing it for me.”

After consistently being among the nation and world leaders in COVID-19 cases for nearly two months, South Dakota dropped to 14th, with 78.6 cases per capita during the last seven days, according to the Centers for Disease Control and Prevention. The state is still No. 2 in deaths per capita, with 2.4 per 100,000 over the same time period.

Despite cases falling, South Dakota is still No. 2 in the country behind Idaho with a 42.8% positivity rate overall and 43% in the last seven days.

Hilary Rockwell, an emergency physician at Avera Queen of Peace, judges the state of the pandemic most frequently on hospitalizations and the number of people coming through the emergency room, both of which have been down in Mitchell recently. Although doctors have been able to supply in-home oxygen and Avera has provided some with oximeters to keep track of oxygen levels to potentially avoid trips to the hospital.

Another advocate for the city’s mask mandate, Rockwell believes it has been part of more increased vigilance in the community to take precautionary measures after seeing 41 deaths in 43 days in Davison County.

“I think there was a time when you knew someone that had COVID and in the end of October, beginning of November, it turned into knowing someone that was in hospital or had died from COVID,” Rockwell said. “Our community awareness increased and people were more likely to wear a mask, stay home, social distance, wash hands — it has to be those things together for mitigation to work.”

Some believe Mitchell was hit with an inevitable surge and is now experiencing the natural decline. But Rockwell disagrees and has pointed to efforts from Vermont, a state with comparable population size to South Dakota, along with a Republican governor.

Vermont Gov. Phil Scott ordered statewide shutdowns and a mask mandate and eventually reopened the economy slowly. Since the beginning of the pandemic, Vermont has recorded fewer COVID-19 cases and deaths than any state in the country.

According to the CDC, South Dakota is second to North Dakota in total cases per 100,000 people and its rate of 10,533 is higher than the national average of 4,959 and more than 1,000 higher than the next closest country (Andorra).

North Dakota jockeyed with South Dakota for most of the fall in COVID-19 cases and deaths, but since implementing a mask mandate on Nov. 13 and putting restrictions on business, both have dropped. North Dakota has dropped from first to 10th in new cases per capita during the last two weeks.

Davison County, meanwhile, had 873 active cases on the day of Everson’s executive order and the number dropped by nearly 200 in 10 days and it has plummeted to 256 as of Dec. 15.

“We’ve certainly been putting the information out there for a long time for mitigation techniques, but we weren’t necessarily making a difference,” Rockwell said. “We were still seeing numbers climb. I do think that the mask mandate helped our numbers go down and a big reason was people beginning to do their part.”

Continuing mitigation to avoid relapse

A positive sign in the Mitchell medical community has been decreasing numbers after warnings of a post-Thanksgiving surge. Davison County has not reported more than 26 new single-day cases since Nov. 28, although there have been 15 new deaths during that time period.

The combination of decreasing numbers and the approval of two COVID-19 vaccines has some medical professionals urging people not to give up on precautions, particularly with Christmas and New Year holidays coming during the next two weeks.

“It’s hard to think with your head and not your heart,” Kenkel said. “... We’re so close to that vaccine, so the scary thing for me is people are going to give up, they’re so COVID-fatigued and for Christmas they’re going to pretend it doesn’t exist. People are going to end up getting sick and dying right before getting the vaccine.”

Even after vaccination, Rockwell says mitigation procedures must remain in place until the majority of the population receives both doses. While the Pfizer vaccine that was delivered this week is proving to be 95% effective in trials, there is a risk of still being able to carry and spread the virus.

There is also a concern that people, believing they and families or friends have been acting safely, will gather for the holidays. Rockwell reiterated that wearing a mask or washing hands are part of the process of stopping the spread, but are not singular solutions.

Despite the Davison County surge, the 2,452 total cases represents between 13-20% of the population, meaning there is a significant percentage that can avoid the virus with mitigation. Avera is also starting to see some reinfections from those that had the virus in the spring.

“We’ve seen this in other places — the numbers get high, people start working hard to mitigate, the numbers go down and people get into a lull of thinking they don’t have to worry as much,” Rockwell said. “We really need to stay the course. If this was basketball and your full-court press has you almost caught up to the other team, you don’t just stop.”