Looking at a map of covid-19 cases nationwide, it's hard not to long for home.
I'm in New York, a state with 31,000 cases of the infection; but South Dakota, where I grew up, has 41, one of the very smallest counts of any state in the U.S. - spread out over 77,000 square miles. Yes, South Dakota has fewer people, but that's still only one in 21,500 people infected. In New York, the ratio is one in 634.
But South Dakota is worried nonetheless, and with reason. Those 41 cases as of Wednesday represent an increase of more than a third in one day, and community transmission is occurring in six counties. Gov. Kristi Noem warns that 30% of state residents may contract Covid-19 over the next several weeks.
This illustrates one of the frustrating truths about the coronavirus. While transmission may occur more easily in crowded cities, it happens, silently and invisibly, anywhere that an uninfected person comes into contact with an infected one. And it's not always possible to know who's infected.
Like other governors, Noem has told state residents to avoid gatherings of 10 or more, to follow the CDC guidelines on hand-washing and cough-covering and to keep six feet away from one another. And people are doing their best to comply.
Deadwood's casinos are shut. The Black Hills National Forest is essentially closed, and visitor services at Mount Rushmore are suspended. K-12 schools are closed. College classes have moved online, and spring graduation ceremonies are canceled. Office workers have set up shop at home. Funerals are being livestreamed. Kids in Eagle Butte are standing outside the Medicine Wheel Village assisted living center with signs to comfort quarantined residents: "Stay strong, you'll get through this." Groceries stores have empty shelves where paper products should be.
Parts of this may sound familiar. But South Dakota also has special challenges, because it relies on rural hospitals to provide much local health care, and many of these were struggling to survive even before the pandemic. Efforts to persuade Congress to carve out special covid-19 funding for rural hospitals in the $2 trillion stimulus package were unsuccessful. These hospitals will need to settle for some new grant money and increased Medicare funding.
It's not known whether the state has enough hospital beds or ventilators to handle a large outbreak. State health officials have declined to publicize the numbers. The larger hospitals in Sioux Falls are expected to handle the most critically ill patients, including those who need ventilators and other advanced life support. Those patients may need to be transported from less-equipped rural hospitals. Hospital administrators say they expect to also rely on telemedicine to help patients with milder infections.
Given its sparse population, South Dakota should have an easier time testing people and finding the contacts of those who are positive. But it has faced the usual supply problems with tests, protective gear, enzymes, reagents and so on. (Noem called on the CDC and Vice President Mike Pence to restock needed supplies.) And it's not immune to the difficulty of identifying those symptomless carriers contributing to the spread.
Rumor has it the state may soon be locked down like any big city - which gives you a sense of the general level of worry. Just 41 cases is little cause for comfort when the number is on its way up. South Dakota is a haven in many ways. But no place is safe from covid-19.
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This column does not necessarily reflect the opinion of Bloomberg LP and its owners. Mary Duenwald writes editorials on energy, health care and science for Bloomberg Opinion. She was deputy editor of the New York Times op-ed page and a senior editor at Harper's Bazaar, Real Simple, the Sciences and Vogue.