For the first time during the pandemic, Drew Miller was unable to send a severely ill COVID patient to the intensive care unit.
Miller and other staff at the Kearny County Hospital, in southwestern Kansas, had done what they could last weekend, putting the patient on a maximum oxygen flow. But the closest ICU in the area was one county over — St. Catherine Hospital in Garden City — and it was full. The nearest open ICU bed was in Kansas City, seven hours away.
By the time an ICU bed opened up at St. Catherine, the patient needed to be intubated and was in much worse condition.
The experience was "uncomfortable. And unwanted," said Miller, who is the hospital’s chief of staff and the county’s lead medical officer.
It brought home a reality that many in western Kansas have been trying to avoid: The coronavirus is here, it is getting worse and it will put a strain on a rural health care system that is already sparse and understaffed.
Overall, Kansas has more than 85,000 cases. And as of Friday, five rural Kansas counties were among the top 20 U.S. counties with the highest number of COVID-19 cases per resident, according to The New York Times.
Kearny County is not one of them. It had opted out of the state’s mask mandate, as permitted this summer. But on Oct. 14, the county began requiring masks in public spaces and limiting mass gatherings to 25% occupancy.
As of Friday, the county has seen 160 COVID-19 cases over the course of the pandemic, 58 of them diagnosed in October. It’s currently at Level 4, the highest level on a county-created rubric of pandemic severity, indicating a rapidly increasing number of people are testing positive for COVID-19 and seeking medical treatment.
Even so, Miller said, it’s been hard to convey the growing threat of the virus, especially with such widespread misinformation.
"Our county health voice has just been drowned out," Miller said. "It’s hard to get people to wear a mask when they don’t feel it, when they don’t see what we see every day, which is more sick people and more severe cases."
Absence of mask mandates
In nearby Finney County, positivity rates for the coronavirus reached 31% between Oct. 12-16. As of Friday, there had been 2,766 cases in the county, 700 of them reported since Sept. 30.
The virus is spreading widely throughout the community, Finney County Health Department Director Colleen Drees said.
"I wouldn’t say that there’s any specific outbreaks that are causing it," Drees said. "We’ve had several people that have reported that they’re not sure where they contracted COVID because they’re unsure of who near them was sick."
Earlier this year, Finney, Ford and Seward counties — home to four meatpacking plants and 25% of the nation’s beef processing — saw a massive spike in cases. According to state data, 21 clusters have been linked to meatpacking plants, as well as more than 3,600 cases, 113 hospitalizations and 19 deaths. Unlike in other places, the plants in western Kansas did not close.
Dr. R.C. Trotter, an advisor for Ford County, said its numbers (3,491 as of Oct. 30) are no longer as concerning. To his knowledge, the county does not track current moving averages of positivity rates or case numbers, which are common measures for COVID severity.
Ford County does not have a mask order, but Trotter said he sees most people wearing masks in public places, and many indoor gatherings have been canceled. He called the question of a mandate "political."
"I sit on the fence, I’ll be honest," he said. "Is it worth it for me to go out and fall on the sword, which quite honestly, a lot of public health officers are? We’re seeing the rebuttal for that."
While other health officials have warned for months that the fall and winter would bring a rise in cases — which appears to be happening across a large swath of the country — Trotter said he doesn’t think there’s any scientific evidence that the colder weather increases cases.
"It’s conjecture. We don’t know," he said.
Officials in the Finney County government and in Garden City, the largest city and county seat, have yet to issue any orders relating to coronavirus precautions, such as a mask mandate, gathering ban or social distancing rules. Leaders opted out of Gov. Laura Kelly’s statewide mask mandate in the summer.
The county’s medical director has asked the county and city governments for a mask order through the summer and fall.
The county commission meets next on Monday, Nov. 2. Commissioner Dave Jones said COVID would likely be on the agenda, but he wasn’t sure whether a mask order would be. Jones also said he was concerned a mask mandate would be too overbearing on local schools and preferred to let the districts make that decision.
Finney County Commissioner Duane Drees supports mask wearing, social distancing and other recommendations of doctors, but said he doesn’t feel a mandate is necessary or even enforceable.
"There is a limit to what common sense and the public will tolerate," he said. "You don’t need a law to protect people from their own self. That’s why God gave us common sense."
Drees said social distancing and gathering limits also would be hard to enforce, especially in a county with such a large population of people from different ethnicities.
"African cultures, Asian cultures, Hispanic. Family unit is very important to most of these cultures," he said. "And they tend to get together as a family unit more than the traditional resident."
Families who have been in the area for "100 years," Drees continued, "we tend to have assimilated much more and drifted away from the family orientation."
He believes it’s harder to tell recent immigrants to follow social distancing rules.
"Are they going to pay attention? I doubt it," Drees said.
Garden City Manager Matt Allen said the municipal government decided at the beginning of the pandemic to defer to the county government for a unified message.
While a mask mandate is tentatively on the agenda for the city’s Nov. 3 meeting, he said it was unclear whether the city would decide to depart from the county.
‘We are desperate’
Finney County Medical Director, Dr. Lindsay Byrnes, said she often observes people going unmasked in public spaces. When she went to the county administration building to vote this week, only one poll worker was wearing a mask, she said. Most government employees were not.
"I think our leadership failed to take a strong stance and encourage it," she said.
She pushed for a mask mandate through the summer and fall. It’s the best way, she said, to ensure county residents comply with health precautions during a critical time.
A recently published study from the University of Kansas shows counties with mask mandates decreased their seven-day rolling averages of daily cases per 100,000 people, while counties without mandates have seen those averages increase.
"We are desperate to explain that this must be a community-wide effort," Byrnes said. "It cannot be only the burden of the health care system. It cannot be the burden of a few, it has to be everyone working in concert."
Byrnes said school teachers and hospital staff in the county have had to stay home from work because they’ve caught the virus out in the community, not at their workplaces. That indicates that the virus is widespread and that schools and hospitals may be incapacitated just when the community needs them, she said.
St. Catherine Hospital in Garden City only has eight ICU beds. Patients in serious condition are sometimes transferred to facilities in Wichita, Denver or other large cities within a few hours’ flight, Byrnes said.
If hospitals in those areas also become full, Finney County won’t have any other options.
"It’s not sustainable," she said. "My colleagues are saying, ‘Please, anybody do something. We can’t do this by ourselves.’"
It feels like health care providers have been abandoned, Byrnes said. She used to believe southwest Kansas, where she grew up, was a place where neighbors helped each other, no questions asked. But the resistance to masks has led her to question her community.
"These are the people that would go out and cut your wheat if you were in the hospital or had a problem in the family," she said. "Why is this different now? What happened? Why aren’t people willing to take care of each other?"
Nomin Ujiyediin reports on criminal justice and social welfare for the Kansas News Service.