Badlands

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Host: Welcome to Today Explained. I'm your host, Sean Rameswaram.

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Host: 2020 has been a carnival of anxieties from election to pandemic to protests, Back to election, back to pandemic, back to election, back to pandemic. COVID-19 is once again top of mind across the United States and the planet, as much of us are heading into the cold winter months and some of the headliner holidays. And the pleas to refrain from travel abound, especially in the United States, where Thanksgiving usually brings the most domestic travel of the year. With so much at risk across the country, we thought we'd take a look at how two states are handling this pandemic very differently today. One's doing a relatively great job, Vermont, and then there's North Dakota. North Dakota has held the unwanted title of most COVID deaths and new cases per capita for really most of the last two months. North Dakota now has the highest COVID-19 mortality rate in the world, according to new analysis. In the world, mortality rate, people dying from this. And then about 65% of the COVID deaths that have happened in this state have happened since October 1st. So the last two months have been really devastating.

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Host: Just this week in North Dakota, we heard that some facilities are running critically low on supplies and that nurses are being asked to transition and work in other units for which there hasn't been time for orientation and for adequate preparation or training for that. There are two really core issues here. There's the issue in nursing homes, and obviously that's a massive issue because most of the state's deaths come in nursing homes, as they did during New York City's outbreak, during Washington State's outbreak in the beginning. And then the second really core issue is there is a severe strain on hospitals due to sort of this intense shortage of healthy, available nurses. In North Dakota, hospital staffing shortages are so severe, The state made the controversial call to allow health care workers who have tested positive for COVID-19 but are not showing symptoms to continue to work in COVID units. The governor said last week that hospitals are at 100 percent capacity. And we've heard, you know, increasingly more cases of people in dire need of medical attention sitting in an ER waiting room for hours because there are no available beds. There's nobody to staff those beds. we've heard of hospitals increasingly going on divert, which means they're diverting ambulances in route to the hospital because they just simply can't take any more patients in. And obviously this is an issue that could affect anyone in the state. It sort of supersedes COVID because whether you have COVID or you were in a car accident or you have a heart attack, It's the same issue. You're just not going to be able to guarantee that you'll have medical care in a hospital.

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Host: Jeremy Turley, Forum News Service, Bismarck, North Dakota. What did your state look like in March when a lot of cities and states on the coasts were locking down?

Jeremy Turley: Right. So our first case came here on March 11th, which is around the same time that a lot of other states got their first cases. But the spread of the infection was pretty slow in the beginning. We did have a semi-lockdown. Schools were closed and certain sort of public-facing businesses were closed at that time. But it was nothing like the total lockdown that you saw in coastal states and in big cities.

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Host: I covered a baseball game with paying fans. Seating capacity is only at 500 to promote social distancing guidelines. But boy, the fans have a lot of smiles. On June 15th, between the Bismarck Larks and the Mandan Flickertails, that was a team that was born from COVID. They were not a team before the pandemic, and they formed this three-team makeshift league in Bismarck because the infection rate seemed so low that they could play baseball. Baseball is back a big swing and a miss by Lofton to kick things off here from Bismarck an 0 count There a quote in this story I wrote we the big show in the country for at least the next couple of weeks People really thought that this was like the only baseball league that was operating at this time. I would call my mom in Chicago and she would obviously be worried about me. And I say, this is the best place in the world to sit out the pandemic. I mean, there are just like no cases here in Bismarck. We might get like 10 cases a day for a while or even fewer than that. I remember a time over the summer when Burley County, which is where Bismarck is, had 40 active cases. And that was it. And we do a lot of testing here. That's really like indicative of how small this problem was for much of the summer.

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Host: When does the pandemic get to North Dakota in earnest? So there are a few dates on the calendar that epidemiologists here point to as perhaps having ushered in this upward trending curve of cases that we still have today. The 4th of July is often viewed as like this super spreader weekend because the weather was nice and people congregated at barbecues and parties. There was this one infamous photo that the governor featured at a press conference of a large group of people posing on a sandbar in the Missouri River. And obviously nobody was wearing a mask. You know, we're back to the same things we've said about being North Dakota smart, which is, you know, again, if you can keep six feet of distance away, that's great. If you can't wear a mask, you know, wash your hands, you know, and practice good hygiene. Then there was the Sturgis motorcycle rally, which happened in South Dakota. 250,000 people from across the country expected to attend with no mask mandates in place. The mayor urging personal responsibility, saying he can't stop people from coming. We will never have any idea how many cases stemmed from Sturgis, but it was by all accounts a lot. And then around that same time in late August, most of the schools and colleges in the state reopened. There were flare ups, especially in college towns. And then after that, it really took off into what you would call exponential growth. And deaths have grown exponentially as well, obviously. The three deadliest months of the pandemic here are the last three months. November is already by far the second deadliest month of the pandemic. And we have, you know, half the month to go still.

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Host: And you mentioned that motorcycle rally in South Dakota. Our team was passing around a video just the other day of this nurse in South Dakota talking about how dire things had gotten there. People want it to be influenza. They want it to be pneumonia. They want it to be, I mean, we've even had people say, well, I think maybe it might be lung cancer. I mean, something so far fetched. And the reality is since day one, when COVID started in this area in March, you've kind of been able to say if it walks like a duck and talks like a duck, it's a duck. Like, I hate to tell you that you have COVID, but that's what you have. You know, even after positive results come back, some people just don't believe it. People in the Dakotas will tell you there's sort of a libertarian streak here. People don't like listening to the government. They don't like being told what to do. So that could certainly be part of it. But like I mentioned, I think the virus was severely underestimated here. People had a good reason to believe that it wasn't going to be a problem in June because it wasn't a problem. And so they were lulled into this false sense of security. And when it got really bad, perhaps there were these behaviors that were already ingrained. Not wearing masks, not social distancing, you know, not refraining from these large gatherings that turn into super spreader events.

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Host: Jeremy Turley, he's with Forum News Service. You can find and support his work at inforum.com. After the break, Vermont.

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Host: Julia Blues, Vox, it's been a minute. You still a health reporter?

Julia Blues: I'm still a health reporter. I think since the last time we talked, one baby and two lockdowns later, but still a health reporter.

Sean Rameswaram: Well, it's great to have you back. And you've been reporting on a state that's doing a better job than most?

Julia Blues: That's right. I'm reporting on Vermont. So they've consistently had some of the lowest case counts, infection rates, test positive rates in the country throughout this pandemic. And Vermont is pretty far from North Dakota geographically, but in spirit, there are similarities here. It's spread out, lots of nature, similar size population-wise, and yet Vermont is doing way better. The fact that Vermont's a rural state, the fact that it's a small state, that does not at all fully explain its successes. And yeah, when you think about the raging outbreaks now in the U.S., Wyoming, it's smaller than Vermont. It's one of the worst outbreaks in the U.S. right now. The Dakotas, they're in a mess. So yeah, there are a lot of other things that Vermont has been doing right. And actually, they told me, apparently, your friend Anthony Fauci dropped in on a state health department meeting there and basically started off by saying. This should be the model for the country of how you've done it, notwithstanding that you're a small state, but it should be the model of how you get to such a low test positivity that you can actually start opening up the economy in a safe and prudent way.

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Julia Blues: So what's really interesting, since almost the beginning of the pandemic, we started to have evidence that certain groups were more at risk for the infection. So we know that places like homeless shelters, prisons, long-term care facilities, these are settings where we've seen many, many outbreaks in the United States. They're very high-risk settings because you have lots of people living in a more crowded place. This strategy is focused on protecting our most vulnerable, which based on science and data means the elderly and the very ill. And Vermont identified this immediately. So they expanded a program that they had in place for homeless people that they could stay for free in motel rooms instead of shelters. So basically they were kind of reducing the pressure on homeless shelters to avoid outbreaks there. And in some places in the U.S., we've seen rates of transmission in shelters up to like San Francisco has something like a 66% infection rate among people who are homeless. And until recently, Vermont had had only one infection in its homeless population. Nice.

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Julia Blues: At the beginning of the outbreak, they had outbreaks in old age homes. And very quickly, they started to address that by ramping up testing, by always making people quarantine. So before new people moved into old age homes, they also did this with prisons. They tested them and also put them into quarantine. So basically reducing the risk that someone would move in and potentially bring the virus with them. And until this recent uptick, they haven't had any outbreaks in their old age homes anymore. They were quick to respond and take the pandemic seriously. But they were also really quick to use these very targeted policies for these vulnerable communities. The other thing that they're considering now is a stipend to support isolation. So we know that again like people who tend to be most at risk for the virus are the ones who are more likely to live in yeah these congregate housing settings and more likely to leave their homes for their work and they might be also less likely to isolate if they been exposed to the virus or just have a harder time doing that. And so Vermont now is considering a policy that would actually pay people to isolate if they've been infected.

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Julia Blues: Ben, Jerry, Bernie, the governor? Yeah, it might be the humility of the Vermonters. They're like a pretty relaxed, in fact, people I've gathered in the many conversations I've had over the last week. But they kind of always point to each other for credit. So there was strong leadership by the governor, who is also a Republican, I should point out. I know these are not easy times. There's a lot of economic uncertainty and much concern about the health of Vermonters due to the COVID-19 pandemic. I share the concern in both of these areas. But as we look at the challenges ahead, public safety must come first. And he comes from a business background, and I think it pained him to shut down businesses, but he always prioritized public health in his decision making. There was strong leadership in the state health department, but then there was a lot of work at the community level. So homeless shelters, social service agencies or other types of social service agencies, people who are helping with food delivery and transport for communities or households that might have more trouble with the stay-at-home orders. I talked to researchers at Dartmouth who studied Vermont's response, and they talked about this kind of whole activation of the community there and how at all the different levels. So from the state to these nonprofits to other types of social service agencies, people really activated and took pride in keeping infection rates down.

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Julia Blues: It's sad, Belouz. I mean, there's like a clear path here on how to handle this pandemic responsibly. And so much of our leadership and our fellow citizens are just choosing another one. You know, I was talking to someone this morning who works in global health, and he was saying like, our failure to look to other states, to look to other countries is literally killing people. So if we learned early on, like, what's happening in China from their experience or looking to Taiwan or Rwanda, like, they've consistently using some of the approaches I just described in Vermont. If we looked to other places, we might have been able to avoid some of this and to know, like, these places aren't exceptional. On the other hand, you understand going into the holidays, we want to see our families. We want to relax at home with the people we love and that we haven't seen for months and months. It's completely understandable that people are tired, but I just really hope that we'll take a longer view and know that it's hopefully just a few more months of this and that we can kind of hang tight until then to avoid even more tragedy than we've already seen.

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Host: Julia Blues. If you want to read Julia's reporting on what Vermont is doing right, it'll be up at Vox.com come Thursday.

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Host: Julia's hopeful about the next few months because we got even more good pandemic news this week. Today, Pfizer said that its vaccine we told you about last week is 95% effective and has no serious side effects. And on Monday, Moderna announced that its vaccine was 94.5% effective. Added bonus, one of the actual angel investors on that Moderna vaccine was Dolly Parton. Thanks, Dolly.

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Host: Today Explained is part of the Vox Media Podcast Network. The team includes Amina Alsadi, Will Reed, Muj Zaidy, and Halima Shah. Afim Shapiro is our engineer. Golda Arthur is our supervising producer. And Liz Kelly Nelson is Vox's editorial director of podcasts. Extra help this week from Bird Pinkerton. Fact Checking by Cecilia Lay Music by the mysterious Breakmaster Cylinder And Noam Hassenfeld And Just This Once Vocals by Noam's mom, Joan Vaccine, vaccine, vaccine, vaccine I'm begging of you, please make me immune Vaccine, vaccine, vaccine, vaccine Please get me off this godforsaken zoo

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