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Pandemic broadcasts: It’s 2:30 within the morning in Wyoming: "You might be holding a smartphone so husband says goodbye to his spouse by way of FaceTime after 60 years of marriage."

The first wave of the pandemic hit New York and other densely populated cities. With hospitals overwhelmed with patients and struggling to gain access to adequate personal protective equipment and ventilators, the Midwest and South were largely spared the worst of COVID-19.

Then came autumn.

COVID-19, the disease caused by SARS-CoV-2, began to disrupt families and destroy life far from metropolitan areas, particularly in southern and central western states such as Texas, North Dakota, South Dakota, and Wyoming.

North Dakota has 167 COVID-19 cases per 100,000 while Wyoming has 140 coronavirus infections per 100,000, followed by South Dakota with 124,000 cases per 100,000, according to the Center for Systems Science and Engineering at Johns Hopkins University.

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“You hear stories from Europe and China. You're telling yourself it won't happen here. "

– Andy Dunn, chief of staff at Wyoming Medical Center in Casper, Wyo.

As of Monday, North Dakota had 72,683 confirmed cases and 846 deaths, and the population there has a positivity rate of 7%. New daily cases reached 1,143 cases over a seven-day period. Wyoming has 28,169 confirmed cases, 176 deaths, and a 16.2% positivity rate, and 759 new daily cases.

"Everyone on the front lines has extra hours, extra shifts to keep up with the volume," said Andy Dunn, chief of staff at Wyoming Medical Center in Casper, Wyo. "We need more resources, we're looking for supplies from everywhere because." We also see patients from South Dakota. "

However, the scale of the Wyoming crisis was still a shock. Dunn, a Colorado doctor, moved to Casper ten years ago. He took on the role of Chief of Staff in 2017 and is currently taking on a hands-on role in treating COVID-19 patients at the center.

“You hear stories from Europe and China. They are telling themselves it won't happen here, ”he told MarketWatch. "And then suddenly it's 2:30 in the morning and you have a smartphone in your hand so a husband can say goodbye to his wife on FaceTime after 60 years of marriage."

Andy Dunn, chief of staff at Wyoming Medical Center in Casper, Wyo.

Patients in their forties and fifties

"We all knew it was coming, but you don't get it until it gets here and it hits you. It's difficult in the hospital right now," he said. His patients aren't all older either. There are several patients in his hospital in their forties while numerous others are in their fifties, said Dunn.

The Wyoming Department of Health recently approved requests from 15 counties to implement mask mandates to slow the spread of COVID-19. However, a petition on Change.org asking for end restrictions in Wyoming was signed by 800 people within days.

However, some medical professionals in these Midwestern states are not pro-mask mandates. "Unless it's an N95 mask, you're not sure if it's protecting you properly," said Lisa Drylie, a nurse who works in an operating room department at Sanford Hospital in Fargo, N.D.

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"A mask mandate must be part of containing the spread."

– Adam Hohman, a 43-year-old male nurse in Fargo, N.D.

"So, no, I don't think a mandatory mask mandate will help us," she added. (In a review of mask studies last month, Nature concluded that "Science supports that face coverings save lives during the coronavirus pandemic.")

According to an experiment published in September by Physics of Fluids, a monthly peer-reviewed scientific journal on fluid dynamics, it is preferable to use a good quality drape or surgical masks of simple design rather than face shields and masks with exhalation valves.

States like New York used the mandatory mask mandate as one of the main tools to stop the spread and avoid the second wave in the fall. Starting in July, New York Governor Andrew Cuomo, a Democrat, started the national "Mask Up America" ​​to promote his mask mandate.

But there are moments of calm in North Dakota. Drylie sometimes listens to happy music from the lower floors of her hospital. It gives her hope. "It happens when they celebrate a patient who has recovered and discharged," she said.

Others disagree with Drylie. "A mask mandate needs to be part of containing the spread," said Adam Hohman, a 43-year-old male nurse who lives in Fargo, ND. "Limited government is good, but we've got to a point where we had to do it." do a little more. "

Lack of health workers

Aside from the masks, the shortage of healthcare workers is another common problem that links North Dakota, South Dakota and Wyoming, as well as many other states of the Midwest in the US, according to local reports.

"The biggest problem I hear from my colleagues is that they don't have enough nurses," said Hohman, who is originally from Minnesota and works at a hospital in a rural North Dakota. He was working 10 to 14 hours a day when the pandemic first hit.

Hohman said hospitals in North Dakota are increasing bed capacity by opening some units or remodeling other wards. "But they are struggling to find nurses to keep up with the workload and occupy those beds," he said.

Some North Dakota hospitals even allowed health care workers with COVID-19 to continue working in coronavirus units if they were asymptomatic. And the U.S. Air Force recently deployed 60 medical workers to help the state hospital's staffing crisis.

The shortage of nurses in the US is not a new problem, but the pandemic sheds new light on the problem when the coronavirus pandemic emerged. But North Dakota and Wyoming are actually some of the best in the country in terms of nurse-to-patient ratios.

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The pandemic once again highlighted the shortage of nurses in the US.

North Dakota has 16.4 nurses per 1,000 residents, making it the fourth best state in the country, while Wyoming ranks number 1 with 19.9 nurses per 1,000 residents, according to the Bureau of Health Workforce, an agency owned by the Department of Health and Human Services .

If even two of the top-rated states for US nurse-to-state ratios are struggling, others like Texas, California, or Montana are suffering even more, according to recent research from STAT, a media company focused on health, medicine. and scientific discovery.

"The public health infrastructure and disaster planning in the US remains underfunded and underestimated at all levels," said Hohman. "We are still unprepared to protect our nation's health against the backdrop of current and future pandemics."

When the pandemic hit New York in March and April, Hohman traveled to New York to help his colleagues. “I saw the worst of the worst up there. I think we underestimated our risk here in North Dakota because of our rural location and the not New York mentality, ”he said.

Connected:COVID-19 spread when 5 million people left Wuhan for Chinese New Year, but 50 million Americans will still travel for Thanksgiving

According to the John Hopkins University database, there were at least 257,549 deaths from COVID-19 in the US on Monday, and 12.4 million infections with COVID-19 have been reported since the pandemic began. There are 59 million cases and nearly 1.4 million deaths worldwide.

Over 1 million cases of COVID-19 have been reported in Texas and California. Texas has 1,153,612 million cases, 21,013 deaths, and a positivity rate of 10.6% as of Monday. In California, 1,114,524 infections and 18,726 deaths have been reported, with a positivity rate of 5%.

New York, which was the epicenter of the US pandemic in the early days of the initial surge, has the most deaths of any US state (34,319), followed by Texas, California, Florida (17,991) and New Jersey (16,761). and Illinois (12,050).

With Thanksgiving weekend approaching, the medical community fears that up to 50 million people traveling to see relatives and friends will create even more community transmission. The Centers for Disease Control and Prevention asked Americans to stay home.

Doctors like Wyoming Medical Center's chief of staff Andy Dunn have a memory for Americans, one that is more likely if they follow advice. "Be boring, stay seated," he said from his office in Casper, Wyo. "Thanksgiving is going to be next year."

This story is part of a MarketWatch series Dispatches from a Pandemic.

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