Brian Schwartz thought he had a sinus infection while attending church July 5. But he soon felt a fever spiking. The Garden City, Kansas, native left as soon as service was over — but not without reminding those in his vicinity to wash their hands.

His temperature kept rising. He was tested and had COVID-19.

“I wasn’t surprised,” Schwartz said. “When I quarantined after being tested, my fever would spike every day to about 101 to 101.5 degrees.”

He had taken preventative measures before this. He and his fellow churchgoers would socially distance themselves. Since his work was considered essential, it never closed. But he tried to wear a mask when possible, despite not having a mask ordinance in his town.

Schwartz is one of more than 1,800 people in Finney County, Kansas — population 36,000 — who have tested positive for COVID-19. 

When the coronavirus began spreading across the U.S. in early March, it hit big cities first — leaving many to believe that rural, less populated areas of the country, including the Midwest, would be spared similar rates of infection. 

But fast forward five months, and COVID-19 has spread to rural counties in Kansas and Missouri, leading to spikes in cases that weren’t seen in the earliest stages of the pandemic. A combination of factors — population size and distribution, the presence of meatpacking facilities, and COVID-19 outreach programs — is affecting how these areas are responding to the virus. Many high-risk neighborhoods are also more likely to be low-income, immigrant communities.

For less populated areas with farming communities, there tends to be less person-to-person contact, said Michael Kennedy, associate dean for rural health education at the University of Kansas School of Medicine. 

But the relationships between community members tend to be closer in rural areas. 

“People in small towns tend to be very caring about each other and the health of the people they live with, which is a little different than what you’d find in a big city,” Kennedy said.

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An overwhelmed health care system

Since the beginning of the pandemic, there have been worries about how the rise in COVID-19 cases could overwhelm the health care system, particularly in areas like the rural Midwest that have seen a drastic uptick in the closures of hospitals

Communities in rural Kansas and Missouri have seen waves of hospital closures in recent years — 10 have closed in Missouri since 2014 and six have closed in Kansas since 2015 — underscoring concerns that rural areas may find themselves overwhelmed with COVID-19 outbreaks without a robust health care system in place. 

St. Catherine Hospital — the only hospital in Garden City, Kansas — has not yet reached full capacity since the pandemic began, said Julie King, internal medicine physician and director of medical affairs at the hospital. St. Catherine was almost at the point of implementing a “surge plan,” where it would have used some of the overflow areas, in late May. 

While southwest Kansas had many cases, the majority of those didn’t require hospitalization. Some patients were in the intensive care unit, but others recovered quickly and didn’t need to be hospitalized, King said.

At the beginning of the pandemic, the hospital was using a containment strategy where it would test individuals who presented symptoms and met the testing criteria at a physician’s discretion. The hospital shifted to a mitigation strategy in late March. This meant that it was testing patients who showed symptoms, met testing criteria and required hospital admission at a physician’s discretion. King thinks this change allowed for St. Catherine Hospital to maintain its space and availability. With testing expanded in Finney County, the hospital has returned to the containment strategy.

“People are scared to death they’re going to get sick.”

— Steve Gelios, president of United Food & Commercial Workers Local 2008

In Joplin, Missouri, there were relatively few COVID-19-related cases through April and May, but those numbers began increasing after Memorial Day, said Jessica Liberty, the infection prevention and control manager at Freeman Health System. In May, the hospital started to lift restrictions and resume operations. It was not long after that the hospital began to experience a surge in cases.

Freeman Health System, one of the two major hospitals in southwest Missouri, reached capacity July 2 after expanding its COVID-19 unit for the third time. However, the hospital’s media relations coordinator would not specify how many patients were transferred to Springfield, Missouri, only that “not all the transfers are COVID” as of July 20. Since then, hospitalizations have declined, the media relations coordinator said. 

The Beacon reached out to Mercy Hospital, the other health care system in Joplin, on July 6, but the facility has not responded to specific queries. 

The role of meatpacking facilities 

Throughout rural parts of Kansas and Missouri, spikes in some COVID-19 cases have been traced back to nearby meatpacking facilities. Southwest Kansas is home to four meatpacking facilities, all of which have seen COVID-19 clusters. This includes Tyson in Holcomb, Cargill in Dodge City, and National Beef in both Liberal and Dodge City. Workers at meatpacking plants are considered essential, and those in southwest Kansas have expressed concerns over their safety.  And at the same time meat packing plants in Kansas were becoming hotbeds for the coronavirus, Kansas officials refused to shut them down, according to a recent KCUR report.

The Beacon sent multiple emails to Tyson, National Beef and Cargill for interviews in July. Tyson and National Beef responded with links to their websites for more information, and Cargill declined to comment.

In Finney, Ford and Seward counties, where the four meatpacking facilities are located, Hispanic people make up just more than half of the population. Immigrants from Guatemala and refugees from Somalia also work at the facilities. People of color have been disproportionately impacted by COVID-19 for a variety of reasons, including access to medical care, education and income gaps and working in more high-risk or essential occupations.

Following reports of COVID-19 outbreaks at its meat packing facilities in the Midwest, Tyson began installing dividers between workers, though many are still expressing concerns over their safety. Courtesy of Tyson

Blanca Soto from Kansas Appleseed, a nonprofit statewide advocacy organization, said many workers do not qualify or ask for assistance because they might be undocumented or in the process of obtaining residency. As a result, they aren’t able to quit. 

“A really good portion of our communities in Dodge City, Garden City and Liberal depend on the packing plants,” Soto said. “They work there, and they can’t afford to quit.”

While the meatpacking facilities installed dividers between the workers, other conditions make it difficult to follow social distancing guidelines, like sharing the same locker room and restrooms. 

 At the Tyson plant in Noel, Missouri, mass testing of the facility’s employees and workers’ individual tests found that about a third of its workforce — 371 people — tested positive for COVID-19. In Noel, located in McDonald County, the Hispanic, Black and Pacific Islander communities make up about 60% of the population, with many working at Tyson.

Tyson facilities have now started taking employees’ temperatures using infrared technology. Courtesy of Tyson

“The initial wave of patients locally in southwest Missouri were predominantly migrant workers who worked in the meat processing plants and their direct contacts, their families,” said Erik Martin, an emergency physician at Freeman Urgent Care in Joplin. “A lot of the people that are hospitalized right now, both in Missouri and Arkansas, are the meat processing plant workers and their families.”

In Jasper County, where Carthage is the county seat, immigrants from Guatemala, Mexico and Vietnam work at meatpacking facilities run by Butterball, Martin said. 

But meatpacking facilities in southwest Missouri aren’t the only places with COVID-19 clusters. Newton County, situated between Jasper and McDonald counties, has seen cases rise, despite not having a meatpacking facility. 

Larry Bergner, administrator of the Newton County Health Department, said people travel across county lines to work at meatpacking facilities, and in June, factory workers in the county had been affected the most with positive COVID-19 cases. 

Even though meatpacking facilities have implemented preventative measures to reduce virus transmission, workers still worry about their safety.

“People are scared to death they’re going to get sick,” said Steve Gelios, president of United Food & Commercial Workers Local 2008, which represents workers at the Tyson plant in Noel, Missouri, and in Arkansas.

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Combatting THE SPREAD

As clusters of COVID-19 have formed at meatpacking facilities in the Midwest, organizations like Missouri Rural Crisis Center, a group that supports independent family farms while opposing corporate agriculture in Missouri, are pointing out the already existing problems with the food system in the U.S. 

Tim Gibbons, communications director at MRCC, said it’s large corporations like Cargill — combined with the unsafe working conditions at their plants — that are the problem.

“With lobbying and with policies, we see that the only way that the corporate system works is by putting workers in situations that are not safe for them,” Gibbons said. 

Ozark Center, a community behavioral health center that’s an affiliate of Freeman Health System, has provided crisis counseling assistance during the pandemic through the Federal Emergency Management Agency Crisis Counseling Program to people in southwest Missouri. Before the pandemic, the FEMA program was used to help community members after natural disasters. This is the fourth time the center is providing crisis counseling, including after the May 2011 tornado in Joplin, 2017 flooding in southwest Missouri and May 2019 tornado in Carl Junction, Missouri.

“We try to help citizens with their resilience, empower them to take control or to make a list of things they need to do to restore their equilibrium or their life back to the precipitating event,” said Debbie Fitzgerald, director of crisis services at Ozark Center.

The program has provided remote services like online support groups, suggestions for relaxation activities and educational outreach.  

St. Catherine Hospital was able to prepare early on by planning ahead and working with Centura Health, the health care system based in Colorado, King said.

 “Initially, it was a little nervous and a little bit scary,” King said. “… I would say that we are much more comfortable now, knowing that we have a good plan in place.”

 The community outreach committee at the hospital has worked with the Finney County Health Department to educate the community about and prevent the transmission of COVID-19 by distributing personal protective equipment and educational packets in high-risk areas, which King said is one reason why cases have declined in the county. 

 “Many of our businesses have encouraged the use of masks and have implemented social distancing within the stores,” King said. “I think that has really benefited us.”

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Annie T.H. Le is a freelance reporter for The Beacon. She was also a Summer 2020 intern.