When Tricia Masenthin’s frail, 90-year-old grandmother got severely sick with COVID-19 during an outbreak at a Sabetha, Kansas, nursing home last month, the family started to make preparations for her death.

They had no idea how much the pandemic had affected Nemaha County and the surrounding area until they called a local funeral home.

“Our family was told there was a casket shortage, and her body would need to be stored for additional days if the (casket) order hadn’t arrived by her date of death,” said Masenthin, who lives in Lawrence.

Like most rural places throughout Kansas and the Midwest, Nemaha County, bordering Nebraska in northeast Kansas, was largely untouched by COVID-19 in the spring, when urban areas bore the brunt of the pandemic. But it and other rural counties were slammed by the fall surge, which caused illness and death on a scale out of proportion with their population.

By the end of the year, rural Kansas counties had actually suffered more deaths proportionally in 2020 than their more densely populated counterparts. As of Jan. 12, the top 10 counties in the state for cases per capita all had populations of less than 37,000 people. The top 10 in per capita deaths were all under 11,000. In tiny Gove County (population 2,612), about 1 out of every 130 residents died of COVID-19 last year — the highest death rate in the country at one point.

Few counties were hit harder in November and December than Nemaha (population 10,155), where almost 50 residents died in a matter of weeks.

Late reaction to COVID-19

When Kansas Gov. Laura Kelly ordered schools and non-essential businesses closed in March to quell the pandemic’s first wave, Nemaha County had little firsthand experience with the virus.

After the state opened back up, Kelly agreed to let counties remove themselves from future COVID-19 orders. When she tried to institute a mask mandate in early July, officials in Nemaha County — and most of rural Kansas — opted out. At the time, Nemaha County had experienced only 27 confirmed cases and no hospitalizations or deaths.

By the end of August, the county had recorded a death but still only 53 total cases. It seemed that maybe the pandemic would largely pass it by.

But then the fall surge that health officials had warned about hit, and it spared almost no county in Kansas or the Midwest.

Sabetha family physician Chris Tramp was in the middle of the medical response as COVID-19 hit Nemaha County like a tidal wave. 

“It was just a slow, steady roll of a handful of positives every day, and then all of a sudden in early November, it just spiraled,” Tramp said. 

Like many rural physicians, Tramp treats people in both an outpatient clinic and at the local hospital. The wave started with a persistent rise in the number of sick patients phoning or coming to the clinic asking for COVID-19 tests. Then the percentage of those tests that came back positive kept rising, from about 5% to 10% and finally above 20%, all in a matter of days. Then 25-bed Sabetha Community Hospital started getting slammed with severely ill patients whom the staff had to try to keep stable for longer than they normally would. 

“We do not have an ICU,” Tramp said. “So when someone is in respiratory failure or needs critical care for another reason, they need to be transported. And all of our regional hospitals that we typically refer to were just inundated as well. It was not uncommon for us to make four, five, six phone calls, trying to transfer someone.” 

Meanwhile, the hospital was also short staffed because employees were getting COVID-19.

“At times, it was incredibly uncomfortable,” Tramp said, describing desperate calls to try to find intensive care unit beds for patients in full respiratory failure.

The stress, pressure and fear of the unknown during those weeks surpassed anything Tramp said he had experienced in more than 15 years practicing medicine. 

On Nov. 12, Nemaha County officials voted to require masks in indoor places. Dozens of other rural counties followed suit after Kelly issued another executive order about a week later. 

But by the time the mask order was signed, Nemaha County had 244 active cases of COVID-19, meaning nearly 1 out of every 40 residents was infected. Dozens of hospitalizations and deaths were almost guaranteed. Counties all over the state were in the same situation. 

Physician Chris Tramp examines a patient. Courtesy photo.

Tramp said the lesson for future pandemics — and future waves of the current one — is how quickly infectious diseases can spread out of control, even in places that aren’t as densely populated.

“I think that Kansas, by and large, and our counties up here in northeast Kansas, were relatively late in really understanding the potential impact,” Tramp said, even though the medical community tried, in many different forums, to educate the public about the danger. 

“They were seeing it happen around them, but it just hadn’t quite hit home yet.” 

The worst is over?

With COVID-19 spreading so widely, protecting even Nemaha County’s most vulnerable residents proved impossible. The outbreak breached the walls of Apostolic Christian Home, an 86-bed nursing home facility in Sabetha. COVID-19 has been particularly deadly in nursing homes, and it caused 85 cases and six deaths at Apostolic Christian, according to ProPublica. The home has a five-star rating from Medicare overall, but an inspection in July found some low-level deficiencies in its infection control protocols. 

Ed Strahm, Apostolic Christian’s executive director, said the facility used “all the tools reasonably available to us to fight this virus,” but too many people in the community at large did not.

“Our staff at Apostolic Christian Home was very successful in controlling this virus when there was a relatively low number of active cases in the county,” Strahm said. “When the viral spread got out of control in the county, we could no longer keep it from spreading within our facility. We are heartbroken by the many lovely seniors who prematurely, and unnecessarily, lost their lives to COVID-19 because too many people have chosen to ignore the seriousness of this virus and the impact it has on our senior population.”  

I know everybody wants to quantify how tragic a situation is. But we did have deaths of people who were very loved … and it was heartbreaking for those families.

Chris Tramp, Physician

Tramp said all of the county’s nursing homes did the best they could, but the situation was largely out of their control. Though most of the people who died were elderly, Tramp said that should not lessen the tragedy of their deaths.  

“What bothers me the most is when people say that that’s OK,” Tramp said. “I know everybody wants to quantify how tragic a situation is. But we did have deaths of people who were very loved … and it was heartbreaking for those families.”

There is optimism that the worst is over now in Nemaha County. New cases declined steadily in December, and there were 35 active infections as of Jan. 12. The vaccine has been distributed to the staff at Sabetha Community Hospital, and the workforce should be better prepared for future surges.

But the pace of COVID-19 deaths, which always lags new cases, has only recently begun to tail off. It was 49 as of Dec. 31

Masenthin’s grandmother held on for more than a week after her family contacted the funeral home. By the time she passed away at the end of December, a casket was available. 

“My grandma lived in service to others,” Masenthin said. “She worked elections and whenever the church needed a dish or someone wanted a dress sewn, she was there to help. In her 80s, she assembled rosaries for missions all over the world. She always took care of others, whether she knew them personally or not. She was such a community-minded person, it’s hurtful her neighbors outside the nursing home didn’t take stronger measures to protect her and fellow seniors.” 

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Andrew Marso is a freelance reporter for The Beacon. He is an editor at the FPM Journal and previously worked at The Kansas City Star, Kansas News Service and Topeka Capital-Journal.