Rural red states seeing rampant outbreaks
Some leaders frustrated by residents’ choices
Places where many are skeptical of government pose challenges for Biden’s efforts to fight the virus.
CHEYENNE, Wyo. – Marian Orr is worried.
Orr, Cheyenne’s mayor, watches every day as COVID-19 cases and hospitalizations skyrocket in Wyoming’s largest city, just like public health officials predicted.
Deaths are also mounting, and experts say the worldwide crisis that for months largely spared this ultra-conservative and sparsely populated state, and others like it nearby, is only going to get worse, especially as politicians continue to resist adopting public health guidelines like mask-wearing and business limitations that have become commonplace elsewhere.
“It’s going really badly, to be honest,” said Orr, a Republican. “It’s very unnerving.”
The tiptoeing approach by conservative governors west of the Mississippi River, from North and South Dakota to Utah, Wyoming and Arizona, underscores the challenge President-elect Joe Biden faces as he looks to implement a new national approach to combating the COVID-19 pandemic. To get the nation’s seething COVID-19 cases under control, Biden will have to win over residents in states where voters have been most loyal to President Donald Trump.
Public health experts say Trump’s frequent refusal to wear a mask in public and his repeated public appear
“Coronavirus isn’t Democrat or Republican. And masks aren’t either.”
Matthew Heinz Physician in Tucson, Arizona
ances after getting infected and hospitalized have sent a powerful message to his supporters, who are only just now beginning to pay a personal price for his skepticism and outright hostility toward recommended public heath steps.
Wyoming is one of a few states that has resisted ordering residents to wear masks in public, and experts say the consequences are obvious. In just one month, the number of Wyoming residents testing positive has jumped a staggering 1,000%, from just 120 cases on Oct. 10 to 1,232 cases on Nov. 10.
And hospitals are rapidly filling up: Wyoming has only about 125 ICU beds statewide, and about half of them are already in use.
For Orr, 50, the pandemic is already personal – two of her colleagues are recovering from their illness – and she’s worried what will happen over the next few months.
“It’s very hard to be on the same page when there’s not a playbook. And that’s been the biggest hurdle for all of us,” said Orr, who has a close relationship with the White House. “That, unfortunately, is where the president has waffled a bit.”
An analysis by the Brookings Institution shows that Democrat-leaning states suffered the most new cases from the start of the pandemic until June, when cases began skyrocketing in conservative areas. After delaying public health changes for months, leaders in Wyoming and Utah to North Dakota and Arizona have begun increasingly cajoling or ordered residents in these traditional anti-government strongholds to wear masks, avoid large gatherings and stay home as much as possible.
Today, North and South Dakota, Wyoming and Iowa are four of the five states with the highest number of cases per 100,000 residents, with North Dakota at the very top with 8,393 cases per 100,000 residents. In comparison, Vermont had the lowest rate, at just 454 cases per 100,000.
The governors of Utah and North Dakota have only recently ordered mask mandates, publicly acknowledging they face a widespread public backlash from voters who vehemently oppose measures perceived to limit personal freedom.
Wyoming’s governor last week called some of his constituents “knuckleheads” for not taking basic precautions – but still declined requests by health officials to order masks statewide.
“For this region, it’s ‘ I’m going to do what I want to and don’t tell me what to do,’ ” said Michael Skinner, 32, a Cheyenne resident recovering from the virus. “Some habits are hard to break.”
Experts say that even though doctors and nurses are getting better at preventing COVID-19 deaths, sick patients are overwhelming hospitals and raising the risk other patients won’t get the care they need for a heart attack or stroke. At least 245,000 Americans have died during the pandemic, and public health officials are frustrated that millions of people are ignoring basic science and simple solutions.
“We’re facing an urgent need to strengthen the measures we have in place right now,” said Glen P. Mays, a public health professor at the Colorado School of Public Health. “Part of the challenge is that the strategies we have that work have been politicized. There’s mistrust and misinformation.”
In Utah, Gov. Gary Herbert, a Republican, declared a state of emergency on Nov. 8 and has been pleading with residents to follow his new mask order, and to limit their interactions with people they don’t live with.
“Individual freedom is important – and the rule of law protects that freedom,” Herbert said in announcing the mask mandate. “Laws keep us safe. That’s why we have speed limits and traffic lights, and why we now have a mask mandate in place.”
Like several other rural Western states, Utah was spared the spring coronavirus cases suffered by the coasts, and its peak this summer was just 885 cases on July 24. Today, there are about 3,000 active cases. While the overall number of cases is still relatively low, public health experts say the rapid increase is cause for alarm, especially in a relatively rural state with most ICU beds concentrated in Salt Lake City, which is running out of capacity.
In North Dakota, now the hardest-hit state, there’s a cumulative rate of 8,393 per 100,000 residents. New York City, which this spring saw widespread death from the virus, has a cumulative rate of 3,384 cases per 100,000 residents, according to federal statistics. Washington state, where the outbreak began, has a cumulative rate of just 1,695 per 100,000. Things are so bad in North Dakota that the governor says nurses who have the coronavirus but no symptoms should keep working.
In Wyoming, Gov. Mark Gordon on Friday called on his constituents to take more responsibility for their actions after comparing the state’s residents to headless chickens. At the time he spoke, Wyoming was ranked in the top five nationally for new infections.
But Gordon, a Republican, also acknowledged his efforts to control the virus using the power of government was deliberately “light,” because he had expected people to voluntarily do the right thing. At the time he spoke, 18 of the state’s 23 counties were in “critical” status for infections and lack of hospital space, but Gordon still declined to implement a statewide mask mandate.
Critics have pointed out that neighboring Colorado also has a mask mandate and is seeing a rapid increase of cases, although at a slower rate than Wyoming’s. Health experts say Colorado’s cases are likely increasing because the state this summer relaxed its toughest social distancing restrictions and allowed kids and college students to return to in-person classes.
“We’ve relied on people to be responsible and they are being irresponsible. They think somehow this is all nonsense,” Gordon said, his voice raised. “Well, ask yourself, look around, everybody knows somebody who has been sick with it. Some of them have permanent disabilities because of it. Let’s get serious. Our capacities are overwhelmed. It’s time that Wyoming woke up and got serious about what it’s doing.”
Experts say they’ve heard scattered reports of residents in some conservative states simply avoiding getting tested, even if they’re sick, because it means missing work or school, or suffering the personal inconvenience of quarantine or isolation.
“We’re seeing not just pushback against masks but pushback against testing,” said Dr. Andrew T. Pavia, chief of the division of pediatric infectious diseases at the University of Utah’s School of Medicine.
The widespread skepticism and reluctance to follow guidelines issued by federal experts such as Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases or Dr. Deborah Birx of the White House coronavirus task force has exhausted rank-and-file public health workers who have dedicated their lives to their communities.
Earlier this month, officials in Natrona County, Wyoming, who were discussing a local mask mandate were shouted down by angry residents, forcing them to cancel the meeting and withdraw the proposal in the state’s second-biggest county.
“I’ve never seen anything like this, in terms of how quickly it turned political. It’s an uphill battle every day to get people to do the right thing,” said Jodie Pond, director of Teton County Health Department in western Wyoming. Teton County, home to Grand Teton National Park, is one of only two Wyoming counties to back Biden for president. Officials there enacted a mask mandate in late July after getting special permission from state officials.
Pond, who said she has tried to remain apolitical in her 30 years in public health, is growing increasingly frustrated by her neighbors’ insistence on preserving their rugged individualism at the cost of community health.
Matthew Heinz, a hospital physician in Tucson, Arizona, said Trump’s mocking of masks gave cover to Gov. Doug Ducey, a Republican, to avoid a statewide mask mandate. Heinz got so frustrated with his county’s response to the coronavirus this summer that he ran for and won a seat on the county’s fivemember governing board, which oversees the local health department. Heinz, a Democrat who had served in the state Legislature, said he doesn’t understand how public health got so politicized.
“Cancer isn’t Democrat or Republican. Coronavirus isn’t Democrat or Republican. And masks aren’t either,” Heinz said. “It’s just so bizarre. I tell you that you have a lung mass, you aren’t going to say ‘The president told me it was a hoax.’ You’re going to ask me to remove it as fast as possible.”
Heinz said residents of Western states have long displayed a “don’t tell me what to do” attitude toward government-backed public health regulations, which in years past included seatbelt or motorcycle helmet laws, and now extends to coronavirus.
“I’m hopeful that scales will fall from the eyes and people will come out of this strange political fog over public health. Just seeing our leaders consistently wear masks and talk about it, instead of making fun of it, that’s going to have a tremendous effect,” he said.
Pond said the myth of Western individualism doesn’t actually hold up to reality – she has tried to point out that no farmer ever built a barn, created an irrigation system or rounded up his cattle all alone: Community has always been needed.
“I do not want to be political about this. Masks are not a political statement. They are a statement about caring for your neighbor,” Pond said.
She said the thought of a new, comprehensive approach from the Biden administration “made it a little easier to come to work today.”
Mays, the public health professor, said the Biden administration should consider finding trusted alternative voices to share messages of basic science. One solution might be using the thousands of workers in the mostly rural Cooperative Extension System, a federally funded program through which university research and best practices are shared directly with local farmers and ranchers.
Other partners could be 4-H members or local doctors and nurses who can share what they’re seeing daily. In states where much of life is based around small communities and longtime relationships, that could sway skeptics, Mays said.
In Utah, Herbert’s mask order was accompanied by data collected by researchers at Brigham Young University, the private research university owned by The Church of Jesus Christ of Latterday Saints. The church has urged its members, who make up about 60% of the state’s population, to follow public health orders.
“This winter is going to be rough, very rough. We need to come together in collective action,” Mays said.
In Colorado, Democratic Gov. Jared Polis has been trying to hold off ordering everyone to stay at home again, although there are increasing calls for him to take that drastic step. Polis said he’s surprised that so many people are unwilling to do the right thing on their own, and said the lack of a consistent national strategy has complicated efforts to control the spread.
“Your right to make your own decisions is up against other people’s right to be safe and healthy,” said Polis, who mandated masks statewide starting in July and is now facing increasing calls from local health experts to implement even more restrictive measures. “The grim reaper is the ultimate enforcer.”
Back in Cheyenne, Skinner is on the mend after a coronavirus diagnosis the last week of October. After a few days of feeling feverish, his symptoms worsened into a terrible cough and fatigue, along with a loss of taste. Skinner isn’t sure how he got sick – as a city spokesman, he said he did all the right things: washed his hands, stayed home when sick and wore a mask in public. He acknowledges that many of his fellow Wyomingites have been reluctant to follow the same guidelines, especially when it comes to wearing a mask.
“We’ve become so selfish and so idealistic that if we don’t like it, we won’t do it,” he said. “But with COVID, your actions are not independent. They impact others around you.”
Orr said she has seen that pattern repeated too many times: Her skeptical constituents and neighbors think the pandemic is real only once they know someone who gets it.
She welcomes a new approach from the Biden administration – even though she is a Republican with close ties to the Trump White House. She said Biden should seek guidance from mayors and county leaders like her on how to best approach their communities. Laramie County, which is home to Cheyenne, began requiring masks in public on Nov. 2, a decision Orr said she found easier to support politically because she’s leaving office in January.
“Everything has been chaotic. Chaos creates a lot of anxiety and unknowns, and so we go to beliefs that feel safe to us: ‘I’ll take care of myself and don’t you tell me what to do,’ ” she said. “Unfortunately it takes the death of colleagues and friends to recognize this the real deal.”
“Part of the challenge is that the strategies we have that work have been politicized.”
Glen P. Mays Public health professor at the Colorado School of Public Health