Uptick in COVID-19 not surprising

Jason Ferguson
If you’re waiting for COVID-19 to go away, you’re going to be waiting awhile.
COVID-19, one of many novel corona viruses, isn’t going to disappear, even after there is a vaccine, local physicians say. However, the vaccine will be another tool to fight the virus, and eventually, says Dr. Joy Falkenburg, COVID-19 will become just another virus that is dealt with—albeit with admittedly potentially serious complications.
“How we deal with it will be different in the future. We won’t test for it all the time when we have a better handle on it, just like influenza,” Falkenburg said.
During flu season, the first few dozen potential flu cases are tested, but once it is established flu is in the area, the tests stop.
“If it looks like the flu, smells like the flu, we call it the flu,” Falkenburg said. “I think (COVID-19) will dwindle because the interest will dwindle.”
Dr. Lisa Brown agreed, saying society will accept COVID-19 as the norm, while being cognizant of the potential complications of this particular virus.
Custer County has seen a stark increase in COVID-19 cases in the past few weeks, but it doesn’t surprise either Brown or Falkenburg. They both believe it was going to happen eventually, especially as tourists began to come to town.
“I think we were fortunate to go this long without a rise,” Brown said. “That’s been a little unexpected given that we had tourist volume from the get-go in the summer.”
She said earlier in the summer people were more vigilant about following Centers for Disease Control and Prevention (CDC) guidelines.
“That’s been relaxed,” she said.
Brown said she doesn’t see the recent uptick in cases as a spike, but more of a constant rise, a rise she suspects will continue. Things could become especially confusing in the fall when other respiratory illnesses that appear as winter hits begin to surface.
The doctors agree that everyone who believes they may have the virus does not need to get tested.
“We are kind of past that,” Brown said. “Having a positive test doesn’t make a big change for you.”
Brown said it’s better to just assume any respiratory illness is COVID-19 and stay home from work and self-isolate for 10 days past the onset of symptoms, and around three days with a decrease of no symptoms and no fever. Brown said you don’t have to act like you’re in prison, but it’s best to be alone and away form people—even those in your household—as much as possible.
Falkenburg said if someone has been in contact with a COVID-19 positive person, does not feel ill but still wants to take a test, they should examine why they feel the need to be tested.
If you’re uncomfortable being at home for seven to 10 days, she said, while adding she realizes it can be hard to stay home, you may need to look inward as to why that is. She said COVID-19 highlights an existential crisis in the United States.
“COVID is a distraction from what is really gnawing at us,” she said. “If people will calmy sit and figure out what they are so scared about, they will figure out a much calmer way to deal with coronavirus.”
Brown said there are different beliefs about scientific data, politics and religion when it comes to the virus. She said it is difficult to shift a mindset based on a belief system.
“We would ask people who don’t necessarily believe in scientific data to take a practical look around,” she said. “If you don’t want to listen to numbers or your medical doctor, then take a look at  your community and see what the real-world impact is of this and reconsider where you stand.”
What else can people do now that Custer County has significant community spread, according to the S.D. Department of Health? Brown said do what doctors have been asking all along: maintain distance, wear a mask, wash your hands and avoid public and group settings. It takes only one asymptomatic individual to infect an entire group, she said. The doctors point to clusters that sprang out of a tournament at Rocky Knolls Golf Course and Our Place as proof.
Weddings, parties and any large get-together can contribute to a cluster forming.
There has been an outbreak at Monument Health Custer Care Center (nursing home), as 39 cases have been reported there. Brown said it had to be someone who works at the center who brought the virus in, as the residents have not been allowed out of the building during the pandemic and no visitors have been allowed.
Presymptomatic spread is likely the culprit, Dr. Brown said, adding that although caregivers are screened when arriving to work, one of them may  not have had symptoms while still having the virus.
“They are spreading the virus before they know they are sick,” Brown said. “That is the hazard of not wearing a mask when you go to public things.”
To combat the spread, two wings of the building are shut down and residents in those wings are on quarantine. Staff members are using full personal protective equipment when working with residents and work in only one wing.
Both Falkenburg and Brown agree it’s important not to blame any staff member for bringing the virus into the facility, as COVID-19 outbreaks in nursing homes is a common reality.
“Our staff that works with our residents are incredible, tirelessly doing what is right for our elderly patients who are the most vulnerable in society,” Falkenburg said. “Many of them love the residents there.”
“It’s happening in just about every nursing home due to community spread,” Brown said.
She added while people who don’t work in health care settings might not feel they are making an impact by what they do socially, it is a domino effect because it can add to community spread, which can further tax the health care system and make it harder to care for the increasing number of patients.
“That was the message in the beginning, but because it didn’t happen, people were like, ‘whatever’ after a certain period of time,” she said. “Now we are back with that same message. I don’t know if it will be heard, but I ask people to listen to it.”
While cases are on the rise in the state, hospitalization rates are not rising at the same rate. As of press time, there were 78 people hospitalized with the virus, with 32 percent of available ICU beds used and 79 percent of ventilators in the state used.
Brown said initially doctors may have been more inclined to send a patient with the virus to the hospital. Custer has more hospital admissions now due to the virus than in the spring because of the uptick in the virus here. Monument Health has had two to three people on a ventilator the past two months, compared to five to eight earlier in the year.
So when will things return to “normal?” Brown and Falkenburg say they have no idea. Brown said it’s possible that for some people there will be a new normal that sees them wear a mask in public. It won’t be mandated, she said, but some will feel more comfortable with a mask.
“That may be the new normal, and it may be forever,” she said. “I don’t think that’s totally sci-fi to say that.”
Falkenburg said there will be mixed opinions on masks, especially in a rural setting. Someone who walks a busy city street in Chicago will likely be more inclined to wear a mask as opposed to someone in Custer. There will also be people who have two modes: one for when they are in a small group, outside, etc., and one for when they visit a busy box store.
The important part, they say, is to have a knowledge base strong enough to be informed on choices.
“The question is how do we respond to it. How do we keep a level head and use factual information to go forward?” Falkenburg said. “This doesn’t have to be emotional. This doesn’t have to be political. It is taking the facts of a disease and treating it just like we treat all viruses and being objective about it.”
Falkenburg said those diagnosed with COVID-19 often feel depressed and lonely. She encourages friends and family of those quarantined to check in on them to make their time easier. Even the simple act of putting a coffee on their doorstep can help.
Brown agreed, saying shaming those who have the virus solves nothing.
“We don’t shame people for having a run-of-the-mill cold,” she said.
Both doctors said quarantine doesn’t mean sitting on the bed all day long, either. Custer is the perfect place to be quarantined, as one can go a bevy of places while still being alone or with few people.
The increase in cases was bound to happen at some point, the doctors agree, and while recoveries are high and hospitalizations are low, the public should still work to slow the spread.
“There was a time period when people said, ‘I haven’t seen a case,’” Falkenburg said. “Well, I bet you have now.”

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