SIOUX FALLS, S.D. (KELO) — There were 5,855 nursing home residents in South Dakota in 2019, according to the Kaiser Family Foundation (KFF), and Gov. Kristi Noem has said extra caution needs to apply to those vulnerable adults during the coronavirus pandemic.

During a Nov. 18 news conference Noem’s asked the public to be extra diligent with personal hygiene and to stay home when sick as ways to help protect the vulnerable population.

Noem’s request comes at a time when COVID-19 cases in nursing homes in South Dakota have been surging, according to data and analysis from several sources.

South Dakota is one of 12 states in which COVID-19 cases in nursing homes have doubled in four week intervals from July 26 through Oct. 18, according to a Nov. 12 analysis by AARP.

But it’s not just resident who have been impacted by COVID-19. Studies show that staff cases of COVID-19 have also increased.

More than 80% of South Dakota nursing homes reported at at least one staff member had COVID-19 from Sept. 21 to Oct. 18, according to AARP.

The AARP has been tracking COVID-19 cases and deaths in nursing home and similar care facilities. The AARP has been advocating for states and the Center for Medicaid and Medicare Services (CMS) to publish daily and consistent data on COVID-19 cases including deaths in nursing homes.

South Dakota has had 50 resident deaths per 1,000 people in nursing homes this month, according to the CMS report. The state has 224.9 cases per 1,000 residents.

Nursing home residents are particularly vulnerable to COVID-19 because of age and underlying conditions.

“The COVID-19 pandemic has highlighted the vulnerability of residents and staff members of LTCF,” a Sept. 18 CDC report on a March through May study said.

Nursing home residents account for 8% of all COVID-19 cases in the U.S. but account for 40% of all deaths, the KFF said on Oct. 27.

Cases have been increasing across the nation, particularly since September.

The chief executive officer of Senior Care Pharmacy Coalition, Alan Rosenbloom said in a Nov. 16 news release that  “Patients in nursing homes and assisted living facilities once again face an imminent COVID crisis, with cases increasing more than 40% since mid-September and more expected due to community spread.”

The coalition’s news release was in response to failing to get relief from the federal government for long term care facility pharmacies.

Based on KFF’s 5,855 nursing homes residents in South Dakota in 2019, at the rate of 50 deaths per 1,000 people, the state would have about 275 COVID-19 deaths in nursing homes. However, the rate is as of Oct. 27 and would not include any increases or decreases from November.

COVID-19 cases topped 10,000 on Aug. 14 in South Dakota, according to the South Dakota DOH. Case totals nearly doubled from 7,034 on July 4 to 14,003 on Sept. 2. Compared to Sept. 2, the state has nearly five times more total cases on Nov. 19 with 69,742.

While testing has increased, it has not increased by five times the amount from Sept. 2.

CMS and CDC guidelines for allowing resident activity and visitors at nursing homes depend in part on the level of community transmission in the community and on transmission levels in the nursing home.

Also, the increase in COVID-19 cases in nursing home residents and staff frequently corresponds with increased transmission or case levels in the community.

“Research supports the idea that outbreaks in the surrounding community are the most important factor in explaining outbreaks in a nursing home,” said a study published on Aug. 20 by the Commonwealth Fund.

“The strongest predictors of COVID-19 infection were identified as the NH’s county’s infection rate and the number of separate units in the NH,” said a study called Predicting Coronavirus Disease 2019 Infection Risk and Related Risk Drivers in Nursing Homes: A Machine Learning Approach and published Aug. 20 online by NCBI and by the Journal of American Medical Doctors Association.

“The prevalence of COVID-19 infections in a NH’s surrounding community and a NH’s size were identified as the primary risk factors associated with NH infection, suggesting that the introduction of infection from the outside community as a likely infection mechanism,” the Aug. 20 published study said.

A study from the United Kingdom says “A key implication from our findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible” This was published on Oct. 1 by Lancet.

The South Dakota DOH does not list long term care resident COVID-19 deaths or cases as categories on its website.

The Minnesota Department of Health, for example does. As of Nov. 19, the state reported 9,150 COVID-19 cases in long term care facilities. The state had 2,066 deaths in long term care and assisted living facilities.

Minnesota had 23,444 residents in long term care facilities in 2019, according to KFF. COVID-19 deaths in long term care facilities accounted for at least 68% of all COVID-19 deaths in the state, according to KFF.

The state had 42.5 deaths per 1,000 long term care residents, according to the CMS.

Iowa has had 972 COVID-19 deaths in nursing homes as of Nov. 18, according to the Iowa Department of Health.

Iowa posts long term care COVID-19 information on its website and updates it daily.

About 48% of the COVID-19 deaths in the state are in long term care facilities, according to KFF.

Sentinel testing of staff and residents is being done at nursing homes across the nation to identify COVID-19 cases.

From Sept. 21 to Oct. 18, South Dakota reported 7.2 COVID-19 cases in staff per 100 long term care residents, according to the AARP.

Minnesota reported 4.7 cases while Iowa reported 5.3. North Dakota reported 12.5 cases.

In North Dakota more than 90% of nursing homes reported at least one staff member with COVID-19 from Sept. 21 to Oct. 18.