What could happen to South Dakota hospitals if we don’t ‘flatten the curve?’

KELOLAND.com Original

SIOUX FALLS, S.D. (KELO) — It’s a phrase you probably have heard often lately: “flatten the curve.”

The difference could mean life or death, as hospitals get overwhelmed with COVID-19 cases. Similar problems were seen in places like Italy.

Public health officials and politicians are racing to figure out how to stretch out the spread of COVID-19, instead of one giant peak, by using mitigation strategies like social distancing, working from home and closing restaurants.

This is a visualization of what “flattening the curve” looks like.

Some states are taking intense measures like ordering people to stay at home. Others are leaving it up to local leaders, similar to a patchwork system in South Dakota.

Patients wear personal protective equipment while maintaining social distancing as they wait in line for a COVID-19 test at Elmhurst Hospital Center, Wednesday, March 25, 2020, in New York. Gov. Andrew Cuomo sounded his most dire warning yet about the coronavirus pandemic Tuesday, saying the infection rate in New York is accelerating and the state could be as close as two weeks away from a crisis that sees 40,000 people in intensive care. Such a surge would overwhelm hospitals, which now have just 3,000 intensive care unit beds statewide. (AP Photo/John Minchillo)

Right now, the country’s largest city is seeing a massive outbreak creating a stark difference in what’s happening between New York and South Dakota.

“One of the forecasters said to me, we were looking at a freight train coming across the country. We’re now looking at a bullet train because the numbers are going up that quickly,” New York Gov. Andrew Cuomo (D-NY) said earlier this week.

The New York area is expecting to see a surge beyond what its hospitals can handle, so work is underway to convert convention centers into hospitals and dock a massive military ship off the coast to help increase the number of hospital beds in the state.

In this Friday, March 27, 2020 photo provided by Office of Governor Andrew M. Cuomo, makeshift hospital rooms stretch out along the floor at the Jacob Javits Convention Center in New York. New York Gov. Cuomo said the state wants to build four more temporary hospitals in New York City within weeks, before coronavirus cases are projected to peak. (Darren McGee/Office of Governor Andrew M. Cuomo via AP)

They may not be able to flatten the curve, as the peak could be days or weeks away.

Will South Dakota surge?

South Dakota, however, hasn’t yet seen the same numbers as large metropolitan areas. Despite that, the update on Friday showed a larger than usual jump in the number of confirmed cases. What will determine if South Dakota hospitals will face a similar surge?

“How well we’re able to blunt the peak of COVID cases,” Secretary of Health Kim Malsam-Rysdon said in a Friday media briefing. “And that’s exactly what we’re trying to do in the state as the governor has explained several different times.”

She said minimizing the spread of COVID-19 and keeping the cases down to manage within the beds the state already has is important. Malsam-Rysdon said there are about 2,300 hospital beds in South Dakota.

The South Dakota Department of Health tracks hospital bed usage during situations like this. That information hasn’t been made public by officials.

Gov. Kristi Noem (R-SD) said the state’s forecasts don’t expect a peak (when we will see the highest number of COVID-19 cases) until May or June.

“It would be safe to say we’re going to need all the capacity that we have in South Dakota today,” Noem said. “We will be adding capacity as well. Preparing so we can take care of every individual who might need it.”

Noem said the state is not preparing for a best-case scenario.

South Dakota is somewhat limited in its resources being such a large state geographically, with a small population.

Case in point: The first area of community spread was Beadle County. According to data analysis by Kaiser Health News, the county has only six Intensive Care Unit beds.

ICU beds will be vital during the COVID-19 pandemic for those critically ill, especially for people needing ventilators.

Looking at South Dakota from a national perspective, you can see many counties don’t have any hospital beds in the state.

This analysis is from the latest data available from the federal government. The state hasn’t released exact details, nor have South Dakota’s big three health systems: Sanford, Avera and Monument.

What this data doesn’t show is ICU beds at the Department of Veterans Affairs and Indian Health Service Hospitals. IHS officials have said there are 37 ICU beds across its national system, but didn’t specify where.

Noem said she is in talks with hospitals to scale up with surge capacity.

Malsam-Rysdon said Thursday the state is using a statewide pandemic flu plan as a guide. The last public plan KELOLAND News could find is more than a decade old, but shows possible surge capacity potentials.

As the South Dakota State Medical Association calls out the state’s response, models from Harvard’s Global Health Institute paint a picture of what could happen under a number of scenarios.

“Crucially, we are providing this information at a local, hospital market specific level. National averages are not very helpful in this context. It’s irrelevant to a person in Utah how many hospital beds are available in Boston; we won’t be transferring large numbers of people to different hospitals. But specific, localized data provides a pathway to understanding what we need to do to get hospitals ready,” HGHI’s director Ashish K. Jha said.

South Dakota is divided into two Hospital Referral Regions: Sioux Falls and Rapid City. These are the markets where people generally go to the same hospitals. It’s important to note these federal regions extend outside of state borders.

This study from Harvard puts “flattening the curve” into real-life scenarios.

The study looked to see what happens if 20%, 40% or even 60% of the population contracts COVID-19. At an earlier briefing, Noem said state estimates are that 30% of the population will contract the strain of Coronavirus.

The study also looked at three time periods: 6, 12 and 18 months for the entire pandemic. It’s believed the more extreme the social distancing measures, the likelihood the disease will spread out over a longer period of time. That would allow hospitals to potentially manage the flow of cases better.

How will “flattening the curve” actually play out?

The researchers developed this model by looking at a few different things. They pulled in certain types of hospitals but didn’t include children’s hospitals, psychiatric hospitals and long-term ventilation rehabilitation facilities.

The model doesn’t look at spikes and drips, but rather a steady infection rate. It’s hard to predict a virus, especially one with only a few months of history.

The researchers then combined scientific studies out of China, where the pandemic began, with population data of those who are older and assumes each patient has a 12-day hospital stay, which was also from China’s research.

“Our goal is to give hospital leaders and policymakers a clear sense of when they will hit capacity, and strategic information on how to prepare for rising numbers of patients with COVID-19 needing care,” Jha said.

To further understand the model from Harvard, this is some of the information from the two regions:

Opening up the Midwest?

President Donald Trump signs the coronavirus stimulus relief package in the Oval Office at the White House, Friday, March 27, 2020, in Washington. (AP Photo/Evan Vucci)

As this is happening, President Donald Trump alluded on Fox News that he may work to get the economy opened back up in “certain parts of the Midwest.”

“I think we can start by opening up certain parts of the country: you know, the farm belt, certain parts of the Midwest, other places,” Trump said Thursday in an interview with Fox News Channel’s Sean Hannity. “I think we can open up sections, quadrants, and then just keep them going until the whole country is opened up.”

Public health experts have cautioned that move would not help to flatten the curve.

Dr. Anthony Fauci, the nation’s top infectious disease expert, cautioned against artificial timetables.

“And you’ve got to understand that you don’t make the timeline, the virus makes the timeline,” Fauci told CNN Wednesday. “So you’ve got to respond, in what you see happen.”


KELOLAND News reached out to the South Dakota Department of Health to get up-to-date hospital and ICU bed count data. We have not yet received a response.

KELOLAND News also reached out to the state’s three major health systems: Sanford, Avera and Monument Health.

Sanford Health issued this statement:

At this time, Sanford Health is not experiencing capacity issues related to COVID-19.  We are working hard across our system to prepare and ensure there are plans in place to manage treatment and supplies for COVID patients as the need increases. Based on patient need, capacity can change rapidly. We are collaborating closely with local government and other medical centers to plan for capacity needs, including the possibility of dedicated care centers for COVID.

Sanford Health

Avera Health and Monument Health did not return KELOLAND’s request for comment. If they do, we will update this story.


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