COVID-19 gets personal in a South Dakota town as neighbors die and a mask mandate is debated

MITCHELL, S.D. - A cold wind whipped through the prairie as they laid Buck Timmins to rest.

Timmins, a longtime coach and referee, was not the first person in Mitchell, S.D., population 15,600, to die of the coronavirus. He was not even the first that week.

As the funeral director tucked blankets over the knees of Timmins’s wife, Nanci, Pastor Rhonda Wellsandt-Zell told the small group of masked mourners that just as there had been seasons in the coach’s life - basketball season, football season, volleyball season - Mitchell was now enduring a phase of its own.

Pandemic season.

In a state where the Republican governor, Kristi Noem, has defied calls for a statewide mask mandate even as cases hit record levels, many in this rural community an hour west of Sioux Falls ignored the virus for months, not bothering with masks or social distancing. Restaurants were packed. Big weddings and funerals went on as planned.

Then people started dying. The wife of the former bank president. A state legislator. The guy whose family has owned the bike shop since 1959. Then Timmins, a mild-spoken 72-year-old who had worked with hundreds of local kids during six decades as a Little League and high school coach and referee.

His death shook Mitchell just as its leaders were contemplating something previously denounced and dismissed: a requirement that its staunchly conservative residents wear masks.

As Wellsandt-Zell led those mourning Timmins in the hymn “Jesus Loves Me,” the rumble of an approaching helicopter cut through the sound of the singing and the mourners’ soft tears. In Mitchell, the medical emergency helicopter, once a rare occurrence, now comes nearly every day, ferrying the growing number of people desperately ill with COVID-19 to a hospital that might be able to save them.

Sirens echoing through the empty streets of New York marked the pandemic’s first phase. Swirling blades of helicopters on the American plains is the soundtrack of a deadly fall.

Oh, my God, here we go again, Wellsandt-Zell thought. Another one.

‘We trusted each other’

News of Buck Timmins’s death spread quickly through town just hours before the first vote.

Kevin McCardle, the city council president, heard the news in a text from a fellow referee and was shocked. He had not even known Timmins was sick. How could he be dead when McCardle had seen him filling up his tank at the gas station just a few days ago?

Timmins fell ill with the virus Oct. 24, his wife said. She was pretty sure he picked it up at one of the many games he went to, where people were casual about wearing masks.

“You may need a mask to get in the door, but once you were inside, you looked around and there were 300 people in the seats watching volleyball, pretty much going maskless,” she said. “Mitchell, South Dakota, is a small town. We trusted each other.”

Nanci had stitched Buck a mask out of quilt scraps - in the most manly pattern she could find, brown with little yellow flowers - but she wasn’t sure if he always wore it when he was out of her sight.

They both became ill at the same time, but Nanci had a mild case. Buck seemed OK, too, until about a week in, when he became weaker and weaker and didn’t want to eat or drink, or leave his old brown leather recliner. She plied him with all the flavors of Gatorade, Smartwater and Ensure she could find, but he drank very little. Because Buck was not having trouble breathing and the hospital had patients who were far sicker, he stayed at home. Nanci, a retired X-ray technologist, administered his oxygen and insulin treatments.

That morning, Nov. 16, Buck woke after a restless night and called out for his wife. He mumbled something - she thought he said, “I love you” - so she wrapped her arms around his head and said, “I love you, too!” Just after noon, he was gone. They had planned on taking an Alaskan cruise together next year, but now she was alone, 10 days before Thanksgiving with a stack of bills on the table she wasn’t sure how to pay.

“It’s just - not there,” she said. “So much life left, and then it’s just not there.”

Three hours later, McCardle walked into the Corn Palace, the city’s civic center and auditorium, with Buck Timmins’s death heavy on his mind. Timmins had coached in his Little League. They had refereed high school sports together. Now his eyes rested briefly on the spot in the bleachers behind the visitor’s bench where Timmins, in his role as state coordinator for high school refs, always sat during games.

McCardle had a yellow legal pad under his arm with his daily tally of coronavirus cases in Davison County since March. The growth he had been so carefully recording had exploded in recent weeks, with 359 cases Oct. 1 to 1,912 that morning, a 433% increase. Locally, 10 people had died in less than seven weeks. South Dakota is now is second in the country for total cases as a percentage of its population, according to Washington Post statistics.

The positivity rate at two local testing sites - a key indicator of the virus’s hold on a community - was 33% at the beginning of November and would soar to 49% near the end of the month, according to Avera Queen of Peace Hospital in Mitchell.

Queen of Peace, which only has eight ICU beds, became overwhelmed and sometimes had to turn patients away, opening up a second COVID-19 wing Nov. 8 that filled quickly. Doctors warned of a 50 to 100 percent increase in hospitalizations in the weeks to come. “GOD BE WITH US,” the pandemic-inspired sign outside a feed store read.

McCardle said he found the numbers as alarming as the public health officials did. He is a 57-year-old camper salesman whose biggest worry as council president before the coronavirus was cleaning up algae in the town lake. But when Susan Tjarks, the lone female member on the council, had raised the idea of a mask mandate a month earlier, he had ridiculed her for wearing one and grumbled: “You don’t see the grocery stores putting mandatory masks in. Nobody would go to ‘em. They’d lose business.”

But now McCardle and others on the council, rattled by Timmins’s death, listened attentively to Tjarks’s proposal, sitting at socially spaced tables on the auditorium’s basketball court in front of murals depicting their hardy pioneer ancestors. The draft ordinance would require masks in buildings and public spaces, with a fine of up to $500 and 30 days in jail.

Tjarks, who owns a drapery company called Gotcha Covered, is a conservative Republican. But she became convinced the city had to act as deaths began tearing a deep hole in the community’s civic heart.

“What we have been doing isn’t working,” she told the city council. “I don’t want to lose any more friends. I don’t want to lose any more neighbors. We have to do what we need to do to step up and prevent these cases from rising.”

So many town leaders have died in such a short time that the impact has been profound, Tjarks said. Who will fill Timmins’s shoes as a mentor for young referees in the state high school athletic association? Who will raise money for the veteran’s park and the rodeo stampede now that state legislator Lance Carson is gone? There would be smaller absences too: her neighbor, John, now missing from the morning group at the doughnut shop.

Throughout the autumn, towns all over the Midwest in conservative states where Republican governors have avoided mask mandates have tried to pass their own restrictions, often prompting virulent community debate. The town of Huron, S.D., just up the road passed one, as did Washington, Mo. In Muskogee, Okla., the city council failed to pass a proposal even after one of its members wheeled in a casket as a prop.

During the public comment section in Mitchell, a handful of anti-maskers spoke, alleging that masks don’t work and that the measure was an overreach that would violate their civil rights. Local doctors and nurses overrun by COVID-19 patients pleaded for help.

“Every single day, I come to work and have more and more positive COVIDs,” said Diane Kenkel, a nurse practitioner who runs a small independent health clinic in town. “The stress on the hospital is very real. It’s really scary as a provider to come to work and have very ill people and know there might not be a hospital bed for you.”

Ultimately, the Mitchell City Council passed the draft measure unanimously Nov. 16. But Mayor Bob Everson - one of the mask-doubters - still had to issue an executive order to put it in place. And the draft had to survive what was expected to be contentious public hearing and final vote the following week.

‘There’s hope’

The following day was a bad one, the worst so far in the pandemic, at Kenkel’s small health-care practice located in a low-slung brown brick building just a block from the Corn Palace.

After her last patient of the day, Kenkel, 62, had hung up her only blue protective gown, tucked the N95 mask that she has been using since March in a paper bag, sat down at her desk and took a sip of the cold coffee she had been trying to finish since morning. Her poodle, Junie B., a registered therapy dog, curled up in a sheepskin bed alongside her.

Kenkel was barely out of the shower that morning when one of her longtime patients - a young mother of four - texted to say her coronavirus symptoms had worsened and she was having trouble breathing. What should she do?

With symptoms that acute, Kenkel would have normally sent the woman to the hospital. But there were no beds available, so she had to arrange to send oxygen to the woman’s home. Avera - the hospital system that runs Queen of Peace - expanded its home health-care program to include COVID-19 patients this summer and now 1,400 people across the system, some who would normally be treated in a hospital, are being treated at home.

Like the young mother. And then the firefighter with whom Kenkel had a Zoom call after that, who - unbelievably but truly - was suffering through his second coronavirus infection. He was sicker than she had ever seen him, Kenkel said. He had so far resisted going to the emergency room, because he was afraid he was going to die.

It was the week that the pandemic became personal. Four friends, including Timmins, had died. Her younger patients were suddenly becoming acutely ill when they had not been before. She had known the young mother since before she had her babies. She knew the firefighter because he had worked with her husband, Kevin, the town’s library director, on the local jazz fest.

She was exhausted. Exhausted from having to come home, shower immediately, cook dinner while wearing a mask, then sleep separately from her husband. Exhausted from not being able to touch or hug her patients, or hold their hands while she prayed for them.

It felt like she was living in an alternative universe these days, where seriously ill COVID-19 patients overwhelmed the hospital and her clinic and neighbors were dying as folks were living their lives, eating out in restaurants, drinking in bars and attending weddings, funerals and the Pheasants Forever fundraising banquet.

Then there were the patients who didn’t even believe the coronavirus was real. That week, a patient in his 40s came in for a physical - he was high-risk and asthmatic - and his gaiter pushed down when she walked into the exam room. He said he couldn’t breathe in it and didn’t believe the whole pandemic thing anyway. People were dying from pneumonia because they were being forced to wear masks, he told her.

“The next thing you’re going to be calling me to come in and take the vaccine, and I’m telling you right now I’m not going to get it,” he told her.

Kenkel told him calmly that the research he was reading was flawed. She didn’t raise her voice but later questioned herself - why she had felt the need to sway somebody’s opinion in the exam room?

“To have people say it’s not real, that’s just unbelievable,” she said. “Well, they haven’t seen what I’ve seen. So maybe it is unbelievable. They just want to believe it’s not true.”

At her desk, she opened her email. First, there was a note from a statistician with an update on the virus’s spread - a color-coded map of South Dakota that showed active cases skyrocketing in many counties. Then, the good news, an email from her husband saying the mayor had issued an emergency order for masks that would stand until the final vote in a week.

“So that’s making my day better,” Kenkel said, her eyes filling with tears. “There’s hope.”

‘Ladies and gentlemen, the virus is real’

Staff and students have been wearing masks since the school board passed its own mandate in July, which has allowed them to keep schools open for in-person learning for all 4,000 students. And they seemed to be working: A high school science teacher did an analysis that showed the infection rate was about 3.8% at the schools compared with 10% in Davison County as a whole.

Nonetheless, a vocal group of anti-maskers continued to protest that decision even though the district has no intention of changing its mind. That led to a viral video in September showing a burly man refusing to leave the meeting after being asked to put on a mask. “Force me out!” he taunts the officers who came to lead him away, while a woman films the scene and screams, “This is disgusting!” The man, Reed Bender, a local sewer and drain technician, was later charged with obstructing police. Bender declined to comment.

Mitchell Schools Superintendent Joe Graves said the schools were considering moving their board meetings online to avoid such scenes going forward.

“We don’t want this to become an open wound in the long term,” he said, or “an ongoing scar.”

The current council debate had re-energized the anti-maskers, and they pelted city officials with calls and emails running 2 to 1 against, exhorting members of its closed Facebook group to come to the meeting to protest.

The night of the final vote, a cold, clear evening in the 30s, more than 100 people gathered at the Corn Palace, sitting spaced out in the venue’s faded blue folding seats. The “World’s Only Corn Palace” and its whimsical domes had showcased the town’s agricultural bounty and brought tourists to town since 1892, and seen Mitchell through fires, floods and the blizzards of 1949 and 1966. Now, men and women stood ready to debate for hours over the utility of a 4-by-7-inch piece of cloth during the worst public health crisis the town had seen in a century.

Thirteen deaths from COVID-19 were reported in Davison County during the week between votes.

The anti-mask forces sat with naked faces, defying the mayor’s order. One by one, they got up to air their grievances. They wept. They swore. They cited junk science: Positivity defeats the virus. So does a healthy lifestyle, eating wild-caught sardines, pasture-raised beef liver and drinking raw organic kombucha. A young mother stood up and compared anti-maskers to Jews persecuted in the Holocaust: “The bare face is the new yellow star of Nazi Germany,” she said.

Mack Miller, 33, a member of the Army National Guard who did two tours overseas, got up to say he had sacrificed his family life to serve and protect the country’s freedoms.

“Wear a mask if you want to; that is your right,” he said. “Choice is what makes America, America. Our own voice, our own choice, our own freedoms.”

As the evening wore on, members of the beleaguered medical community could not hide their distress.

“I cannot even remember how many death certificates I have signed in the last few days,” Buck Timmins’s doctor, Lucio N. Margallo II, told the crowd. In fact, he had lost eight people in the last week.

“Ladies and gentlemen, the virus is real. It’s not a fantasy. It’s deadly, and it’s surging out of control. Scared? Yes I’m scared. . . . I’m scared for everybody and scared for myself.”

Kenkel got up to speak following one anti-masker who seemed to be in the throes of a respiratory infection.

“I’m scared to stand right here because of the people coughing and hacking,” she said, before pleading: “Please stand firm. We’re dependent on you guys. Amen.”

After the public comment period was over, the council immediately got busy stripping the mandate of its penalties. They removed the city’s fine, leaving only the court costs of about $90, should it come to that. They were opting for a “soft approach,” the mayor said, to “educate” people.

“We’re putting together an ordinance that has no teeth!” McCardle, the council president, protested. He had spent the week agonizing over his decision. One day he was for it, the next day he was against. He would miss his friend Buck Timmins at all the games, but he was also moved by the soldier. Miller had served to protect our country’s freedoms - how could McCardle vote to take them away?

But in the end, McCardle couldn’t even bring himself to vote for the toothless mandate, which passed 5 to 3.

The resulting decision - “chickens---,” Miller deemed it - made few on either side happy. The town was divided as ever, and people of Mitchell still had to wake up the next morning and face each other at the grocery store, church and the local sushi restaurant.

By the end of the night, mostly anti-maskers remained in the auditorium. Kenkel had ducked out just after she spoke, going home to write up 18 patient charts before bed, including six patients seriously ill with COVID-19. She was long gone by the time one city councilman hopefully suggested that maybe they wouldn’t have any mask citations after all this, and the mayor pointed at the crowd and said, “Did you listen to these people?” and they all laughed.