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Erin Grace: Health care workers face exhaustion, PTSD on front lines of coronavirus pandemic

A South Omaha doctor can’t sleep. Dr. Kristine McVea is worried sick about the families she and her colleagues are treating through car windows and computer screens.

An overnight nurse is fall-on-his-face tired, sleeping more than ever. Mark Palacio’s normally taxing job now requires even more nonstop brain work with the novel coronavirus protocols.

Then there’s Teresa Anderson. She’s the public health director of a rural Nebraska hot spot that includes Grand Island, having to manage one of the nation’s worst virus outbreaks amid testing shortages and as most of Nebraska begins to reopen for business.

This insidious virus that has killed tens of thousands of Americans and upended life for everyone also exacts a mental toll, especially on front-line workers who must cope with dizzying new stresses on top of already-demanding jobs.

There is a real worry about burnout and an affliction usually ascribed to soldiers, post-traumatic stress disorder. The worst possible outcome occurred last week in the suicide death of a top emergency room doctor in New York City.

“She tried to do her job, and it killed her,” Dr. Philip Breen told the New York Times about his daughter Dr. Lorna Breen. Breen, age 49, took her own life last Sunday. She had contracted coronavirus and was recovering but had relayed to her family horrifying stories of what she was witnessing.

A new doctor hotline has been created for free psychiatric help. A bipartisan effort is underway to shrink the current 10-digit national suicide prevention hotline — 800-273-8255 — to an easy-to-remember three-digit one patterned after 911.

And various hospitals, universities and other health care workplaces are trying to incorporate resilience training, mindfulness practices and other ways to keep their workforce going. CHI Health, for example, is cycling some volunteer critical care doctors from Omaha through its hard-hit St. Francis Hospital in Grand Island.

“It’s super-collaborative,” said Dr. Randy Pritza, chief medical officer of CHI Health’s physician enterprise, which includes some 900 providers in Nebraska and Iowa. At the same time, he said, this is “not sustainable.”

Pritza said it’s important that caregivers have support systems, take breaks and band together as teams.

“You can’t keep doing that day in, day out, day in, day out,” he said. “It takes a toll on your family, a toll on your own health.”

The field already has a problem with burnout and historically had a high-pressure culture that sidelined or punished people who complained — though that is changing.

Still, it can be hard for those in the trenches to consider self-care given what they see around them.

Kristine McVea

“It is JUST CRAZY. We’ve been overrun,” said McVea, chief medical officer at OneWorld Community Health Centers, which treats a mostly poor population.

McVea said COVID-19 cases among clients are increasing. She’s worried about their health, community spread and the lack of ways to help a clientele who are often living and working in close quarters and on thin margins.

She’s also grappling with loss. Patients, including young people with no apparent underlying health conditions, have died of COVID-19, the disease caused by the coronavirus.

One patient who is pregnant and newly widowed because her husband succumbed to the coronavirus while at home is frightened, and McVea feels there’s nothing she can do for her besides talk over the phone.

“I really wanted to give her a hug,” she said. “You carry around the weight.”

Then she worries she could bring the disease home to her husband and 19-year-old son or to healthy people she’s treating. At one point, McVea thought she had symptoms of the coronavirus and she said that before she tested negative, she was “really scared” about upcoming hospital rounds to check on newborns and their mothers.

“I was really worried I’d become a vector, that I would infect (others),” she said, her voice choking up. “You still have this desire to protect your family, and I would feel so guilty if I were to be the person who brought this into our home.”

Mark Palacio

For Palacio, the already-pulsating work of emergency room nursing quickened under coronavirus, with everyday procedures changing. It’s hard to remember it all even though it’s constantly on his mind. He now has to enter Nebraska Medicine’s midtown emergency room through a different door and wear a mask “100% of the time,” along with a face shield.

Sometimes he must don a bulky motorized air filtration headpiece.

Coronavirus protocols mean his very job has changed. Fewer people can be in an emergency examination room at the same time because the ER can’t risk the potential spread of the virus among its staff. This means Palacio must juggle additional tasks.

He can’t just walk into an exam room and start pulling out tools. That risks the tools.

He can’t just run to the emergency when the code alarm goes off.

Visitors aren’t allowed, which means Palacio is calling family members.

The complicated business of delivering oxygen now requires even more care and focus.

“To do anything requires so much preparation and forethought before I can enter the room,” he said. “I have to think about everything I do before I walk in.”

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Palacio, 32, is married. He worries about an how this enigmatic virus affects people differently and offers little predictability. He worries about Monday, when businesses and churches around Omaha reopen and more people relax about the restrictions that, so far, have fairly insulated the city against the worst.

“My biggest fear is getting inundated,” he said. “The other night … three patients came in within two hours and needed intubation. There were 12 different CAPRs that had to be used. We don’t have 12. We had to reuse. We don’t have enough face shields. It was very, very stressful.”

The usual ways to decompress are not available. Palacio said he liked to go to The Neighber’s after his shift for a beer with his fellow overnight workers. That’s out.

Instead, when 7 a.m. comes and he’s done for the day, Palacio goes home, strips off his scrubs, showers and falls right to sleep. That is when he doesn’t first need to have a good cry. Sometimes, Palacio pours himself a whiskey, pulls up some YouTube videos of soldiers coming home to their dogs and snuggles with his dog, a Chow mix, Arya. He lets himself emote and then feels ready for the next shift.

Teresa Anderson

Anderson’s job could bowl her over if she let it.

She’s head of a three-county central Nebraska public health department that is managing through the brunt of the state’s coronavirus cases. Hall County, where Grand Island sits, is home to 3% of Nebraska’s population but, as of Friday, almost a quarter of the state’s COVID-19 cases. Anderson estimates she has worked the past 40 to 50 days straight with no breaks.

At 63, age places Anderson in the higher-risk category. With one staffer infected, she was waiting Friday for test results to see if any more members of her staff had fallen ill. That would introduce a whole other list of complications. Anderson has steeled herself against getting sick. She can’t add that to the region’s burden.

So she’s disciplined about going to bed early. She shuts off her phone at 8:30 p.m. knowing her email and text messages will explode. There is benefit: She works out problems in her sleep, waking at 1 a.m. with fresh ideas on problems. When she rises at 5:30 a.m. she feels ready for another sprint through her marathon.

“I go about 110 miles per hour,” she said. “If I don’t call it at 8:30, I’m totally going to lose it. My main coping mechanism right now is I get enough sleep.”

The problems confronting the Central District Health Department are like an ever-shifting puzzle. You get the corner pieces and start framing it and then the rectangle shifts into a triangle or circle.

“Every day is reconstructing what has to be done,” she said, and that includes keeping her staff going.

She said antidotes are collaboration, clear purpose and a workforce that’s so committed, “people are smiling.”

“I don’t know exactly how,” she said, adding that the public health workers are getting assistance from the state and community. People bring food to the office, “and we like that!”

Mindee Swanson

Other caregivers say their coping mechanisms include shutting off the news and social media, particularly Facebook, where coronavirus-deniers make it hard “not to get angry,” as Mindee Swanson put it.

The 32-year-old nurse practitioner in Omaha said support is critical. She said her husband is working from home and shouldering the load with their children, ages 5 and 3. A messaging app at OneWorld, where she works, helps her support colleagues. They remind each other to take care of themselves.

Erica Parish

Erica Parish, a 37-year-old emergency medicine nurse in Omaha, said she had to overcome her fear factor after receiving “a mind-blowing email” from Nebraska Medicine in March about the coming pandemic. That plus a Twitter feed of dire news out of Italy and New York made her worry about getting the virus herself or watching her co-workers fall ill and potentially die.

None of that has happened, which is a big reason why her anxiety level is down. She also got proactive: exercising more, practicing yoga more, trying meditation. She took advantage of some Nebraska Medicine programs that aim to build resiliency. She created a Google document of coping techniques and asked her co-workers to add theirs. And she took heart in the support she’s gotten from home — caramel rolls shipped from her folks in Chadron, Nebraska. Plus restaurants and do-gooders in Omaha have kept the med center staff fed.

Pritza, the CHI chief medical officer, said caregivers are entering a phase of acceptance.

“I don’t think that anybody believes that COVID is going to go away, and we have to mentally adjust to that,” he said.

He said the medical establishment will have to focus on making practices as safe as possible, preparing for a flare-up this fall and knowing that a vaccine, once it’s developed, won’t be perfect.

This will all take time.

It is important for caregivers to give care to themselves. We need Dr. McVea to get a good night’s sleep. We need Nurse Palacio to blow off steam. We need Director Anderson to stay strong. In turn, this front line needs us to follow medical advice and to stay home. And healthy.

Photos: Nebraska's coronavirus helpers

Buffett has simple message for shareholders during pandemic: 'American magic has always prevailed'

Warren Buffett had a simple message as he spoke to an economically anxious world from an empty, cavernous arena in Omaha: Nothing can stop America, not even the disruptive coronavirus pandemic.

“We have faced tougher problems, and the American miracle, the American magic, has always prevailed,” Buffett said during a unique virtual meeting with his shareholders Saturday. “And it will do so again.”

But while Berkshire Hathaway’s chairman showed his trademark bullishness on the long-term prospects of America and its markets, he was not ready to predict when the economy will emerge from its pandemic-induced lockdown. He called the range of economic possibilities still “extraordinarily wide.”

And he believes the pandemic will lead to fundamental changes for some industries, as evidenced by his disclosure during the meeting that he had dumped Berkshire’s $6 billion position in the four major U.S. airlines.

The uncertainty appears to also be the reason Berkshire has made no major purchases of other stocks or attempted to buy back significant shares of its own, instead holding on to a pile of cash that has now grown well beyond $130 billion.

“We don’t know what will happen next week or next month or next year,” he said. “There are a lot of different scenarios that will play out.”

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It was a surreal scene Saturday as Berkshire Hathaway held its 55th annual shareholders meeting in Omaha — minus the shareholders.

Chairman Buffett sat alone at a table surrounded by thousands of empty seats that in a normal year would have been packed to the rafters with tens of thousands of Buffett fans.

But the coronavirus pandemic has made this anything but a normal year. The threat of spreading the deadly virus prompted Buffett to cancel the public portion of the meeting and all the other events surrounding the celebration of capitalism that plays out in Omaha during the first week of May each year.

Instead, millions from around the world watched online as Buffett spent 4½ hours sharing his thoughts on Berkshire, the conglomerate’s diverse holdings and the wider economic world.

Berkshire Vice Chairman and Buffett sidekick Charlie Munger was also nowhere to be found, the 96-year-old staying home despite being in good health. Instead, Vice Chairman Greg Abel, who oversees Berkshire’s non-insurance operating companies, joined Buffett for the traditional Q&A session.

The online meeting had a very different feel with no crowd in the arena, Buffett quips that would have elicited echoes of laughter in the past instead greeted with silence.

But one thing that did not change was the 89-year-old Buffett’s incredible stamina. He offered thoughts and answered questions posed remotely by CNBC business journalist Becky Quick without a single break, sipping from his trademark can of Coke.

Shareholders and the wider world were awaiting Buffett’s thoughts on the coronavirus and the havoc it has wreaked on the world’s economy. Millions have been thrown out of work as businesses have shut down and curtailed operations in an effort to flatten the curve of the virus’s infection and death.

Buffett said there’s never been anything quite like this time. He noted it differed significantly from the 2008 financial crash, when the economy “went off the tracks” due to fundamental weaknesses in the banking sector.

“This time, we pulled the train off the tracks and put it in a siding,” Buffett said, a particularly appropriate analogy given Berkshire’s ownership of BNSF Railway. “I don’t know of a parallel.”

He spent more than an hour at the start of the meeting giving a lengthy U.S. history lesson, noting that America has been through a civil war, world wars and the Great Depression and always in the end emerged stronger.

His long-haul faith for the future remains unshaken, he said. He said over time, stocks will certainly outperform keeping money “under a mattress” and remain a sound investment.

“If you say the day of investing in America is over, I would disagree with that quite violently,” he said. He repeatedly said no one should ever bet against America.

But he said it’s impossible to predict the market’s short-term future, in part because the virus is so unpredictable. It may ebb in the summer, but then it may come back again at a later date. Not only is it impossible to predict, he said, it’s impossible to know how consumers would react to a second attack.

“Fear is the most contagious disease you can imagine,” he said at one point. “It makes the virus look like a piker.”

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He hinted that uncertainty is a major factor in his recent inaction on new investments and Berkshire’s retention of so much cash.

“Anything can happen, and we want to be prepared for anything,” Buffett said.

Buffett’s bet on the future of America also apparently does not extend to the future of the airline industry.

His bombshell disclosure of the session was that Berkshire recently sold all of the airline stock it had accrued since 2016. The travel industry has been hammered in the pandemic. And even after it passes, Buffett said he doesn’t know if people will fly as much three years from now as they did before.

“As it turned out, I was wrong about that business,” he said, one of numerous investment mistakes he has fessed up to over the years.

Buffett also faced questions as to why he has not invested more in his own company through stock buybacks during this downturn. The company disclosed earlier in the day it had recently bought back a modest $1.7 billion worth, that despite the fact the stock has recently traded as much as 30% below its previous high.

Buffett said he just did not see this as a compelling time to do so, noting there was value in having cash available in the future “to step up in a big way.”

Buffett said going in he would not answer questions about politics during this election year.

The closest he came to treading on that topic was when he defended capitalism but added that he does not want “unfettered capitalism.” Buffett believes in helping those who fall through capitalism’s cracks — and right now there are millions more in that boat.

There are always questions about who will succeed Buffett as Berkshire chairman when he is gone, and the decision to have Abel as the only other manager to join him for the Q&A will likely fuel speculation Abel could be the anointed one.

Buffett gave no new hints on the name he and Berkshire’s board have already agreed to, offering praise for the abilities of all of Berkshire’s top managers.

“They know a lot of people, they’ve got a lot of energy, and their minds work the same way as ours,” he said.

For his own part, Abel said he doesn’t see the culture of Berkshire changing after Buffett is gone.

Buffett said he was in good health, and during the marathon session, he certainly seemed to be, too. “We’re not going anywhere voluntarily, but we will probably go somewhere involuntarily,” he said.

In response to a question emailed in from actor (and shareholder) Bill Murray, Buffett offered praise for the health care workers and others on the front line in the pandemic.

“People who are doing the kind of work Bill talks about, they are contributing a lot more than some of the people who came out of the right womb and got lucky and know how to arbitrage bonds, and for a large part I’m one of those guys,” he said.

Buffett is always energized by the chance to meet with his shareholders, and he was surely disappointed at the circumstances that forced this year’s drastic change in format.

He ended the meeting with a hopeful note about the 2021 shareholders meeting.

“We’ll see you next year,” he said. “We’ll fill this place.”

Photos: Nebraska's coronavirus helpers

What do New York City and a Nebraska meatpacking center have in common? They rank among U.S. communities hit hardest by coronavirus

What do New York City, a ski resort community in Idaho, the homes of two large Ohio prisons and a northeast Nebraska meatpacking center have in common?

All rank among the American communities hit the hardest by the novel coronavirus.

A World-Herald analysis of data for the nation’s counties shows those with the highest per-capita rates of COVID-19 infection range from the densely populated northeast, into the Deep South, and to food production centers scattered from the Great Plains to the Rockies.

They include high-income, fashionable suburbs on Long Island and dirt-poor counties in rural Georgia.

Two Nebraska counties now rank among the nation’s top 25 counties for confirmed cases per capita. That includes Dakota County, which has recently rocketed all the way to No. 4. And Nebraska’s Hall County, which sits just outside the top 25 in virus spread, now ranks in the nation’s top 100 counties for coronavirus death rate.

In short, no matter where the virulent bug has been allowed to go to seed, it’s shown it can perilously spread like prairie wildfire.


The sun sets behind the Tyson Foods beef plant in Dakota City, Nebraska. Dakota County, with a population of about 20,000, has more coronavirus cases than Douglas County, with a population of about 500,000.

“This virus is transmitted person to person, so it’s going to infiltrate a community wherever people are gathered,” said Dr. Angela Hewlett, an infectious disease expert at the University of Nebraska Medical Center. “We’re seeing this everywhere. No community is immune.”

As the coronavirus pandemic in recent weeks has rapidly spread through meatpacking communities in Nebraska and Iowa, The World-Herald analyzed data for all 3,100 counties in America to find the places the virus has most prevalently spread.

Not surprisingly, New York City and numerous surrounding counties in New York and New Jersey rank high for both infection and death rate. The images of refrigerated trucks storing bodies outside overwhelmed hospitals will always cement New York as ground zero in the nation’s pandemic.

But look at the most infected counties today and numerous other trends emerge — at times in places where many didn’t expect to see the virus spread so severely.

Five weeks ago, President Donald Trump during a White House coronavirus briefing reeled off a list of states that he said were “lightly affected.”

“You look at Nebraska, you look at Idaho, you look at Iowa,” he said. “You look at many — I could name many countries that are handling it very, very well and that are not affected to the same extent, or, frankly, not even nearly to the extent of New York.”


A discarded face mask outside the Tyson Foods beef plant in Dakota City, Nebraska, which has closed for deep cleaning.

Today, Nebraska, Idaho and Iowa all have counties ranked among the nation’s top 25 for infection rate.

While the largest cities in Nebraska and Iowa have indeed been only lightly affected, the large number of meatpacking hot spots as of Thursday had driven Nebraska’s state per-capita rate to the 18th highest among the 50 states, and Iowa’s up to 17th.

Look no further than Blaine County, Idaho — one of the nation’s first coronavirus epicenters outside New York — to see how quickly and easily the virus can spread.

The bug was likely first introduced in early March by one or more of the thousands of tourists who flock each winter to the mountain community, home to Sun Valley ski resort. And those visitors started mingling shoulder to shoulder on the lifts and with the locals in the packed lodges and restaurants.

Sun Valley quickly transformed into a snowy mountain petri dish.

“There were many introductions, and the epidemic became fairly violent there,” said Dr. Andrew Pavia, a pandemic expert at the University of Utah. “That was one way in which the virus easily seeded much of the rural west.”


Jeannie Jackson, left, wearing a face mask, sits more than 6 feet away and visits with her daughter Tracy Jones while picking up some homemade banana bread in South Sioux City, Nebraska.

Now the nation’s biggest hot spots can be found much closer to home — in the Midwest meatpacking plants where workers at times stand feet apart doing the grueling, gritty work of turning cows and pigs into food for America’s tables.

Nebraska’s Dakota and Dawson Counties both rank in the nation’s top 25 in per-capita cases, particularly noteworthy in that just over three weeks ago the two meatpacking centers had a single confirmed case between them. Hall County stands at No. 26.

To be sure, those Nebraska counties have not seen anything close to the amount of death in New York, on either a real or even per-capita basis. But COVID-19 deaths tend to lag a week or more behind infections, and this past week brought some ominous signs.

On Wednesday, the three-county health district that includes Hall County reported 10 deaths in a single day. In the eight-county Omaha-Council Bluffs metro area, that would equate to a one-day death toll of 124.

The deaths were enough to help move Hall — which as of Thursday had seen 28 deaths overall — up to 86th nationally in coronavirus death rate.


Yard signs with positive messages outside Regency Square, an assisted living center with multiple residents who have the coronavirus disease, in South Sioux City, Nebraska.

While neighboring Hamilton County was too small to be included in the Word-Herald analysis, which only ranked counties with populations of 10,000 or more, the county’s eight coronavirus deaths give it a per-capita rate that would rank it 30th highest nationally.

“I think the deaths, unfortunately, may be coming,” Pavia said of meatpacking country. “People haven’t had time to get sick enough to die.”

After a week in which U.S. coronavirus cases topped the 1 million mark, here’s a look at some of the trends that have emerged over the course of the pandemic. In fact, the vast majority of the most infected counties fall within four distinct trends.

New York City region

Officially, the first confirmed coronavirus case in New York City was reported March 1.

But experts today concede the virus had almost certainly been quietly circulating undetected for weeks in America’s most international city, likely brought in by numerous travelers from abroad. There’s no other way to account for the speed with which the virus spread, despite belated efforts to lock the region down.

“What probably happened in New York is multiple introductions, and by the time it came on anyone’s radar, there were substantial transmission events,” said Hewlett, the medical director in the Nebraska Biocontainment Unit at UNMC. “When you think about other outbreaks in our lifetime, we had never seen anything like this. Although a lot of us knew this would come, it took us a bit by surprise with how rapidly this occurred.”

New York City and surrounding counties make up 10 of the top 25 counties for per-capita coronavirus infection. And the grim list of the top 25 for per-capita deaths includes eight counties from the region.

Though it appears cases have now peaked, New York and New Jersey are still seeing hundreds of deaths daily.

Questions remain as to why New York was so severely infected. After all, some other major cities in the United States have in comparison been lightly impacted. Not one county from metro area Chicago, Los Angeles or Atlanta appears even among the top 50 in infection rate. Boston has a single county in the top 25.

Just for comparison, while Douglas County’s daily case numbers have recently been hitting new highs, New York City has 17 times Douglas County’s infection rate and more than 50 times its death rate. Douglas County ranks 825th nationally in per-capita infection rate.


Eleazar Becerra, 14, rides his bike with his family after they went to Dollar General for snacks in Dakota City, Nebraska. It was their first time outside their home and backyard since the middle of March. Dakota County, with a population of about 20,000, has more coronavirus cases than Douglas County, with a population of about 500,000.

But Pavia said not even Chicago or Los Angeles can really compare to New York City. It’s by far the densest city, with more people riding together in high-rise elevators and on subways.

“Other cities are crowded,” Pavia said. “In New York, the magnitude of time you spend really crammed together with others is really of a magnitude of difference.”

There will also be second-guessing whether officials in New York acted quickly enough to shut down daily life. California was quicker to issue a stay-at-home order, even though the West Coast never saw the kind of exponential spread that New York did.

Omaha Public Schools Superintendent Cheryl Logan actually moved to extend spring break and keep district schools closed three days before New York City shut down its schools. Pavia said he knows New York City’s leaders were reluctant to shut down schools because of the large number of students who rely on school meals.

While federal health officials were also clearly slow to respond to what was coming from overseas, New York Gov. Andrew Cuomo in a recent interview pondered whether the state should have responded more quickly.

“I wish someone stood up and blew the bugle,” he said. “And if no one was going to blow the bugle, I would feel much better if I was the bugler blower last December and January.”


An Our Lady of Guadalupe window display in the front of a home in South Sioux City, Nebraska.


To date, no Nebraska prison inmate has tested positive for coronavirus. But a look around the country shows how explosively the virus can spread once it gets within the confining walls of a prison.

Four of the nation’s top nine counties for coronavirus rate are homes to major correctional facilities.

More than 80% of the 2,500 inmates at Ohio’s Marion Correctional Institution have tested positive for COVID-19.

The figures for the prison counties are no doubt influenced by high rate of testing, as most all prisoners in those facilities are being tested to try to isolate the sick and contain the spread.

The prison outbreaks as a whole have also not been particularly deadly. But a prison in Ohio’s Pickaway County that includes the correctional equivalent of a nursing home has seen the deaths of 18 inmates and one nurse.

“In some of these prisons, you get close to a 100% attack rate,” Pavia said. “What will be interesting to see is how much these prison outbreaks ultimately spread into the community.”

Impoverished regions

Of all the counties that lead the nation in infections, none are more head-scratching than a group of small, mostly contiguous rural counties in southwest Georgia.

They account for two of the nation’s top 25 and five of the top 50 counties in infection rate. And three others would crack the top 50 if they weren’t so tiny to be excluded from the analysis.

The virus has also proven extremely lethal there. Five of the Georgia counties rank in the top 10 nationally in per-capita deaths.


The words "Quality of Life" grace a water tower in South Sioux City, Nebraska.

Published reports have said a large, 200-person funeral in late February is believed to have served as a super spreader in the region. But the region has no other obvious factors such as industries or unusual social practices that have helped seed the disease. The counties are isolated, dozens of miles from cities of any size.

“Georgia is really odd,” Pavia said of the outbreak.

However, Pavia and other experts have little doubt about why the disease has proven so deadly there.

Many of the counties rank near the bottom nationally in median household income. It’s long been well-known in public health circles that impoverished communities have poor access to health care and much higher rates of chronic medical conditions including diabetes and heart disease.

Those are also just the kinds of preexisting conditions the coronavirus has proven to feast upon.

That same economic factor is likely why the home county of New Orleans and nine others in Louisiana rank in the top 50 in coronavirus death rate.

A Mardi Gras celebration that in hindsight should have been called off may have helped widely circulate the virus. But underlying poor health is what made it so lethal.

“COVID-19 has just brought those things to the surface,” Hewlett said.


The Tyson Foods beef plant in Dakota City, Nebraska. Tyson Fresh Meats has announced a temporary closure of its massive Dakota City beef plant to deep clean amid the novel coronavirus pandemic.


On April 2, health officials in Louisa County, Iowa, reported the community’s first COVID-19 infection.

“While this is Louisa County’s first case, this may not be the last,” the local public health administrator said that day. It certainly proved an understatement.

Within just over two weeks, the southeast Iowa county that’s home to a Tyson pork-processing plant had emerged as one of the nation’s first coronavirus meatpacking hot spots. And many more have followed.

Today, seven of the nation’s top 25 counties for coronavirus rate are meatpacking centers, including two in Nebraska, two in Kansas and one each in Iowa, Minnesota and Indiana. Often, it takes less than two weeks for a meatpacking community to shoot toward the top of the rankings.

“This is moving really fast,” Hewlett said. “It’s definitely a disturbing trend.”


Dakota County, with a population of about 20,000, has more coronavirus cases than Douglas County, with a population of about 500,000.

It’s also not hard to understand.

Working from home is not an option at these facilities, and the demands of the fast-moving production line make social distancing difficult. Thousands of workers stand nearly elbow to elbow doing work that was often grueling and dangerous even before the pandemic.

“These are just very difficult facilities to maintain social distancing in and stop the spread,” Hewlett said.

Of all the types of major outbreaks, those in meatpacking have also proven the most controversial.

Workers and their advocates say the plants aren’t doing nearly enough to protect them from the deadly virus, sacrificing worker health for profits. Nebraska Gov. Pete Ricketts and others have said the outbreaks aren’t solely the responsibility of the plants but are also a “community issue.”


Discarded face masks sit in the grass outside the Tyson Foods beef plant in Dakota City, Nebraska.

Most workers in the plants tend to be immigrants and refugees, and many live in extended family households and among tight-knit communities. But advocates point out that immigrants working in other industries aren’t seeing the same kinds of explosive outbreaks, pointing to the packing plants as the primary driver.

Meanwhile as the illnesses mounted, the president last week signed an executive order requiring the plants to stay open to protect the food supply. Many have nonetheless suspended operations.

Nearly all the plants report doing the same things to try to arrest the virus. They’re using thermal scans to identify employees with elevated temperatures; handing out more personal protective equipment; installing acrylic shields and other barriers; and increasing the amount of cleaning and sanitation.

But the spread continues, hitting more plants every week.

So what is the answer? A team of Hewlett’s UNMC colleagues have been working on it, last week releasing a list of recommendations it’s hoped can make a difference.

Pavia said it will be interesting to see how many new packing plant outbreaks pop up in the weeks ahead.

Overall, Pavia said what all the numbers in The World-Herald analysis show is there really is no such thing as a national outbreak in this pandemic, or even a state outbreak.

In every county around the country where the lethal virus has taken hold, the reasons, the circumstances, the victims and the outcomes have proven in some way unique.

Said Pavia: “Every outbreak tells a story.”

World-Herald staff writer Erin Duffy contributed to this report.


The Tyson Foods beef plant in Dakota City, Nebraska. Tyson Fresh Meats has announced a temporary closure of its massive Dakota City beef plant to deep clean amid the novel coronavirus pandemic.

Top 25 counties with the highest per-capita rates of COVID-19 infection

Top 25 counties with the highest per capita rates of COVID-19 infection