Montana Town’s High COVID-19 Death Rate Is A Warning For Rural America

By Nate Hegyi, Mountain West News Bureau

This story was powered by America Amplified, a public radio initiative.

Shelby, Mont. is home to a lot of wheat and barley fields, a decent high school football team, and an Amtrak train that passes through town twice a day. It's a place where almost everyone knows everyone. 

"The people here are fantastic," says William Kiefer, CEO of the only hospital in the county that offers 24/7 emergency medical services. "There's a huge sense of community."

So when people began getting sick and even dying from COVID-19, it hit hard. 

"I think everyone's reaction is one of despair," Kiefer says. "We feel terrible."

The virus ripped through the hospital's assisted living facility in late March and infected more than a dozen staff and residents. As of April 15, it's killed three people across Toole County. The area now has one of the highest per capita death rates from COVID-19 in the entire West, which means this quiet, high plains town has lessons to offer the rest of the rural West.

"Left to its own devices, [the virus] will spread like wildfire," says Christine Porter, public health professor at the University of Wyoming.

She says, at least so far, most of the region's rural communities have been insulated from the pandemic. They aren't as crowded as cities so the rate of transmission is lower, especially in places like Shelby that don't attract many tourists.

But a single traveler stopping for gas or a railroad worker coming home from an out-of-town trip can bring coronavirus into a rural community like Shelby and potentially wreak havoc. Residents are often older and most rural towns have limited medical capacities. The Marias Medical Center in Shelby, for example, only has 21 hospital beds and two ventilators.

Despite the threat, some rural Westerners aren't taking coronavirus seriously because they haven't seen many cases in their county. Porter says this is a frustrating – yet common – public health dilemma. She explains it using a parable called "babies in the river."

"Let's say you're standing by the river having a nice picnic," she says. "Then you see a baby floating by and drowning. What do you do?"

Naturally, you jump into the river and save it. But then you see another baby floating down the river. Then another. And another. 

"Then there's a thousand babies in the river that are all drowning," she says. "What do you do? You can't save all the babies."

This is how some rural communities in the Mountain West are treating the threat of COVID-19. When there are no babies drowning in their own river, they don't see a need to change their behavior so drastically. 

"Until we see the suffering, we don't believe it and we don't think it's worth the cost of these public health measures," she says. "Once you start seeing the effects in your community, it's not too late to save some lives, but it is too late to prevent the slam."

Still, a handful of conservative states have resisted enacting stay-at-home orders, including Wyoming and Utah. And in Idaho, a couple of elected officials have called Gov. Brad Little's directive unconstitutional. 

In Montana, a small group of protesters are planning to march at the state capitol in Helena. Larry Bonderud, the former mayor of Shelby, supports that march and believes the stay-at-home directive doesn't work to stop the spread of COVID-19. 

"A lot of people wonder whether the shutdown was even necessary," he says. "Main Street businesses are closed. Everyone's adapting to it but nobody likes it." 

But other community members are in support of the stay-at-home order. Every night at 8 p.m. residents lean out of their doors and send out a howl for medical providers and emergency workers. 

Porter says that staying at home is one of the only ways to protect your neighbors from the virus. In Montana, state epidemiologists recently released a report showing early signs that social distancing and the governor's stay-at-home-directive is helping flatten the curve. 

Back in Shelby, Marias Medical Center CEO William Kiefer says these practices are helping his town take control over the outbreak. 

"We believe that everyone staying in their homes and following the guidance of the CDC is incredibly important," he says. "To this point it's been very successful in Toole County."

There's also something else that Marias Medical Center did that other U.S. hospitals should all take note of for future pandemics. It planned ahead before the virus even reached our shores.

"We have a group of dedicated people here that thought, 'Wow, if it does hit the United States, we're a very rural frontier facility and we should do everything in our power now,'" Kiefer says. 

Back in January, Marias began purchasing and storing personal protective equipment. The excess masks, face shields and gowns reduced the chances of exposure for their staff after the outbreak in the hospital's assisted living facility took hold. However, Kiefer says he wishes they were wearing them regularly before the virus arrived in Shelby because once the first patient tested positive, many of the medical center's employees were unwittingly exposed to the virus.

"We actually had a huge exposure. Folks had to leave, go home and quarantine for 14 days. So they were out of work," Kiefer says. 

That can leave a rural hospital short-staffed in a crisis. So, it's a lesson he wants to pass onto other communities, big and small and in between. All are vulnerable. Shelby has that Amtrak train that passes through town twice a day between Seattle and Chicago. Trucks that roll along the main highway. Families getting back from vacation. 

"Although we're small, we're not isolated," Kiefer says. "People do move around quite a bit."

And in this pandemic, it's that movement that can kill. 

This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.