The only hospital in Grand Island, Neb., is full. The mayor has asked for a statewide stay-at-home order that the GOP governor insists isn’t needed. More than one-third of those tested for coronavirus in the surrounding county are positive — and there aren’t enough tests to go around.

Grand Island is the fourth-biggest city in a state President Donald Trump and his top health officials repeatedly name check for keeping the virus at bay without the strict lockdowns 42 other states have imposed.


Except that new cases there and in Iowa, South Dakota and other parts of the heartland are starting to spike, raising concern about new hot spots that could quash Trump’s push to reopen the economy and extend the public health crisis well into the summer.

Trump and red state governors for weeks have fairly bragged about how large parts of the farm belt have escaped the ravages of the virus without the enforced shelter-in-place policies common on both coasts. It’s still unclear whether the states actually “flattened the curve,” or if the virus just reached there later. But now, cases are erupting, threatening a local population that doesn’t always have easy access to the same health care as more urban areas. And the outbreaks are striking the heart of the nation’s farming and meatpacking industry, potentially disrupting the national distribution of food as meat processing plants close down and truckers who move food across the country are sidelined by illness.

Grand Island and surrounding Hall County have 214 confirmed cases of coronavirus, nearly a quarter of the state’s total. At least 28 workers at JBS USA beef plant, Grand Island’s largest employer, have tested positive.

“The concern is where we are going, not where we are today,” said Chuck Haase, a member of the Grand Island City Council.


Nebraska’s case count has jumped nearly 30 percent in the last three days, according to the state health department. But even as cases grow in places like Grand Island and Douglas County, home to Omaha, Gov. Pete Ricketts is adamant his plan built around voluntary social distancing is working.

“This is a program that depends on people exercising personal responsibility and their civic duty," Ricketts said Wednesday. "This is about making that decision, not the heavy hand of government taking away your freedoms.”

That’s why he feels the measures he’s put in place — urging residents to stay home, avoid large gatherings and use the six-foot rule as much as possible at work — are doing the trick without the need for a statewide stay-at-home order.

Arkansas Gov. Asa Hutchinson helping Arkansas National Guardsmen unload a truckload of personal protective equipment, said plans for field hospitals in his state will now be shelved “unless something goes totally haywire.”

The seven other holdout states — Arkansas, Iowa, North Dakota, Oklahoma, South Dakota, Utah and Wyoming — similarly say they’re not looking at ordering residents to stay at home.


“We’ve avoided the cataclysmic outcomes we’ve seen in other countries and other locations,” North Dakota Gov. Doug Burgum boasted in a press conference earlier this week, noting that hospitalizations in the state are only in the teens and deaths remain in single digits.

But researchers and health experts caution that no state is immune no matter how robust its health system or sparse its population.

“Perhaps there are governors who believe they have the medical capacity to deal with this [without a lockdown order],” said Charles Branas, the chair of the Epidemiology Department at Columbia University, who developed a model tracking hospital shortages and virus outbreaks around the country. “But I don’t know if that is wise, because once it gets out it can spread unabated and overwhelm any medical system of any size. Every state is at risk and should have aggressive social distancing policies.”

Over the last five days, confirmed cases have increased more than 30 percent in North Dakota, 22 percent in Arkansas, 26 percent in Oklahoma, and 260 percent in South Dakota. That compares to roughly 26 percent over the same period in New York, the epicenter of the pandemic.

Trump has repeatedly suggested that these states could lead the way in his plan to reopen the nation’s economy in “beautiful little pieces.”

“They have fewer people and have lots of room,” he said at the White House on Tuesday night. “There are numerous states that are in great shape right now...They are set to open practically now.”

Reports from the ground, however, paint a different picture.

A pork processing plant in Sioux Falls, South Dakota’s most populous city, was forced to close after about 240 employees contracted the virus. Republican Mayor Paul TenHaken asked Gov. Kristi Noem this week to issue a stay-at-home order in Minnehaha and Lincoln counties, where more than 800 of the state’s 988 positive cases have been confirmed.


Noem refused, prompting the city council to introduce a three-week lockdown ordinance on its own that members lament will take a week just to pass.

“Whatever we were doing wasn’t working, and it’s taking off like crazy now,” Pat Starr, a Sioux Falls City Council member, said of the virus.

He told POLITICO that the state lacks adequate testing, complicating efforts to mobilize to track the virus.

“My concern is that we don’t flatten the curve and so we overwhelm our medical facilities. We are not to that point yet, but we’re approaching it very quickly,” Starr warned. “We’re gonna continue to see some really high numbers, and we’re going to see people that we can’t take care of.”

Iowa on Tuesday reported its single largest daily jump in confirmed cases — roughly half stemming from an outbreak at the Tyson Foods plant in Columbus Junction. Company officials closed the facility, one of the nation’s largest pork processing plants, earlier this month.

Meatpacking plants or the egg hatchery in Grand Island, which serves 10 percent of the U.S. egg market, are considered essential to the national food distribution network — meaning workers would gather regardless of a stay-at-home order. And outbreaks at other big agricultural facilities have occurred even in states with lockdowns.

The governors who have held off also argue that their more tailored executive orders, which limit business and encourage people to stay home, accomplish the same goal as stay-at-home orders with less economic pain — and keep the health system from being overwhelmed the way it was in New York and New Jersey.

By that metric, these governors say they are doing well.


“We’re on a good trajectory under the circumstances,” Arkansas Gov. Asa Hutchinson told POLITICO on Wednesday. “We’re beating the curve and flattening it.”

Just a few weeks ago, the state predicted a peak of 1,000 hospitalizations and made tentative plans to build field hospitals. But with just over 1,500 total cases, fewer than 100 hospitalizations and 33 deaths, Hutchinson said those plans will now be shelved “unless something goes totally haywire.”

Though it's still not clear if the virus is just taking longer to reach the state, the governor credits his more targeted approach of closing schools, banning some out-of-state visitors and shutting down some businesses and public spaces — combined with ramped-up testing and contact tracing in nursing homes and prisons — for suppressing the disease. He claims these steps have made Arkansas a potential model for transitioning the rest of the country out of lockdown.

“We are where other states need to go,” he said. “When we have the capacity to do testing and contact tracing and isolation, that allows us, if we’re disciplined, to lift some restrictions. In that sense, we can prove to be a way out for other places.”

Multiple models tracking hospital capacity currently predict that not one county in Arkansas will see its medical system overwhelmed. One of those models, however, assumes that the state will order residents to stay home and close more nonessential businesses, while the other assumes that residents will voluntarily decrease their interactions with others by at least 30 percent.

Some local officials worry that isn’t happening, and say the lack of a stay-at-home order may make residents complacent.

“I do think it would send a clearer message to Arkansans [to have a stay-at-home order],” said Greg Leding, a Democratic state senator from the Fayetteville area. “I represent a college town and just this weekend a fraternity held what appeared to be a large party where no one was practicing social distancing. That’s really troubling.”

Leaders in North Dakota and Wyoming, which have some of the lowest number of cases and deaths in the nation, cited their aggressive contact tracing efforts as one reason they felt they did not need a broader stay-at-home order.


“We can be targeted in our isolation as opposed to these broad-based, shut-down-the-whole-economy approaches,” North Dakota Gov. Burgum said, describing the state’s work sending teams of contact tracers into areas with an outbreak. “We want these rapid response teams that can do this, so we make sure a mini-hot spot doesn’t blow into a big prairie fire. Testing and contact tracing have to be part of our way of life.”

Burgum is confident the state’s voluntary social distancing guidelines are working, but he predicts it will be hard, with a longer, flatter curve, to persuade residents to keep up the restrictions in the months ahead, especially if the president orders other states to reopen. On Wednesday, he ordered the state’s restrictions extended for 10 days.

“One of the challenges we’re going to face in North Dakota is that we might be going up [in cases] while other states are on their way down and that’s going to be confusing for people,” he said. “They’ll say: ‘Wow, New York had all these deaths and they’re opening up. Why aren’t we opening up?’”

Elected officials in Utah, which has one of the top testing rates in the country, credit partnerships with the private sector and nonprofits for tracking and mitigating the spread of the virus. The state has tested more than 47,000 people and has enough capacity to do random testing to potentially identify residents who may be asymptomatic.

About half of the state’s 2,542 cases are confirmed in Salt Lake County, where a majority of Utah’s Covid 19-related hospitalizations have occurred. And the state believes it has hospital beds and ventilators to spare and that coronavirus cases are stabilizing.

“I think that we will quickly enter this stabilization phase, perhaps faster than other states,” said Tanner Ainge, chairman of the Utah County Commission.

Lt. Gov. Spencer Cox told POLITICO that Utah officials realized from the beginning how critical social distancing was because the state lacked testing capability early on. A significant increase in testing capacity and contact tracing, Cox said, was Utah’s only way out of this crisis.

Cox said he’s hopeful Utah can “slowly” and “cautiously” begin to reopen parts of its economy. But he indicated that there would be a new normal: continued social distancing, an emphasis on washing hands and sometimes asking residents to wear masks until a vaccine is widely available.


“We feel like we’re definitely trending in the right direction,” he said. “But we’re also concerned about if we open everything up, do we get another spike, and what would that look like?”