Even as South Dakota becomes a US coronavirus hotspot, its governor is ignoring the strict social distancing measures adopted by other states in favour of trials of hydroxychloroquine – the drug that Donald Trump has hyped against the advice of medical experts.

One of the least populous states, South Dakota has reported 868 Covid-19 cases and six deaths. They are heavily concentrated around the city of Sioux Falls, where a cluster of cases recently emerged at a pork processing plant that accounts for 4 to 5 per cent of the US’s pork production. With nearly 300 employees testing positive, the plant is now closed.

As the number of cases surges, the mayor of Sioux Falls, Paul TenHaken, said that without a stay-at-home order from the governor, the city will lose valuable time in its fight against the virus. “Quite honestly, it’s crap that we have to wait that long to act.”

Yet despite the mounting numbers and the brewing anger at her perceived lack of action, Republican governor Kristi Noem has resisted pressure to issue a state of emergency or stay-at-home order, proclaiming that she has “faith” in her state’s residents to be cautious in the face of the pandemic. “They’ve been absolute rock stars in working to protect their communities and their families,” she recently said.

While Ms Noem has issued several executive orders to combat the spread of coronavirus, they have stopped short of blanket stay-at-home orders even at the local level, making her one of only a handful of governors to have stopped short of imposing lockdowns.

In trialling hydroxychloroquine, however, her state is a pioneer. Announcing the new initiative, Ms Noem cast the clinical trial in ambitious terms: “We’re very excited to have an announcement that talks about us going on offence against Covid-19 in our state. We are going to be the first state in the nation to run a statewide clinical trial on hydrochloroquine (sic) …

“This will be the first ever state-endorsed, state-backed, statewide clinical trial in the United States that would not only treat patients, but also give us the data we need to be prepared to fight this virus long into the future.”

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While President Trump and many conservative commentators have enthusiastically promoted hydroxychloroquine as a treatment for Covid-19, it remains highly controversial, with many clinicians cautioning that any evidence it can treat the disease is “anecdotal”.