“It already feels like a lifetime ago,” says Jill Franken. It’s late August and the public health director for Sioux Falls, S.D., takes a moment to reflect on how her city responded to a major coronavirus outbreak last spring. A ready reminder from that time is the director’s ever-present laptop, festooned with colorful stickers. A cluster of red and white irregular hexagons with the words “SO THIS IS PUBLIC HEALTH,” take up the most space, interlocked like so many cells. Each of the 11 stickers represents a week she and her team operated out of a temporary Emergency Operations Center (EOC). “We were in the police department,” she says, pointing out a large shield-shaped sticker in the corner. “So that's why this one's here.”

With a population of 184,000, Sioux Falls is home to nearly a third of the people in the entire state, one of the least densely populated in the country. The city is routinely ranked among the best for health, clean water, good drivers and low debt. Forbes magazine recently declared it to be, “The best small place for business and careers,” and “best small place to retire.”

Originally based on agriculture and quarrying, the local economy has since diversified and become more service-oriented. The list of the city’s largest employers is topped by two health providers and the Sioux Falls school district. The fourth spot is held by Smithfield Foods, employing 3,700 people and well known as the center of a major COVID-19 outbreak this past spring.

Situated on the banks of the Big Sioux River, the complex of brick buildings that make up the Smithfield plant is dominated by an eight-story white façade, punctuated by a few windows and a row of delivery bays. Colorful plastic signs are hung end-to-end, covering most of the spiked black fence out front. “Heros work here,” says one. “No spitting/No escupir,” says another. Other signs describe the company’s COVID-19 paid-leave policy and how to protect yourself from the disease. The Sioux Falls facility supplies almost 130 million servings of processed pork a week, making it one of the nation’s largest.

By mid-April, the Smithfield plant had surpassed the Cook County jail and the U.S.S. Theodore Roosevelt to become the No. 1 coronavirus hot spot in the country. But the area’s first positive tests for COVID-19 didn’t come from the pork plant. Director Franken remembers that an early case came from a school in Hartford, S.D., 15 miles to the west. “However, that community works a lot in Sioux Falls,” she says. “So just because it happened outside of the city limits, it's still our issue. And ours to be taken seriously.”

The Smithfield meat packing plant in Sioux Falls.
 
By the time the Smithfield plant closed in mid-April, it was the No. 1 hot spot in the U.S., accounting for more than half of the state’s COVID-19 cases. (Photo: Kidd)

Suddenly, cases started occurring within Sioux Falls itself. Franken’s team was monitoring the county numbers. “We're starting to see those rates go up,” she says. “That was the very moment that I remember us saying, ‘okay, here we go.’” Soon after, cases from Smithfield began to appear. The local health provider was noticing an increase in positive tests among their Smithfield patients and alerted Franken’s team. “And I remember that moment too,” she says. “We started seeing a lot more cases associated with Smithfield. It took off pretty fast.” 

The Value of Frontline Experience

The EOC was up and running at the nearby Law Enforcement Center on March 13, the same day Gov. Kristi Noem ordered a state of emergency, instructing schools to close for a week and ordering all nonessential state employees to work from home. The statewide number of positive test results at that point was nine.

Franken’s frontline experience with health care and health management proved invaluable when COVID-19 hit Sioux Falls. Before she was tapped to be the city’s director of health in 2010, she was a pediatric intensive care nurse for nine years, followed by an eight-year stint as manager of clinical operations at a local hospital. “That's how I got my entry into this world,” she says.

The EOC brought a number of disparate departments together, communicating and coordinating with the state, the counties, the schools and businesses, making the best use of available resources. “And how do you train up workforce?” asks Franken. “It's not their day job to do that. But when needed, and called upon, they function within the EOC in very critical roles. I don't know what we would have done if we hadn’t had those folks well trained and ready to be able to respond.”

Starting in mid-March, the Emergency Operations Center was open for 100 days. (Photo courtesy of Sioux Falls Dept. of Health.)


Typically, an EOC in Sioux Falls would be dealing with floods and tornados, mostly relying on first responders and public works employees. The COVID-19 outbreak necessitated a staff of health professionals be added to the mix. “This is way different than a physical disaster,” says Franken. “Everybody was willing to just say, ‘okay, this is a little out of my comfort zone. But let's go. Let's do this.’”

Everything didn’t always go as planned. Franken and her colleagues were reacting to events as they happened, often without the luxury of time to prepare as they normally would. It was stressful then, but now she cheerfully recalls the moments before a council meeting where she was slated to speak. “And I still hadn’t seen a final draft of the policy that I had to get up and present.”

Inevitably, the usual tasks of the health department fell by the wayside as the number of COVID-19 cases increased. “We really had to focus on treating people who needed to be tested, who were showing respiratory symptoms, etc.,” Franken says. “We saw fewer patients. We were only seeing real and true emergencies and didn't do any preventive care or other operatory type of scheduled work.” Many of the programs providing help to the underserved and uninsured had to be put on hold.

No Time to Relax

Things have settled down since Franken and her team moved out of the EOC and back into their regular offices and jobs. She confesses now to feeling some stress when things were going full swing. “I think I can hide it pretty well,” she says.

For much of the time, the job kept her busy seven days a week. “We were often times not leaving the EOC until later in the evening and [returning] at 5 in the morning.” Her husband and grown children are all strong supporters of the public health system. “They understand what I do and why I can't be as close to them.” But her two grandchildren are a different story. “I haven't really hugged my new grandson since March,” she says. “I yearn for the day when I feel comfortable doing that.”

Even though new case numbers are relatively low, she knows this is no time to relax. “We're not quite there yet,” she says. “Because of the dynamic nature of this, it isn't over yet. We have to double down in our community.” With flu season approaching and the recent reopening of schools, everyone’s resolve will be tested in the coming months. Without a statewide mask mandate, Franken is pushing the practice as much as she can. “We have to get people to do the core things that they need to do,” she says. “Wearing masks, socially distancing, washing their hands, etc. Everybody now knows what they have to do.”

Besides the stickers documenting Franken’s weeks in the EOC, her laptop is also decorated with a few others, most of them whimsical. Just above the police department sticker, she’s taped the tiny paper strip from a fortune cookie, received at the end of a Chinese lunch during the height of the pandemic. “You will continue to take chances,” it says. “And be glad you did.”

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Jill Franken's laptop. (Photo: Kidd)