BLOOMING PRAIRIE, Minn. ― Typically in late October, the Friday night lights of McFarlin Field turn on a little after sunset. The Blooming Prairie football team would walk together to the field from the school at game time.

This season, there's a possibility every week that their game gets canceled.

The team's latest game to be called off because of COVID was the homecoming one, slated against Hayfield on Oct. 29. On the day before the parade and game, both events were canceled due to COVID-19 infections.

Alison Mach, associate principal and activities director at Blooming Prairie, said the school learned a player was exposed on Thursday afternoon. They canceled the game by 2 p.m.

"We've done everything we can all year long to try to provide opportunities for our athletes to participate, and you know certainly it's disappointing," Mach said. "But we've always worked to make sure everyone was safe first and foremost."

Minnesota's COVID-19 cases surpassed 150,000 on Nov. 1, according to the Minnesota Department of Health, with an average of about nine deaths per day in October. Data from the department shows that rural areas of the state are showing the most new cases of COVID-19.

As the case numbers have risen, the number of available hospital beds have fallen. That has changed standard operations at rural hospitals, which are used to sending their most serious cases to larger facilities. With those larger hospitals full, rural hospitals have no choice but to request assistance from their communities. And the communities have been heeding those calls, even when it means cancelling a football game.

The nation's hot spot

This fall, North Dakota has separated itself as the worst COVID-19 hot spot in the country. The state, which doesn't have a statewide mask mandate, has the most cases and deaths per capita in the U.S.

Beverly Vilhauer is the CEO of South Central Health in Wishek, N.D. South Central Health owns four health clinics within a 45-mile radius from Wishek, which has a population under 1,000. Vilhauer said the small, critical access hospital is owned by the community, which is a community that she grew up in.

"I was born in the (Wishek) area, went to high school here, got married here — and my husband passed away here," Vilhauer said.

She has worked at the hospital since high school, working her way up over the years. Before the pandemic, the Wishek hospital had never been denied when attempting to transfer a patient to another hospital.

"Now with COVID, those hospitals are full, and their ICU beds are full," Vilhauer said. "I don't think it was our intent in March to keep COVID patients, but we do keep them now."

If COVID-positive patients aren't experiencing breathing problems or don't need ICU care, they can be treated the entire time in Wishek. Vilhauer said that South Central Health can intubate patients but "can't staff it 24/7."

"We intubate on a short-term basis, and get them out of here," Vilhauer said. "We just don't have a respiratory therapy department to maintain that type of service that they need."

Friday with no lights

The pandemic has upended the seasons of student athletes across the Midwest, and it hit the Blooming Prairie football team when it was riding at its highest. The Awesome Blossoms went 13-0 to win their first Class A championship last season. The team had four All-District players coming back this year and eight seniors.

An hour before the scheduled kickoff, the only sounds coming from around McFarlin Field were from the construction of a roof across the street. No cars were parked along Third Street where fans could watch from the insides their vehicles or in the school parking lot. Smoke from a nearby landowner's fire pit lingered towards the empty field and stands, giving off an eerie vibe. Blooming Prairie without its Friday night football looked apocalyptic.

Across from US Bank in the city's downtown is the Blooming Prairie Cue Company, a place for people to watch the livestreams of Awesome Blossom games. The establishment and its restaurant, Pizza Cellar, are owned by Tony and Colette Lea.

Zach Koster, a bartender at Cue Company, said he was dealing with a smaller crowd at 8 p.m. than they planned for during homecoming week. He said a typical game night means it's busy from 6-10 p.m.

"It definitely isn't a regular Friday night in town," said Koster, who's worked at Cue Company for more than 10 years. "It'd be pretty full in here if we had the game on."

The Blooming Prairie Cue Company streamed high school football games in past years for locals unwilling to travel with the team. This year for some fans, the livestreams are the only way they'll get to watch the Blossoms play.

With no homecoming events to patrol, Blooming Prairie Police Chief Greg Skillestad was found chatting with an officer about 15 minutes before kickoff was scheduled. Skillestad said it was disappointing for the city to not have its Friday night football, but he understood the reasons.

"We're more concerned about the health and welfare of the kids than we are playing games," Skillestad said. "Our biggest concern is those who have to deal with COVID."

Not enough beds

The people of Blooming Prairie aren't alone in worrying about the health and welfare of their community. Across rural areas, health care providers have urged behavioral changes to make sure there is sufficient capacity in hospitals and clinics to care for people who need care.

Vilhauer described a worrying last few weeks at the Wishek hospital, as the staff has "really struggled" with patient bed availability. And it's not just COVID patients they are having difficulty fitting in, but people with heart conditions, strokes and other serious afflictions too.

Vilhauer said the hospital transferred one patient to Sioux Falls, S.D., via helicopter ambulance service.

"We have to do what we do," Vilhauer said. "The family has to understand that the beds are full."

The hospitals in Bismarck, more than an hour and a half away, are being asked to take in not just Wishek patients but also patients from Dickinson, Devils Lake, Bowman, Hettinger and other North Dakota communities, said Vilhauer. Those areas also are served by small, critical access hospitals like the one in Wishek.

Nurse practitioners and one physician assistant serve the hospital in Wishek, with no physicians on staff, Vilhauer said. That's only achievable because South Central Health is signed up for eEmergency services through a telemedicine center in South Dakota. The emergency room in Wishek connects directly with the emergency department in Sioux Falls.

"If we need help, expertise or advice, we hit a button and we're hooked up to eEmergency in Sioux Falls," Vilhauer said.

The eEmergency services, which South Central Health pays for monthly, provides an emergency room doctor on-screen with the provider and the patient. The physicians are there so that Vilhauer's staff can focus on being hands-on. If the Wishek hospital needs to transfer a patient out, the telemedicine service will arrange it all, said Vilhauer.

A staff overwhelmed

Even though Vilhauer's staff has risen to the challenge to combat COVID and the hospital has stopped all visitations, she's worried what the future will bring.

"I think my staff is getting tired, they are exhausted," Vilhauer said, adding that the ambulance staff was also reaching the point of burning out.

She said ambulance transfers and emergency room visits have tripled in the last 60 days. They aren't seeing as many people in the clinic, she said, but they're still always busy with having to space visits and keep rooms sanitized.

She said things didn't start to peak with COVID cases in Wishek until a couple months ago.

Vilhauer tiptoes around her words when talking about the nursing home in Wishek, which has managed to keep COVID from getting to residents, because she doesn't want to jinx anything.

"Our local Wishek Living Center has been able to keep COVID away, they are doing a really good job over there," Vilhauer said. "We're doing what we can for our community."

The Wishek Living Center, which consists of three wings of 60 long term care residents, updates the community weekly on its COVID testing. The center has had some employees test positive for COVID since it started testing biweekly in May, but so far has not had a single resident test positive.

But Vilhauer said within a 45-mile radius of Wishek, residents at nursing homes haven't fared as well in keeping COVID out. The Strasburg Care Center has lost five residents to COVID and Napoleon Care Center has lost at least two residents. There has been one death connected to COVID in Wishek, said Vilhauer, of an elderly individual dealing with underlying conditions.

"From my perspective, one is too many," she said.

As COVID infections spike across the Midwest there's also a steady stream of people who are more unwilling to wear masks or abide by social distancing guidelines. Vilhauer recently reached out to local businesses in Wishek to ask for their help in "slowing this down so it's manageable."

What prompted her to reach out was a nurse practitioner walking into her office recently and asking if they "could just ask" local businesses to have their employees wear masks.

"I needed them to understand what we're dealing with on the health care side of this," she said.

Vilhauer said she believes there are a lot of people in the community who have underlying conditions.

"McIntosh County is probably one of the oldest counties in the United States, so it's worrisome," she said. "It's worrisome that the elderly can't fight it off and some of them aren't choosing to become as educated on it — how do we protect them to protect themselves as well."

She said when the pandemic first started, there were many unknowns. Now they're having some success using remdesivir, the first FDA-approved COVID-19 drug, as well as treating COVID patients with dexamethasone, a steroid.

"Those people who come in here and aren't experiencing the breathing difficulty part of it, we keep them, and isolate them and convalesce them through it," she said.

But those patients aren't the ones that make Vilhauer lose sleep at night.

"It's the ones that come in here on respiratory distress and you can't find a bed, or they're in your emergency room until 10 o'clock in the morning, until 6 o'clock at night, until it becomes possible to get them out of here."

"Those are the ones that are high stress," she said.