(drums tapping) (crowd clamors) - [Narrator] The week before Saint Patrick's Day 2020, O'Neill, Nebraska, gathered downtown to, once again, paint the town green.

Some hadn't heard the news.

- [Radio Announcer] The World Health Organization has declared the coronavirus outbreak a pandemic.

Cases have been rising dramatically in Europe.

- [Narrator] It seemed so far away from Nebraska, but that day a COVID case showed up one county over.

Around the state some schools shut down.

(spectators cheer and clap) The state basketball championships played without fans.

- Panic never does anybody any good.

- [Narrator] People left work, unaware it would be months before reclaiming their cubicles.

Churches canceled services.

By Saint Patrick's Day, Nebraska state health officials mandated only nine customers and a bartender could be inside any bar.

- [News Anchor] "Stay at home"; That is the order tonight from four state governors.

- [Narrator] Everyone began to understand that whatever happened next, it was gonna hurt.

- For the all the business, everybody losing money, yeah.

(conversation murmurs) ♪ It's the end of the world as we know it ♪ ♪ It's the end of the world as we know it ♪ - [Narrator] Nebraska's public health districts had been planning for this all along.

- How do you plan for a pandemic?

- [Narrator] Even if what followed didn't follow the training script.

- They know they can turn to us.

That was a lot on our shoulders, but we were ready for it.

- [Narrator] Over the next twelve months, public health workers would track the virus, try to limit how it spread and coordinate testing of Nebraskans from every walk of life.

- We're asking for some time to let the curve flatten a little bit.

- [Narrator] Public Health Districts were more visible than they'd ever been before.

These are the chronicles of just some of their stories.

♪ Time I had some time alone ♪ is launching a major effort tonight to get Americans in quarantined areas of China out.

The deadly coronavirus is spreading quickly there, with tens of millions- - [Narrator] As the earliest reports of a new respiratory virus emerged from Wuhan, China, some understood from the start there would be a Nebraska connection.

(engines whining) (helicopter blades chopping) Americans evacuated from China would be monitored by contagious disease experts with the University of Nebraska Medical Center.

They were quarantined for 14 days at a National Guard camp in Ashland, a facility on the edge of Three Rivers Public Health District.

- It was true emergency preparedness.

This is our plan.

This is what it looks like.

This is what we're gonna do.

- [Narrator] Local public health departments didn't get much attention before 2020, but they'd been around for 90 years.

16 districts in Nebraska work to prevent injury and illness and prepare for when there could be a threat.

- A lot of the things that we did prepared us but you're not really fully prepared until you get into the actual response itself.

- [Narrator] A second group of Americans removed from a cruise ship in Japan arrived in Omaha.

Those who contracted the virus needed treatment at the Med Center's unique bio containment and quarantine facilities.

- The ones that had the inside cabins had not been outside for a long time so they were very glad to be out in the open air.

- Lots of people were traveling and that's probably one of the reasons that things spread so quickly in the United States.

- [Narrator] In Central Nebraska, the South Heartland Public Health District planned on the return of Hastings College students studying abroad.

- We had about 100 students in Europe, when there was kind of the first outbreak.

So, we had a team working very early to get those students back safely.

- [Narrator] As a precaution, students and faculty agreed to quarantine in their dorms and homes and be alert for early symptoms.

- It keeps people who may have been exposed away from others during the period that they might develop the disease.

- [Narrator] Within a matter of days, the College sent students home to complete their courses.

- I couldn't believe it.

I didn't realize it was gonna be this big.

- [Narrator] It was another Nebraska traveler returning from Europe, who unknowingly brought the virus to Fremont.

- I don't think anybody in Nebraska was even thinking anything about the COVID-19, the virus kinda happening.

(spectators shouting) - [Narrator] It was certainly nothing anyone thought would interfere with the Special Olympics basketball playoffs at the Fremont YMCA.

- [Jerry] It's a great social activity.

It's great for volunteers, it's great for the kids.

- [Narrator] That weekend in February, the Y hosted hundreds at the Special Olympics, a tennis event and a hockey tournament.

A week later, the State Health Department alerted Three Rivers Public Health a participant had COVID.

- I was in Nashville, Tennessee, and I got a call.

It was about 6:45 on a Friday night, "Terra, we've got our first case of COVID."

- [Narrator] Terra Uhing alerted the YMCA in Fremont.

- [Jerry] Kind of a panic mode kind of looking at what's happening.

I'm thinking 5,000 people coming just from the Fremont YMCA.

- It was the first one in the whole state and there was a huge exposure involved.

So it was just like, what does this mean for all of these hundreds of people that potentially were exposed?

- So, at first you're thinking, "We know this call was gonna happen and here it is."

- [Narrator] A week before COVID came to Fremont, community leaders had scheduled a meeting to do some planning, just in case.

- As you guys can imagine, our weekend has been just a little bit crazy.

- "Just in case" turned into "just in time."

- It is fluid, it is moving and things that I tell you right now can be different in about 15 minutes.

- [Narrator] Local government, first responders, the school districts, all had the same questions for the public health experts.

"What can be done to contain the virus?"

"When will the worst of it hit us?"

- If we start to see community spread and we seem to seeing some of that now, we would expect a wave of viral infection to last about 2 to 3 months as it travels throughout the communities.

(phone rings) - [Lyndsey] Hi, this is Lyndsey with Three Rivers Public Health.

- There is no perceived risk (women speak over top of each other) - That Monday morning, I remember I was on the phone every five minutes with people calling and concerned and wanting to be tested or wondering about exposure.

- I can just assure you that we are taking all the necessary action that we can.

We are trying to inform the public to the best of our ability.

- You know, they wanted answers so it was a lot of that reassuring "I understand this is hard.

"I wish I could do something else to help you, but..." - As you guys can know, we have had a lot of activity over the weekend.

- [Narrator] The first chance Terra Uhing had to brief her staff came the Monday afternoon after the call from state health officials.

- Because right now, we are in a weird predicament and something that is really unsettling to a lot of people so just trying to get that consistent messaging out and tell them it's okay.

What do we do as public health professionals to really calm everybody down and to give them the most accurate and up-to-date information?

- What about if we did a quick video, like maybe interviewing each other or something, because one thing we learned about social media is videos are a lot quicker.

- I've had a number of voicemails that they sounded fairly angry in their voicemail and then you call them and talk to them and they just need to talk to somebody, 'cause they were worried.

- I want to reassure to you guys we are not panicking.

Tell people to quit hoarding toilet paper.

(staff chuckle) - One final reminder is: People, you only need one roll!

- [Narrator] Within days of finding out about the exposures at the YMCA, Three Rivers Health got slammed with a new crisis.

- One of the biggest concentrations of positive COVID-19 cases in the Omaha area has been at an assisted-living facility in Blair.

- [Narrator] Terra Uhing gathered reporters to announce both residents and staff had tested positive at an assisted living community called Carter Place.

- This is the very first nursing facility outbreak within the State of Nebraska, so we had a lot of work to do.

We had several people that ended up that were positive, that were actually at the hospital.

And then, we had several staff members that were symptomatic and who, they said, were told they had to work.

- In that case, a lot of it was trying to figure out how did it get into the facility?

You know, what touched off the outbreak?

'Cause it was one of the first times that something like that had happened.

- [News Anchor] Residents didn't begin self-isolating until March 23rd, the same day as the first positive test of a resident.

- We could almost guarantee when we looked at the clusters because they were all sitting together, they were all eating together, they were all playing cards together.

We could almost tell you who was going to be potentially positive.

- Unfortunately there wasn't really a playbook they could follow.

We kind of had to figure it out as we were going along, of what's the best in this scenario, what can we do.

- Well, you know, in public health, these, unfortunately, are the types of things that we train for and exercise for all the time.

This is why local public health is in place.

- It really identified that long-term care facilities were gonna be a huge source of concern.

- [Narrator] The Carter Place was still making headlines when Three Rivers Public Health learned of another first in the district.

The Saunders County Jail became the first corrections facility in Nebraska to recognize an outbreak.

- I get a call one evening from one of our staff members that said, "Hey, I got some test results back "that I'm positive for this."

- So I went in, looked at the facility so I can just better understand, you know, if we did have inmates that were going to be positive, where we were going to put them, if we had staff that was gonna be positive, what were we gonna do?

- We're going into unchartered waters, really, trying to determine on how to most effectively deal with it.

- A jail setting is unique, just given the dynamics between those that work there and those that are jailed there.

- The first directives we received were that any staff that had contact with our individuals that had tested positive would need to quarantine at home for the next 10 to 14 days.

Well, when you're running a 24 hour facility, everybody's in contact with everybody else.

So that would have essentially wiped out our entire staffing.

- [Narrator] The Saunders Medical Center provided testing for the correctional staff.

- He goes, "And they're not confirmed."

- [Narrator] Three Rivers Heath got the confidential report of who tested positive.

The contact investigation that follows become one of the most important tools to slow the spread of a contagious disease.

- So that's where you reach out to that person, you find out where they had been 48 hours prior to their symptom onset date.

So then you call, you identify, and you give guidance to all of the contacts of the confirmed case, along with the actual case itself.

So that's contact tracing.

- Alison Woita called the officer who had started showing coronavirus symptoms.

- Hey, we don't have your test results back yet, but I wanted to start doing a contact tracing with you just because of your symptoms.

Gathering information, not only so that we can track people down who may be infected, but also to get more information about the disease, to learn more about it.

And now were just gonna go through a list of everything that you've done in the last couple of days.

And there's just gathering a lot of information, what they've done for the last two weeks, what they've done before they went into isolation., what their symptoms are.

And you had contact with a staff member at Saunders County Correctional who had symptoms, correct?

- [Narrator] With each phone call, the staff at Three Rivers could see a single person, unaware that they were contagious, could result in a dozen other COVID cases.

- I'm already getting messages about the inmates that were released and having, and I was like "Don't let them in your house!"

- [Alison] Were the inmates told to quarantine, though?

- I don't know.

- We don't know.

- It's no different than traveling, I mean, they need to go hunker down in a room for 14 days.

(indistinct) - [Narrator] The jail staff test results came in later that afternoon.

(dial tone purrs) - [Sheriff On Phone] This is Kevin.

- Hey Sheriff, it's Terra, how are you?

- [Sheriff] Yes, very good.

- Good, well, I've got some results, I don't have them all.

The preliminary reports is one of them is positive, but I have to wait till I get than confirmation and see- - We could at least maintain staffing for the time being anyway, because it was the majority of our staff were still not, weren't symptomatic.

We only had four staff that were symptomatic and had tested positive at that time.

- Even though they're negative, they still gotta wear a mask.

Because that virus could be incubating.

So if we needed surgical masks, how many are you thinking there?

76, okay, all right, let me see what I can do for you.

Okay, bye-bye.

Hey, Ally.

- Yeah.

- By Monday, the correction facility, they'll need about 76 surgical masks.

- [Narrator] The state's local public health districts became the crucial channel for routine supplies that became suddenly scarce.

- Let's see if there are any requests that were submitted where they are low or don't have anything.

- My job as the logistics section chief is to field all the personal protective equipment requests from our health care facilities, EMS, law enforcement, all of that.

- [Narrator] Just then, a car stuffed with fresh provisions pulled up to Three Rivers.

- Courtney!

- Yeah?

- [Ally] Where do you want this stuff?

- Oh, is she here?

- Yeah.

- Okay, I'm coming.

- [Narrator] This delivery came from a federal government stockpile of government supplies acquired after the 2009 swine flu outbreak.

Everything was 10 years old, but still in good shape.

- Masks are in pretty high demand.

We haven't had a lot of demand for gloves yet, but we'll get there, so it's good that we're getting them.

- [Narrator] State health officials provided rankings of those with the most urgent need for protective gear.

The choices rankled some professions like veterinarians and chiropractors.

(box scraping) - If they are providing lifesaving services, then absolutely, we want to make sure they are being taken care of but if it's elective, it says in the directed health measure, it says no non-essential procedures.

- We had some challenges, but, at the end of the day, I never felt like my staff or anybody in our jurisdiction was unsafe because they didn't have the appropriate PPE.

- [Narrator] Nebraska hospitals needed to protect their medical teams from a virus still not fully understood.

Everyone recognized scarce gloves and gowns were the key to staying safe.

- So, I think that was the big shocker, was all the stockpiles and the availability of the stuff we needed.

And once they said, "Hey, we have it," then all of a sudden, "Oh, California or New York had a big surge.

"Uh, we're gonna just cancel your order."

- [Narrator] Preventing infection demanded medical teams in contact with patients dispose of gowns and gloves after each visit.

Other hospital staff could reuse gowns.

- [Supply Chief] We keep everything locked up just to make sure.

- [Narrator] It was a time when the supply guy at Mary Lanning Healthcare got creative.

- [Supply Chief] A supplier of sporting goods stuff- - [Narrator] The hospital connected with an idled upholstery company in Minnesota with loads of unused vinyl.

- [Supply Chief] I said, "Whatever color you got, I don't care," and they sent us camouflage.

- [Narrator] South Heartland Public Health became the go-to for first responders and nursing homes looking for protective necessities.

- It's kind of hard you know.

People think that "Oh, we're going to get everything we order," but unfortunately not.

- It was a relief when the state just said, "We're gonna start purchasing these, "bulk purchasing for the state "and getting this shipped out and distributed "through the local health departments."

- [Narrator] Early on there was a feeling among many public health workers, there was still a chance to contain and control the virus before a vaccine arrived.

- I think early on, we really felt like we could.

- [Interviewer] Why is that?

- I really felt like the actions of everybody in our community were making such a huge difference that we were really slowing the spread.

- Kind of a rough day yesterday.

We went from 15 in Adams County all the way up to 25.

So, we've got some work to do.

- [Narrator] The daily tally haunted hospitals as new cases, the critically ill cases, began to fill beds in Nebraska.

- I remember arriving in a car and being put in a wheelchair and taken to a room, that was it, that's it.

That's the last memory I have.

- [Narrator] Felipe Chavez-Ramirez, a college professor from Colorado, felt the first COVID-19 symptoms while visiting family near Hastings.

- I begin to just hurt all over.

I get like chills and cold.

But it kept getting worse and I just couldn't really stand up.

So I called the doctor and then they said, yeah, that I should go to the emergency room.

(hydraulics whirring) - [Narrator] His lungs failing, doctors at Mary Lanning Hospital placed Felipe on a ventilator as he slipped out of consciousness.

Not everyone infected goes to the hospital.

For local public health districts, prompt, accurate testing for a virus is the best way to figure out who is infected and where it might spread next.

- Without testing, we don't really know the extent of spread, the extent of the illness in our communities, so widespread testing is a huge goal.

- [Narrator] The Centers for Disease Control limited testing to those showing symptoms and at the highest risk.

Nebraska followed that standard.

- While we have expanded testing, we have not necessarily expanded the criteria for who is going to be tested.

That will be something we phase in.

- [Narrator] The virus itself complicated efforts to track its progress with an unexpected quirk.

Doctor's suspected not everyone infected showed symptoms; even a fever.

Limited testing to those with symptoms blinded local health agencies in the early stages of the crisis.

- That was a challenge because we were only allowed to test the most ill people.

They had to have some specific symptoms in order to qualify for a test.

- So we can't help people isolate.

We don't know about quarantines if we don't know if this is the disease or not.

- It's from 10:00 to 2:30.

Do you think you could do something like that?

- [Narrator] 30 or more requests for testing arrived at South Heartland every day.

Only two or three people met the strict criteria.

- The public health lab was the only lab in the state of Nebraska that had testing.

It could only be through local public health approving it.

- Okay, big breath for me.

Good.

- [Narrator] The lag made it difficult for Mary Lanning Hospital to determine which patients required isolation.

- We'd have to admit what we call PUIs, persons under investigation, until we got their test results back, which took up beds that oftentimes we wouldn't have had to, people were hospitalized when they maybe wouldn't have had to been.

- [Narrator] Cases mounted and the CDC began loosening the rules on who could, who should be tested.

Individual hospitals and private testing labs meant hundreds more tests could be done every day.

- We've learned to adapt on the fly.

Sometimes the guidelines change overnight so we are constantly updating testing protocols.

We anticipate another busy day.

We are tending to collect 20 to 30 samples a day now, now so we're gonna burn through those swabs pretty quickly.

- No, you can just tip your neck back.

- [Narrator] Compared to other states, Nebraska had a low number of COVID cases.

Medical supply providers had higher priorities than rural hospitals just starting testing programs.

- Do you have any updates on our swabs?

Any of those three vendors we've ordered from?

- [Man On Speaker] Nothing's shipped yet.

- Okay, can you keep that on your radar?

- That's on our list as well.

- Terri, this is Michele.

There were more swabs and not viral media.

- We have plenty of media, we need the swabs.

- So, I remember feeling like if we could just get more testing here and how can we get on the list?

- [Narrator] Enter the National Guard, deployed to areas where public health districts didn't have staff to conduct large scale testing clinics.

- Having the National Guard mobilized for this purpose was really important for rural Nebraska.

It was so slick.

Those, those folks were so well-trained and had such a great system.

Okay, we've got a couple of long term care facilities that we're working with.

- [Narrator] South Heartland concentrated on area businesses where at least one worker had taken ill. - Now are you guys wearing masks every single shift?

- Wanting to give them the opportunity to have their employees tested or let their employees decide if they wanted to be tested because of the potential risk.

- [Narrator] The Guard would be in town only two days.

There were supplies for 300 tests.

- As you have been in contact with a positive case.

- We actually do have a testing opportunity.

- Today; yes!

Nothing like wait until the last minute!

- We had a quick turnaround time and we had limited resources.

We didn't want to waste them.

- And now we have 150 places to fill.

And so, these are the larger businesses that we've called.

- [Interviewer] And this is pretty important to fill those slots.

- [Janis] Yeah, so we get a bigger picture of what's going on in the community.

We still have 50 openings.

- [Michelle] So we have 13, is that right?

- I'm following up on these two here, and then I will call them next.

- Okay, let me know.

- [Alex] So, minus 79... - Do you think we'll have any no-shows?

Who could we offer this to that would maybe make the most difference to and could be the best use of those resources?

- Between 10:00 and 2:30 timeframe you can go out there and get- - I think the urgency was because if you know, or suspect that you have one or two cases in those businesses or work sites, you really want to get people tested to find out is there more?

Let's get them isolated, let's get the contacts quarantined.

- Seven for sure.

- [Jessica] Oh good!

- Up to 12.

- [Jessica] Up to 12, I'm gonna put that on the list.

That's great news!

(clapping) Good job, Brooke!

- [Narrator] By the end of the day, every available slot had been filled.

(tape ripping) By summer, the Guard performed over 80,000 tests in 53 counties.

- I just remember thinking, "We want more testing," and now I feel like we have lots of testing options and we still need to do more testing.

- [Narrator] Two miles from the National Guard COVID testing, Felipe Chavez-Ramirez had come back from the dead.

- I think everybody was pretty worried there.

According to the doctor, 90% possibility that I wouldn't be here at this point in time.

- [Narrator] He spent 16 days unconscious on a ventilator.

- It's been a little rough, because I couldn't move, I couldn't swallow; I couldn't talk.

(staff clapping) - [Nurse] Wow!

- [Narrator] Felipe was not aware he would become a model for COVID cases arriving at Mary Lanning Hospital.

(staff whooping and clapping) - Having seen him recover and do so well and be able to get to go home was such a huge joy and celebration for the staff, because we knew we could fight this.

We could win.

The number of cases in the South Heartland Public Health District increased steadily, but it seemed under control.

- We felt really, really strongly that our actions were gonna make a difference.

And I think, to some degree, they did.

It's just that you're exactly right, it's like trying to put your thumb to cover a hole in the dike.

- [Interviewer] It was gonna happen eventually.

- [Dorann] It was gonna happen eventually.

(monitor beeping) - [Narrator] It was already happening.

In mid-April, Hall County, with one-tenth of the population of Omaha, reported the highest number of COVID cases in Nebraska.

It was one of the hardest hit counties in America.

(radio bleeps) - [Dispatch] District 34, Injury accident.

Scene requesting Ambulance Code 1 - When I started this job 15 years ago, I never thought in my life that I'd have to basically go on a hazmat call, every call.

We're responding in hazmat suits and filters and de-conning.

It's just a mini hazmat call, every EMS call.

- [Narrator] The Grand Island Fire Department assumed the virus was everywhere.

- We kind of had an idea that it was coming, we didn't think it would get here as fast as what it did.

- Are they all COVID?

- The gal we picked up this morning was positive.

- [Justin] You watch the Central Health District just skyrocket, and Hall County especially.

- [Firefighter] We got gowns again?

- [Firefighter] 150.

- You realize that, yeah, this is here, it's real.

It's not going away yet.

I'm nervous.

Today is a typical, whatever day it is.

Thursday, right?

- We're having morning briefings and everything and I don't think really anyone knows when this thing is going to come to an end.

- [Leader On Phone] We had an increase in calls in April, 89 more calls over than last year, a 21% increase.

So quite a few of those were due to COVID.

- Our average call volume's 20 to 23 calls, 25 calls a day, roughly.

So, basically a third of the calls are COVID calls.

- [Leader On Phone] We're still in the thick of things here, so don't let your guard down.

(alarm ululates) (door scraping) (dispatcher announcement garbles) - And I can think of one particularly, the guy came out and he was having trouble breathing.

And then it just went to he collapsed right there on the ground.

And then he ended up, from what I understand, being COVID positive.

(siren wails) - I think everybody's a little bit more on edge.

(hydraulics whirring) making sure they aren't touching the patient or touching something of the patient's and then going and rubbing their face, and making sure that they wipe everything down when we're done.

(spray gun buzzes and hisses) I think it's just that added stress of making sure you're not bringing it home with you.

- [Narrator] Time and again, dispatch sent rescue squads to the homes of families working at the JBS beef processing plant.

(sirens wail) By mid-April, infections tied to meat packing workers in Grand Island accounted for about 40% of the cases in the Central Health District.

(horns beeping) - [Emmanuel] We're here to fight for our parent's lives.

- [Narrator] During 2020, it was estimated 54,000 meatpacking workers contracted COVID in the United States.

270 died.

(speaks in Spanish) - [Narrator] Nebraska state health officials recommended people stay home when possible to reduce COVID exposure.

Since many in the food and farm industries were considered essential, most had little choice other than to keep working.

(horns beeping) - [Odeth] These people are not the first thing that you think about.

They are kind of left to the last minute.

- Please help us!

Please help us!

- I felt like they still kept saying that they were forgotten, that people didn't really care about them.

- [Narrator] Food processors fell in a unique category; an essential industry that kept America fed.

The Trump Administration and Governor Ricketts opposed a temporary shut-down or government mandated steps to limit the spread of the virus.

- "And if we have a major disruption in that food supply... (translates in Spanish) - And people are not able to get access to food (translates in Spanish) - We will have broad civil unrest in the country.

(translates in Spanish) - We could keep putting that food into the food chain and put it into the stores, we felt like that was really going to help keep our economy stable and keep the panic at bay.

- [Narrator] At Lincoln Premium Poultry, 1,200 people prepare chicken sold in Costco stores across the west.

They ship two million birds a week.

- Sat down with our leadership team and said, "This is a real thing.

"This is possibly gonna be here."

- [Narrator] The company felt it had an advantage safeguarding workers compared to older meat packing plants.

Even in the modern plant, workers along the production line stood shoulder to shoulder.

- I kind of was like, "Oh man."

'Cause of the way, I've toured them before, so I know how close they work together and everything, I had this picture in my mind of like, "Okay, if we're supposed to distance and all this, "how is that gonna be possible?"

- If we can't spread them out, what does that look like to protect them?

In some cases, it became a plastic barrier between them and another person.

but then we also added face shields in some locations.

It really just depended on the part of the operation and how we could best protect our folks.

- We collaborated with the meat packing plants.

They were listening.

We know it was a good teamwork with them.

They tried to do it as fast as they could.

- So far we found very engaged leaders.

- [Narrator] South Heartland convened a Zoom meeting connecting members of the Hispanic community with a team of infectious disease specialists from the University of Nebraska Medical Center.

- We realize we very much getting a plant management perspective of what's going on.

- [Narrator] The UNMC group toured meat packing plants seeking practical ways to keep production lines running while minimizing the risk to employees.

- [Woman On Zoom] A lot of the Hispanic people that are working at the meat packing places are afraid to lose their job.

- [Narrator] The state and local health departments distributed COVID prevention information in both Spanish and English.

New outreach materials followed, when it was noted not all Hispanic residents spoke the same Spanish dialects.

(speaks in K'iche') - We have a large community of K'iche' speakers, Hmong speakers, and Q'anjob'al speakers, which is a dialect that's mostly spoken in Guatemala.

(engine purrs) - [Narrator] Testing in diverse communities tied to the packing plants became an urgent task requiring diplomacy.

Concerns about one's immigration status sometimes complicated the process.

- It wasn't just the information then, it was that comfort level of somebody that's trusted, that is from your community.

Thanks so much for coming down here, appreciate it.

- It's for our community, we have to do this.

- At first, yes, it was an intimidation for them, but by word of mouth, as they saw more and more people that they knew go and get tested and hearing from them that nothing happened to them, that they just went and got swabbed and then they just left.

They were like, "Oh, okay, so that's all it's going to take.

"Okay then, I can go and do that."

[Leader On Phone] Welcome to week six of the COVID Pandemic.

- [Narrator] By early May, the first surge for the Grand Island Fire Department dissipated.

- [Leader on Phone] We pretty much have hit our stride, we're handling the calls.

- By years end, crews cared for over 900 COVID cases.

- Ambulance I's en route Saint Francis.

(handset clatters) - [Narrator] The two ambulances in town carried over 400 of those to local hospitals.

A third of the department caught the virus themselves.

- I see it in my crew, daily.

And they come to work in there, you can see it in their eyes, you can see it in their faces.

I come to work, shift starts at 7:00, I try to be here about 6:15.

And I used to hop out of the truck and come in the station, sit at the kitchen table, get a cup of coffee and start joking with the off-going crew and get ready for the day.

I pull in the parking lot now and I sit in my pickup and each day, I've noticed in the last two weeks, it's taking me longer to get out of my pickup.

Just the, "Okay, anxious of getting out of the truck.

"Okay, let's start this day."

This is a great job, I love my job, but it's not fun right now.

(laughs) - We had seven new cases yesterday, three of those were in Clay County.

- [Narrator] As the frightening spike of the hot-spot county subsided, the number of reported cases statewide remained steady, fed by a stream of infections in rural Nebraska.

- [Dorann] Jessica, I'm feeling a little overwhelmed today.

- [Jessica] Do we have a lot of cases already?

- [Dorann] I don't even know.

- Some of the smaller communities that are less populated just didn't think it was gonna happen to them.

- But I feel like, we got a report of something going on at a nursing home.

They were of the mindset of, "Well, we thought all the cases were in Hastings.

"We didn't wear masks.

"We went to the bar, we did this, we did that, "because we don't know anybody here that's had it."

- [Narrator] The South Heartland District watched as numbers steadily climbed in Webster, Nuckolls, and Clay Counties.

Rural counties lost their immunity to COVID-19.

- So I first of all wanted to just start off and ask you, have you been notified by someone that you were a close contact, or your daughter was a close contact?

- [Narrator] The contact investigations found clear patterns.

Too many people in small towns weren't staying at home.

- We had every kind of normal gathering that people would have in the summer.

Weddings, funerals, birthdays, holidays.

- And potentially, she could be contagious to you up to 48 hours before she starts having symptoms.

So then you would be exposed to somebody with COVID, right?

We worked with several situations where there were events where there was one, then there was two, and then there was four.

There was maybe just a little bit of denial and thinking that it was on somebody else's doorstep.

- [Narrator] In the past, when a public health department came out with advice on tuberculosis or a food poisoning outbreak, they were the experts, the good guys.

For a certain segment of the population, driven by politics, social media, and distrust of science, the script had flipped.

- There were people that would tell us that COVID is not real, that COVID is, it's just a little cold.

- You could just tell that they weren't gonna be compliant.

That was kind of challenging.

- [Woman On Zoom] They are refusing to self-isolate, I guess I'm asking other county attorneys and other people what is the process to try to get them to adhere to some of the directive health measures?

- [Narrator] During Michele Bever's conference calls with area elected officials, there were regular reports of people unwilling to follow some of the most basic safe choices.

- We can not only request that they self-isolate, but because of the directed health measures we can actually issue an isolation or quarantine order.

We try to educate and provide information first.

- We've got several churches that are actually thinking everything is okay now and there are some churches that are going "We need some more guidance on this."

- All you can do, really, is to give people the information and ask them to do what is recommended that they do.

- [Narrator] It was often pointed out, the goal was to flatten the curve.

- We were watching other states and seeing what overwhelmed health healthcare systems looked like.

- Knock knock!

- [Narrator] The number and pace of the public infections should never outstrip the capacity of local hospitals.

- It was in the understanding that we want to reduce the spread so that we don't have so many sick people, so that there's a place to care for those that do get sick, so that we don't get to the point where we have more deaths.

- [Narrator] Mary Lanning Hospital felt the pressure.

While never overwhelmed, the numbers of critically-ill COVID patients placed constant strain on the staff.

- That's the most challenging part, is I can find a bed, I find lots of beds, but do I have the nurses that are gonna be skilled, but also comfortable with taking care of some of these patients.

- I mean, our ICU was pretty much full the entire time.

And number two is the mortality.

I mean, greater than 65, 70 years of age on a breathing machine with COVID, you're probably gonna die.

- [Narrator] Early in the pandemic, the hospital anticipated it would need more isolation rooms, providing a safe buffer for protected medical teams.

Fiberglass hutches were built outside rooms where staff could safely don fresh gloves and gowns.

- There was a lot of people, very, very sick, that didn't have any access to loved ones in the room with them.

Holding hands, talking.

- So that first surge was a little bit of the unknown, of "Are we doing the right thing?

"Are we doing what the patient needs?

"Is this gonna be, is this gonna work "or is this not gonna work?

(tense monotone music) Whereas the second surge was so scary because there were so many more people and they were so much sicker.

There were more vents, there was more death.

There was so much more death, the second surge that we had and part of that was the elderly population.

They were 80s and 90s.

(tense monotone music) When these patients died, you had been working for two weeks to a month to try everything you could to keep them alive.

And so staff really felt connected to these patients and their families.

And when they, either the patients or the family, decided "This is long enough, "we're not coming back from this, "this is not the life they wanted to live', and we withdrew care, we stopped doing all the extra things, everyone felt like it was a little bit of a failure.

Like "I worked my hardest to keep you alive "and unfortunately, I didn't win, I lost."

- It's just everybody's exhausted and you can see exhaustion, slumped shoulders, baggy eyes and even the comments of like, "Okay, this is another day of COVID."

It's just a long haul.

- This is what's needed of us, this is what we have to do and we're gonna do it and we're gonna do it the best way we can.

- There's still that feeling of, - [Rhonda] "Okay, is this really gonna get better "or are we in for another round?"

- [PA Announcer] Ladies and Gentlemen, here come the Tigers!

(crowd cheering) - [Narrator] The Governor had said from the start: "If you want to see football this fall, "you better be staying home."

It took some doing, but high school football came back on schedule.

- [PA Announcer] The current guidelines from Three Rivers Health Department state that people not in family units should be six feet apart without a mask or three-to-three feet apart with masks on.

(crowd cheers) - It's just one of those pieces of high school kids need.

They need to have the Friday night lights.

They need to have the activities.

They need to have that, so it's important to keep it going.

- [Narrator] There were rules for the team.

(referee whistles blast) (crowd roars) - [Ref] Everyone needs to be on a dot, unless they're in the rotation.

- And one of them is we have dots.

We have dots on our sidelines and you'll see our kids standing on dots that are not in the game.

(band music) - [Narrator] There were rules for the band.

- We bought 24 different shower caps from Amazon.

You put a terry cloth on a brass or woodwind instrument, that diminishes the risk of students getting secondhand exposure for COVID-19.

- [Narrator] There were rules for the fans.

- We don't want to do it, obviously, but you kinda have to.

I mean, it's either this or no game.

- And I told my seniors tonight, "This could be it.

"This could be your last game as a football player.

"This can be taken away in a heartbeat.

- [Teacher] We're taking 125, divide it by 25.

Use your calculator please.

- [Narrator] School districts looked to state and local public health authorities to come up with practical steps that balanced safety with a kid's need to learn.

- We've got 445 right here.

- How do you keep kids in school, right, when you're quarantining them all the time?

If you have them spread out and they have a mask on, and they're not symptomatic, let's do our very, very best to keep them there, keep them engaged because we know that there's mental health issues.

- It was exciting, I think, and encouraging.

We wanted very much to have schools in person if possible.

And so, what was that going to look like?

- Before you look through and get frustrated, you have to remember that it's going to be opposite.

- [Narrator] How could a community measure what's safe and convey the information to the public?

The answer was the four-color risk dial to measure and illustrate the local risk of contracting COVID.

- This is an overall summary of our districts, certain metrics in our district that gives us an idea.

It's not perfect, but it gives us an idea where things are.

- [Narrator] When the number of sick people and deaths increased, when hospital beds became scarce and test results were in short supply, the risk to the community increased.

When conditions improved, restrictions relaxed.

- And you're gonna need to work with that locally based on what's going on in your community.

- [Narrator] It was a device schools could use to plan and measure whether in-person classes and sports were safe.

- Anything else?

- No two schools are the same so we had to look at our characteristics, we had to look at what makes up Hastings Senior High School.

(speaks in foreign language) - [Narrator] At schools in Hastings, safety began by requiring masks through the day.

- It's been a little bit of an adjustment.

But, you know, sometimes after talking for a while, I kind of forget that the mask is there.

I lost my thermometer.

- All of our students are checked at the beginning of each class.

Our protocol is if a student has a temperature of 100.4 or greater, they're sent to the nurse's office.

- I've tried to space kids as far as I can in here, and everybody has done a good job of doing the best they can to protect themselves and protect others and wear their masks.

(spray gun buzzes and hisses) - [Thomas] They understand the enormity of what's going on in society today.

- [Narrator] The most vulnerable, the most on guard had no escape from the impositions on daily life.

Senior living communities and nursing homes remained on lock-down for months, keeping family and friends at a safe and sad distance.

- That's my darling wife.

She's always got a good smile.

- Some of our residents are quite elderly and this might be their last few days, weeks, months, here with us on earth.

And that's what they wanna do, they wanna be able to see their grandkids and their families and visit their loved ones.

- One of the things I really remember is in late October, into November, before Thanksgiving, being so worried, probably more worried than I ever remembered being during the pandemic.

- [Narrator] For all the effort by the state's public health districts, by autumn the true surge rolled through Nebraska's hospitals.

(buzzer drones) - [Woman] We've got a unit coming in.

- [Narrator] A steady stream of COVID patients arrived at Great Plains Health from March through September.

By fall, many with heart issues and kidney conditions compounded the new wave of infections.

- Is it okay if I listen to your heart?

- So now they've been without care for essentially six months, and now they're really sick and dying.

And then you add in the COVID surge on top of that, and things were very difficult.

- I think this has probably been the hardest year out of 20 years of pharmacy practice to really see the effect that everything's having on the patient.

(man exhales deeply) - It's hard to manage senior team exposed to something that could potentially infect them and kill them every day.

Those are things that people don't understand.

- [Narrator] The pandemic dragged on long enough that medical teams, however exhausted, were better prepared to respond.

Great Plains obtained new treatments like monoclonal antibodies, just approved by the FDA.

Created in a lab, they mimic the body's natural immunity.

- We need to do it.

Let's not wait, because these patients keep coming and once they get to the hospital, they go to the ventilator it's a very, very tough situation.

- It's like trying to stop an avalanche.

Do you do it at the bottom of the hill or the top of the mountain?

And so, we recognize that these monoclonal antibody therapies allowed us to stop the avalanche at the top of the mountain before patients became severe and required hospitalization.

(device beeps) - [Narrator] Great Plains Health administered the IV drip at the hospital and at area nursing homes to seniors who'd contracted the disease but were yet to show symptoms.

- The BAM medication in the nursing homes.

I think our data indicates that 91% of them didn't require hospitalization after receiving it.

- We have had treatments that even our friends on the East don't have.

And so we've been so fortunate and so aggressive in our treatment of COVID in a small hospital like this; it's just been incredible.

- [Narrator] Treatment of COVID could never replace prevention.

- I remember at one point in time, just longing for our community to implement some sort of a mask mandate.

- Hey, I needed to call and visit with you about your exposure to a- - [Narrator] Contact investigations by local public health during the school year showed schools where masks were required limited outbreaks among students and teachers.

- Anyone else at the party?

- [Narrator] When there were outbreaks, cases clustered around students socializing outside of school, without masks.

- This one case has given me probably at least 20 people I'm gonna have to contact.

- [Narrator] Even as evidence showed masks worked, Governor Ricketts insisted the choice should be left to the individual.

- Mask mandates actually just breed resistance from people.

- [Narrator] The authority to require masks statewide rested with state health officials and ultimately, the Governor.

- At the end of the day, he's got a job to do.

He is our governor and we do respect that.

- But probably would have gotten more on board with wearing a mask if it was mandated across the state.

- This meeting is called to order at 5:30 p.m.

This is the council meeting of November 23, 2020.

Kim, please call the roll.

- [Narrator] City and county governments are allowed to institute their own mask mandates, and local public health districts like South Heartland could make the case to elected officials.

- South Heartland District Health Department is recommending a universal masking policy for the city of Hastings that coincides with the passage of similar policies in Kearney and Grand Island.

(sighs in frustration) - We on the front lines are not working tirelessly.

We are exhausted and we are sick and tired of people calling us heroes and thanking us for what we do and then turning around and obstinately refusing to do the bare minimum to make our jobs easier and protect their neighbors.

- [Mayor] Please pull up your mask, sir.

Please pull up your mask.

- [Man] I can't breath or talk that way.

- [Narrator] Mask opponents stood their ground.

- We are entering Nazi Germany here, where we are ending up into that very same thing where we're losing our freedoms because of what's being call a pandemic, when it's not a pandemic.

- [Narrator] Hastings City Council members who questioned mask mandates were persuaded to change their minds.

- I don't like the government to be heavy-handed, I really don't, but there are times we have got to figure out a different direction than what things are going right now.

- [Mayor] The motion passes, eight to zero.

- You guys saw a huge campaign.

"Wear your masks!

"We don't want our hospitals overwhelmed."

I think that really helped us going into the holidays for Christmas and then for New Year's.

And then hopefully as people continue to see this, okay, it's getting better.

(roller door clatters) (cart clatters) - [Narrator] Enter the vaccines, delivered to hospitals across America and across Nebraska.

(polystyrene packing squeaks) - It was very exciting.

It's a turning point for us as a health department, because we've been working on this for so long and it feels like you can see, hopefully, a light at the end of the tunnel.

- When we started with the vaccine, there was so much hope.

It was just such a dark time and there was so much hope instantly, and...

When you get that vaccine, it's like a weight is lifted off your shoulders.

- [Narrator] Some hospital staff and first responders remained skeptical after a year of sometimes murky science and conspiracy theories.

- There's some relief, but there's also some anxiety about it.

Okay, this was so new and it got pushed through so fast.

Is it really going to do what they said it would?

And we're trying to educate people as effectively as we can to say, "Yes, this is safe."

- All right, thank you very much!

- Lemme get you a Band-Aid here.

- Okay.

- [Narrator] Deciding which groups needed early access to the vaccine fell to state health officials.

The local health departments helped organize the events and get it done.

- Like, we've got 45,000 people, where do we, where do we take that?

Who's prioritized?

- So, hang on!

- [Narrator] 10 months of long hours and high pressure took a toll on the hearts and minds of those working behind the scenes in Nebraska's public health districts.

- We reached the point, as a department, that this was wearing on all of us.

- I want to sleep.

(chuckles) I want to sleep.

I want to go to the...

I wanna go to some island, just where there is nobody, so I don't get coronavirus.

- This is so unlike anything we've ever dealt with, that it was really hard to work through it as we got into it.

- I guess there's no way to really fully prepare for what the reality would be.

- It's easy to get caught up in and get drained by the negative things that you're hearing, over and over and over, and really failing to remember that there are a lot of positives coming in as well.

- [Interviewer] Are you proud of what you did?

- Hah, absolutely!

I absolutely am proud.

I feel like I gave it my all, I tried so hard.

We all did, we all worked so hard.

(melancholy guitar music) We just had a lot of pressure, deal with a lot of changes.

We had to deal with limited resources.

We had to deal with the unknown.

In some cases, a lot of angry people.

It kind of gets on you after a while.

You have to work with people that are scared and upset.

And so, yeah, I'm really proud of the work that we've done at the health department.

I think we wanted to slow the spread of the virus until the vaccine came along, and I think we've achieved that.

(pensive electronic music) - [Narrator] A year and a half after the pandemic arrived, public health officials expressed concerns over a new wave of hospitalizations and deaths.

- [Woman] We're well on our way to seeing some level of a surge.

- [Narrator] The new variants sicken younger populations and is more contagious than the original outbreak in 2020.

- [Woman] We see more and more people, a greater percentage that's unvaccinated.

We've got to get this variant under control.

(pensive music)