Why is no one celebrating South Dakota?

The Mount Rushmore State has remained open on the advice of Republican Gov. Kristi Noem, one of only 13 states to do so. The governor's office has teamed with Sioux Falls-based Sanford Health to conduct a statewide hydroxychloroquine trial, the only one of its kind in the nation.

And South Dakota has the nation's lowest death rate: 0.49 percent. Only 11 deaths. No other state comes close.

It's not that the state didn't catch the coronavirus. There are 2,313 confirmed cases to date. That said, 1,392 have recovered. That's 60%, behind only Hawaii (80%), Montana (78%), Oklahoma (66%), Wyoming (65%), and Alaska (63%).

Perhaps its most impressive feat: South Dakota successfully managed the largest single-source coronavirus breakout in the U.S. at a meatpacking plant owned by a Chinese conglomerate.

Sioux Falls, the state's largest city, made national news recently due to a coronavirus outbreak at Smithfield Foods. Smithfield is a Chinese-owned global food empire. It is also America's largest meat producer. Smithfield became the largest single-source hotspot for the virus earlier this month, with 518 cases (another 126 people were infected by its workers). Despite this burden, South Dakota has recorded the lowest death rate of any state, and the third-lowest number of total deaths.

The meatpacking plant was closed on April 12, and has since received strict guidelines on safer work practices from the CDC. One key problem: a language barrier. It's surprising to find 40 foreign languages spoken anywhere but the United Nations, let alone a state that is 89% Caucasian or American Indian. Here's what it looks like to do manual labor for a Chinese-owned company in America:

A team of CDC inspectors toured Smithfield Foods on April 16 and 17, just under a week after the plant temporarily shuttered.

According to the report, inspectors were "unable to identify important demographic information about the workforce," limiting the team's ability to understand the diversity of the employees. However, plant management told the CDC that there were approximately 40 different languages spoken by employees in the plant, including Spanish, Kunama, Swahili, Nepali and Tigrinya, among many others.

Only a handful of employees were in the facility during the inspection, performing maintenance and distribution tasks. However, inspectors said several of the employees they did see were congregating less than six feet apart when away from their workstations.

The report also noted hand sanitizer dispensers and hand washing stations were located in "limited" areas around the plant, but management say they plant to increase the number of sanitizer stations to 3,500.

--ABC News

It had all the makings of a massive breakout: workers in close quarters, unsanitary conditions, pushed to the brink by uncaring and geographically distant ownership. And despite the outbreak, South Dakota rallied. It remains one of the few free states in the Union, all while containing the virus better than anyone else.

So why are so few people dying in South Dakota? The short answer may be related to hydroxychloroquine.

Hydroxychloroquine (HCQ) is of course the controversial drug touted from the early stages of national outbreak by President Trump. Cheap, readily available, and widely used for over 50 years, HCQ has been smeared by fraudulent tests and slow-tracked by coronavirus task force doctor Anthony Fauci.

Gov. Noem was a proponent of HCQ before the trial was announced, and made sure the state had supplies of the drug. From an April 14 press conference:

Noem noted that doses of the drug were already being administered to patients. She added, "We're going on offense to help every single person deal with this virus and be willing to fight it and get better and go home to their families."

--Washington Examiner

Perversely, mainstream media has highlighted the bad science (such as the zinc-free, non-clinical VA Hospital study of elderly veterans with multiple comorbidities), and ignored large, peer-reviewed studies that support the efficacy of HCQ when combined with azithromycin and zinc, and administered during early onset of the virus, not as a last resort.

As noted, the Smithfield meatpacking plant in Sioux Falls was closed on April 12. South Dakota's statewide hydroxychloroquine trial began the very next day.* Which brings us back to Gov. Noem and her healthcare team. Sanford Health is incorrectly cited in some national press coverage as a "rural healthcare provider." Far from it. Sanford is a $5 billion medical services firm with global reach. Its international subsidiary, Sanford World Clinic, has aggressively expanded into Ireland, South Africa, Germany, NZ, Vietnam, Ghana, and China.

In other words, Sanford Health is not a long-haired French doctor like Didier Raoult, MD, the lead researcher on three HCQ trials. Sanford Health is not Vladimir "Zev" Zelenko, the rumpled, shaggy upstate New York Jewish doctor who claims to have successfully treated over 700 patients with HCQ. Raoult and Zelenko are easily painted with the "anecdotal evidence" tag. They don't quite look the part.

Preventative Use of Hydroxychloroquine

Sanford Health is a buttoned down, global healthcare company. It is, in its own words, "one of the largest health care systems in the United States." Sanford's annual engagement numbers, from its website:

• 5.3 million outpatient and clinic visits
• 84,466 admissions
• 136,436 surgeries and procedures
• 9,537 births
• 210,129 emergency department visits

So Sanford would seem to be a perfect fit to conduct a test on a controversial drug. However, upon closer inspection, the Sanford Health HCQ trial is not what it seems.

I reached out to representatives at Sanford, and they declined to discuss their study. Therefore, some inference is necessary. Sanford has published an overview of the study online.

When I first heard news of the statewide HCQ trial, I assumed that South Dakota was going to treat half of its COVID cases with HCQ (and presumably azithromycin and zinc), and provide the other half with a placebo in a double-blind test. That is not the case. Nowhere is azithromycin mentioned, nor is zinc. Nor are patients sick with the coronavirus.

That's right, they are NOT treating sick people with HCQ in this study.

Further, the asterisk a few paragraphs above denotes a claim on Sanford's website that the study was to begin "immediately," whereas the overview claims an April 24 start. I take this discrepancy to mean that the preparations began two weeks ago, but the trial itself started later. Any trial takes time to prepare, especially a statewide one.

But this isn't a statewide trial. Not exactly. The study size is 2,000 subjects, and they are to be composed of South Dakota healthcare workers and civilian volunteers. But not just any volunteer. To qualify as a citizen test subject, Sanford stipulates that you must be "high risk."

For those of you who have followed CDMedia's coronavirus coverage, this should send up a number of red flags. First, this isn't a test of HCQ's efficacy versus patients sick with the virus. It's a test of "high-risk" individuals--people with recent proximity to COVID-19 positive people, and for civilians, at least one serious health issue.

The test group--an odd marriage of healthcare workers and civilians who feel fine but have been around others with coronavirus--is noteworthy. But the final qualifications are oddly reminiscent of the sample selected in the VA study: you must have a high risk health issue. Heart disease, emphysema, and the like. Behaviors thought to increase the chance of death, such as smoking.

In other words, the closer you are to death, the more likely you qualify to be in the study.

As for the Sanford Health employee subjects, the net is too big by far. They don't have to be South Dakotans. They can be any of nearly 30,000 Sanford employees in the world. Clinical trials should eliminate as many temptations to alter or fudge results as possible. Allowing employees is a mistake in itself. Allowing employees from around the world into a "statewide" test is downright fishy.

But it doesn't stop there. Any Sanford Health patient from around the world can qualify if they meet the ridiculous criteria.

An 85 year-old Irishman with heart disease who visits a Sanford clinic in Dublin after chatting with a friend who had the virus could qualify to take HCQ for this "South Dakota" study. What on earth does that tell us about the efficacy of the drug?

Is this a study of how to prevent death among at-risk members of the population? If so, it should be defined as such, not a "statewide trial on hydroxychloroquine." If it is a study on the prophylactic effect of HCQ, that should be stated, but in that case, why muddy the waters with at-risk people who stand a higher chance at infection due to recent exposure?

Lastly, of the people who qualify for this test, who would be willing to volunteer? Elderly people with existing conditions are doing all they can to steer clear of hospitals.

Noem, the Anti-Whitmer

The battle of the Midwestern brunette governors is well underway. Gretchen Whitmer of Michigan has been lampooned for closing her state, outlawing the use of hydroxychloroquine (before reversing and pleading with the federal government for a supply). When constituents protested lockdown by surrounding the capitol building in Lansing in their cars, Whitmer threatened to lengthen lockdowns.

Michigan has the third-highest number of coronavirus deaths at 3,407, behind only New York and New Jersey.

Meanwhile, in South Dakota, free citizens threw a parade for Gov. Noem. Yes, a parade in sleepy capital of Pierre (pop. 14,008), complete with fire trucks and American flags.

It hasn't all been smooth sailing. Hydroxychloroquine is enough of a political football to create political strife between Noem and local labor bosses.

The president of the United Food and Commercial Workers International Union said Thursday that he is urging Sioux Falls Smithfield workers who contracted COVID-19 not to participate in a statewide study into the effectiveness of a malaria drug to treat the disease.

“We are very, very concerned about it, and strongly recommend that our members do not take part in that study,” he said.

Perrone said he was concerned by reports that patients treated with the drug had a higher death rate than those who received just standard care.

--Argus Leader

The study Mr. Perrone is referring to is the fraudulent VA Hospital observational trial mentioned earlier. As noted, the study was riddled with sampling errors and didn't include other drugs shown to work effectively in combination with HCQ. It's shocking to think how many people may lose their lives due to partisanship.

South Dakota continues to surprise the nation with its bold approach to fighting COVID-19. Perhaps their legacy in this strange time will be to show rural America how to effectively deal with future virus outbreaks. In the meantime, CDMedia will keep an eye on their curious "statewide clinical trial."

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