ELLENDALE, N.D. — Dickey County, N.D., is a place of extremes when it comes to the coronavirus.
Last fall, the county south of Jamestown was the state's rural epicenter of the COVID-19 pandemic. With one of the highest infection rates in the nation, its perfectly rectangular shape often appeared colored in a deep red hue on virus heatmaps.
To this day, no county in the Peace Garden State has seen a higher COVID-19 death rate per capita. Thirty-three Dickey County residents have succumbed to the disease — the ninth most of any North Dakota county and a higher toll than nearby Richland County, which has more than three times as many residents.
Kayla Kale, nursing director at CHI Oakes Hospital, recalled several weeks after the October infection apex that it was "heartbreaking" seeing locals struggling to breathe and knowing there weren't any beds available at Dickey County's only medical center.
But the county of nearly 5,000 people has emphatically flipped the narrative with the arrival of COVID-19 vaccines. Its pandemic story is now one of redemption and reemergence as it leads North Dakota in the rate of COVID-19 vaccination.
Nearly three-fifths of the county's eligible residents are fully vaccinated — more than 15% higher than the statewide rate, according to the North Dakota Department of Health. Meanwhile, vaccination rates in many North Dakota counties, especially in the southern and western parts of the state, have come to a near halt as doubts about the vaccine seep into the public conscience.
Dickey County sticks out in vaccine administration even amongst its demographically similar neighbors, so what makes the pastoral patch known for pheasant hunting a jab-giving pacesetter?
There's no singular explanation for Dickey County's outlier status, but some who live and work there believe the pain endured at the peak of the fall outbreak has ignited a greater desire to take the shot and expel the deadly virus from their lives.
"We saw the damage that (COVID-19) could do," said Alicia Glynn, a manager at Evergreen Place nursing home in Ellendale. "People were ready to get back to a normal way of living."
What makes Dickey County special?
When the vaccines first became available for older residents, workers with the Dickey County Health District didn't have to do much convincing to get doses into the arms of locals.
Amber Miller and Laurie Wang, two of three nurses who have administered the majority of the county's vaccines, said the first eligible residents were "giddy" to get the jab earlier this year. Miller remembers one woman weeping for joy on the phone after being told it was her turn to come in.
"I've never seen a group of people happier to be getting a shot," Wang said. More than 80% of Dickey County residents 70 and up are now fully inoculated, well above the statewide rate.
The enthusiasm to get the vaccine among the older age groups is partially a result of the county's suffering a few months prior, health workers noted.
Miller said many residents have family and friends who "didn't make it through the battle," giving them a very real sense of how devastating the disease can be. Wang said being among the nation's worst-hit counties embarrassed some residents and gave them another reason to get on board early with vaccinations.
But the wide acceptance of the vaccine among older residents doesn't fully explain the county's top-ranking jab campaign. Though Dickey County's population is slightly older than the state average, it has a lower proportion of residents over 65 than any of its neighboring counties in North Dakota, according to U.S. Census Bureau estimates.
To reach the pinnacle of the county leaderboard, the public health team had to win over younger residents. They offered shot clinics throughout the county, including at a nearby church and on the campus of Trinity Bible College in Ellendale. Pharmacies in Oakes at the other end of the county also offered vaccinations.
The flood of demand for jabs has more recently slowed to a trickle, but public health employees started reaching out to unvaccinated residents by phone and mail, prodding them to stop by for a shot.
On a rainy Wednesday, the four workers at the Ellendale office spoke about their next immunization targets, referring to them only by first name — a style of conversation made possible by the closeness of the rural community.
Around midday, administrative assistant Kerry Waldo put down the phone and exclaimed, "Troy is coming in!" A half hour later, Troy Goehring walked through the door, and Miller gave him a dose of the one-and-done Johnson & Johnson vaccine. Goehring, a math teacher at Ellendale Public School, coaches the high school track team with Waldo, and she recognized she could get him to come for a vaccination during his lunch break.
"We know our people and that helps," Wang said. "That's a huge advantage over the big health units."
Outside of personal ties between workers and residents, the public health agency has built strong bonds of trust with the community over years of offering flu shots to the broader public and routine vaccinations in schools, Miller and Wang said.
More uniquely, Dickey County's public health workers performed the county's COVID-19 contact tracing themselves instead of outsourcing it to the state. That practice meant the workers had already established strings of communication with many locals during the pandemic, Miller said.
Glynn heaped praise on Miller, Wang and the public health team, saying they were “dang spectacular” in getting the word out about the vaccine.
State immunization manager Molly Howell said counties with high vaccination rates have credited their success to robust preexisting connections between their public health units and communities. Howell said it's unclear why some local health officials have prospered more than others in building trust with residents, noting that all are trying their best to dispel misinformation and convince their constituents to get vaccinated.
Crucially, Dickey County has made getting the COVID-19 shot the norm — a hurdle low-vaccination regions have not yet cleared, Howell said.
Public health workers couldn't have achieved that without help from vaccine preachers like Oakes resident Dorothea Rath, who said she has persuaded neighbors to get the jab. Rath said she hasn't encountered many objectors, noting that the family-like supportiveness of her home county has been the true key to the vaccination efforts.
"It’s about all of us pulling together," Rath said. "Everyone I know wants to be part of the solution — part of making everyone safe."