Elkhart County wrestles with how to respond to a spike in coronavirus cases

While the spread of the coronavirus has slowed for most of Indiana, the number of cases in Elkhart County has done the opposite, spiking in recent weeks and alarming local leaders who worry an outbreak could force the county to shut down again.

In May, the county’s number of COVID-19 infections more than tripled, and the increasing rate landed the county on a list published by the New York Times of America’s most probable next hot spots for the virus. In most of Indiana, meanwhile, the rate has decreased, including neighboring communities such as St. Joseph County.

“The fact we even made that list is concerning enough,” said Goshen Mayor Jeremy Stutsman. “While the state of Indiana is doing well, we seem to be on the verge of going the opposite way.”

In the face of the more rapid spread, however, local leaders are still wrestling with how to respond.

For example, government officials have resisted ordering people to wear masks, despite calls by hospital and business leaders for such a measure, and despite the fact the increasing infections may be linked to the types of social activity in which masks could limit the spread.

Stutsman last week wrote an open letter urging businesses to do more to head off an outbreak, though some local officials insist there is no evidence that RV and other factories are responsible for the rising COVID-19 cases.

At the same time, County Commissioner Mike Yoder told The Tribune local officials likely will delay moving the county to the next phase of Indiana’s “Back on Track” plan to reopen the state — set to move to the next stage in mid-June — if Elkhart’s numbers don’t improve.

Stutsman, in his letter, said the numbers in Elkhart County have attracted the attention of state and federal authorities, and “we are at risk of them taking action to shut us down again.”

In an interview, he said he had not heard directly from state officials that they were considering placing the county back on lockdown, but there is precedent for the move. Gov. Eric Holcomb has exempted Marion, Lake and Cass counties from previous stages of reopening because of their rates of infection.

Experts expect the number of COVID-19 cases to continue rising as the number of people being tested also rises. The problem in Elkhart County is that a greater percentage of people being tested are positive for the virus.

In April, about 9% of all COVID-19 tests in Elkhart County were positive, according to data from the Indiana State Department of Health. That percentage increased to about 11% in the first half of May, and almost 20% in the second half of the month.

By comparison, statewide, the rate of positive tests decreased to about 9% in the second half of May, down from 17% in April. St. Joseph County’s rate of positive COVID-19 tests also was about 9% in the second half of May.

Between May 1 and May 31, Elkhart County’s cumulative number of infections increased by about 350%, while that number doubled in St. Joseph County over the same period. And while Elkhart consistently lagged behind St. Joseph in total cases, that changed in the last week. As of June 4, Elkhart County reported 1,592 cumulative cases, while St. Joseph had 1,357.

Healthcare providers say the increased spread in Elkhart County has so far not led to a big jump in hospitalizations, in part because a high number of the infections have been among younger people who are less vulnerable.

About 20% of all the county’s COVID-19 cases have been people 20 to 29 years old, according to the state data. People 30 to 49 account for another 35%. But the rising numbers, if left unchecked, could eventually lead to outbreaks in nursing home residents and among other vulnerable groups, experts said.

“The people who are working are, not surprisingly, having more exposure and more infection,” said Dr. Michelle Bache, vice president of medical affairs at Elkhart General Hospital. “Where it becomes a problem is when these young, healthy people live or work with individuals who are more vulnerable.”

What’s causing the spike?

Officials point to several factors that could explain the accelerating number of COVID-19 infections in Elkhart County.

Many county residents don’t seem to be taking recommended precautions, such as wearing masks in public, practicing physical distancing and avoiding large gatherings. The county has a substantial population of Hispanic people, who have seen disproportionate rates of infection. And as the RV capital of the world, the county’s workforce includes tens of thousands of people working on factory floors.

In the letter to the business community, Stutsman said there was correlation between Elkhart County returning to work and the increased cases, and he urged companies not to let up on policies meant to limit the spread of the virus. The letter was signed by the mayors of Elkhart and Nappanee, as well as county and economic development officials.

At some factories, employees have raised concerns about lax policies. In an Elkhart Truth article in May, the newspaper reported that Utilimaster, a truck manufacturer in Bristol, had seen at least six workers infected. Several employees said workers were placed too close together, were not given adequate protective gear and were fired if they wanted to quarantine at home while awaiting test results.

Utilimaster denied the allegations in the Elkhart Truth story. A spokeswoman did not return a Tribune call seeking comment.

Dr. Michelle Shelly, medical director of the Center for Healing and Hope, a nonprofit health clinic that largely serves Goshen’s Hispanic community, said she has heard reports that some factories have been sending home workers who test positive, but not the workers who may have come into contact with an infected person.

Some county officials acknowledge factory work comes with an obvious risk of viral spread.

“We have thousands of workers that are side-by-side every day,” Stutsman said. “Our businesses, a lot of them are doing great, they have great policies in place. There’s some businesses where we need to do a little more.”

Dr. Lydia Mertz, Elkhart County’s health officer, said there’s no evidence factories are behind the county’s accelerating numbers of infections. However, it’s unclear how many infections in the county are linked to specific workplaces.

Mertz said the county health department has data on the workplace of each person who has tested positive for COVID-19, but she refused to share the data, even with identifying information about patients redacted.

“You want to make it that it’s the factories, but that’s not the case,” she told a reporter who asked for the workplace data. “It’s not like factories are germ places.”

At Thor Industries, one of the county’s RV giants, officials say only a minuscule number of employees have been infected. Out of 15,000 employees, just 63 have tested positive, said Todd Woelfer, a Thor senior vice president and general counsel. Fewer than 35 of those people are Elkhart County residents, he said.

Woelfer said Thor has implemented mandatory temperature checks and masks or face shields for all employees. He said the company conducts its own rigorous contact tracing anytime a worker tests positive, and it sends home employees who had contact with that person while they await test results. Numbers of employees are limited in common areas such as break rooms, and plants have suspended in-person group meetings.

Woelfer said he believes Thor’s competitors are taking similar measures.

“If we didn’t do things right here,” he said, “we would end up being shut down.”

A mask order?

Rather than workplace outbreaks, county officials have blamed the recent spread on an uptick in travel, social activity and gatherings among residents, often without the recommended precautions.

Mertz, the health officer, and Yoder, the county commissioner, pointed specifically to Mothers’ Day get-togethers, though they had no explanation as to why the holiday would have led to increasing rates of viral spread in Elkhart but not other counties.

“Maybe we practice Mothers’ Day differently here than other places,” Yoder said.

Mertz, Yoder and Jenn Tobey, the county’s director of emergency management, said officials need to redouble their efforts to inform the public about the importance of hygiene, distancing and masks. Mertz posted a letter on the health department’s website and social media channels Friday outlining research that shows those measures are effective in limiting the spread of the virus.

But all three said they did not believe the county needed to issue an order requiring masks in public spaces, as the St. Joseph County Health Department did in May.

“I don’t think it takes the government to mandate somebody to wear a mask if they feel safer in a mask,” Tobey said. “If someone feels safer in a mask, they’ll wear it. People need to take ownership, research the coronavirus and do what you feel you need to do.”

According to the U.S. Centers for Disease Control, the main purpose of wearing a cloth face covering is not to protect oneself, but to avoid spreading the virus to others.

Both Bache, the Elkhart General vice president of medical affairs, and Dr. Daniel Nafziger, the chief medical officer at Goshen Hospital, said they support a mask order. Woelfer said Thor also would like to see the county make masks mandatory.

Missy Schrock, the executive director at the Center for Healing and Hope, said she would like to see a mask order but believes it “would never happen here” because wearing masks had been “politicized” in Elkhart County, breaking along liberal and conservative lines.

St. Joseph County votes mostly Democratic, while Elkhart County leans Republican.

Experts say there is also evidence of significant spread of the coronavirus among the county’s Hispanic population, sometimes in clusters within families. They attribute those instances in part to the close-knit family and social ties in Latin culture, sometimes involving children, parents and grandparents living under the same roof.

According to state data, more than 13% of COVID-19 cases in Elkhart County are among Hispanic people. That figure is based on incomplete data because many cases reported to the state do not include information about race and ethnicity. The most recent Census data estimated Hispanic people make up about 16% of the county’s population.

Hispanic people throughout the United States have been infected with the coronavirus at disproportionate rates. In St. Joseph County, Hispanic people have accounted for 20% to 30% of COVID-19 cases, though they comprise just 9% of the population.

Elkhart County officials say they are working to provide more information to the Hispanic community.

And if the county is going to keep its economy open, Bache said, its leaders, businesses and residents cannot let up on measures to slow the virus.

“We can’t all be quarantined inside until we get a vaccine,” she said. “It’s not pleasant. I don’t like wearing a mask either. But we need to figure out how we are going to be a community and society that is going to function in a COVID world.”