GREAT FALLS, Mont. — For months, the jail in central Montana’s Cascade County was free of the coronavirus, which seemed as distant a threat as it did in much of the nation’s rural Mountain West.
Then a few people who had the virus were arrested. By the time Paul Krogue, the jail’s medical director, realized there was a problem, nearly 50 inmates were infected in the jail, where some had been sleeping on mats on an overcrowded floor. After several weeks, Mr. Krogue got a call that infections were spreading to a side of the jail that had been virus-free.
He hung up the phone and put his head in his hands.
“I just kind of lost it, like, ‘My God, I don’t know how much longer I can do this,’” Mr. Krogue, a nurse practitioner, recalled. “I was just scared that I’m not going to be able to see it through, that I’m going to get sick — you just feel so exhausted and it’s just a lot.”
The Mountain West, which for months avoided the worst of the pandemic, has rapidly devolved into one of the most alarming hot spots in a country that recorded its eight millionth confirmed case on Thursday, a day when more than 65,000 cases were announced nationwide, the most in a single day since July.
Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the pandemic. And the spread through sparsely populated areas of rural America has created problems in small towns that lack critical resources — including doctors — even in ordinary times.
Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week. Reports of new infections have recently reached record levels in Alaska, Colorado and Idaho. And Montana, where more than half of the state’s cases have been announced since August, is averaging more than 500 cases per day.
In Cascade County, more than 300 inmates and staff members have been infected in a facility meant to hold 365 people, the county’s first major outbreak in a region where the virus is suddenly surging.
The county seat, Great Falls, is seeing its worst case numbers yet. The local hospital and its 27-bed Covid-19 unit is at capacity. The county health department is racing to hire new contact tracers. And Mr. Krogue, who also teaches nursing at Montana State University’s Great Falls campus, has seen attendance in his classes dwindle as students fall ill or quarantine.
One place where the infections have spread has been local jails, which are confined, often crowded spaces. Jails are staples of local communities and tend to have people coming and going more quickly than prisons. Jails can hold everyone from people awaiting criminal trials for months to those picked up for a suspended driver’s license for a few hours. With so many people filtering in and out, jails pose extra risks for the virus’s spread — not only inside facilities but in potentially feeding outbreaks in the rest of the community.
Nationally, jails and prisons have seen disproportionate rates of infection and death, with a mortality rate twice as high as in the general population and an infection rate more than four times as high, according to recent data.
A New York Times database has tracked clusters of at least 50 coronavirus cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the pandemic. Among them: the Purgatory Correctional Center in Hurricane, Utah, with 166 infections; the jail in Twin Falls, Idaho, with 279; and, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.
In Cascade County, infections at the jail make up about a quarter of all known virus cases in the county. Health authorities say that the jail’s outbreak, which began in mid-August, was not believed to be the main cause of the community’s recent surge, but that it had led to some cases. In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.
Great Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks. The Cascade County Detention Center sits along a highway at the edge of town. Drive five miles in any direction and you are surrounded by wide-open plains.
Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtown’s Central Avenue, where shops and cafes are still recovering from shutting down in the spring. Others go without masks, citing the open space and lack of crowds.
Bob Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it started.
“I think that by the very definition of a jail, hopefully, the disease will be incarcerated, as well as the patients,” he said. “Is there concern? Sure, there’s concern. But is there overreaction? No.”
Some residents’ nonchalance about the risks of the virus, said Mr. Krogue, the jail’s medical director, can be traced to a spring and early summer when almost no one in Cascade County knew anyone who had been sickened.
“We benefited from that early on,” he said. “But in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.”
That has quickly shifted now, he said, as cases have spiked.
The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade County’s health officer. The county has seen 1,261 cases and six deaths during the pandemic, a Times database shows. Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants. Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.
“Our hospitals are at capacity, our public health system is at capacity,” she said. “It’s not sustainable at this rate.”
When the outbreak at the jail began, social distancing was impossible, the authorities said. Three inmates shared cells designed for two. At night, men slept on thin blue pads in every available space: on the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.
Inmates did not receive masks until August, and jail officials said many have refused to wear them.
In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary. They said their pleas for help often went unanswered by nurses and guards.
Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.
Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the virus. He said he had been unable to eat for three days, had intensive body aches and suffered from a headache so powerful it felt as if it was “behind my eyes.”
“After the fourth day of like, not eating and stuff, I just shut off, you know?” he said.
At one point, Mr. Hawley said, he and other prisoners protested the way the virus was being handled by refusing to leave their living areas and by blocking new inmates from entering. Everyone was ultimately tested, Mr. Hawley said, and each prisoner was given a disposable mask.
Sierra Jasmine Wells, 25, another inmate, said women in her dormitory had grown ill, one after the next.
“Everyone around me was getting sick and it was tough on me,” she said. “By then, I had already accepted the fact that I was going to get sick.”
When she became infected, she said, she was given cough syrup and Tylenol.
“I kind of was just left alone to deal with it,” she said.
Jesse Slaughter, the county sheriff who oversees the jail, said that the jail’s medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care. Seven inmates, as well as some staff members, were hospitalized. No one from the jail has died from the virus, officials said.
Mr. Krogue said that since the start of the outbreak he had been working up to 16 hours each day and sleeping in his basement, away from his wife and children. He remains healthy but says he fears bringing the virus home. The virus has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.
“You can start to see what some of these other places experienced much earlier on, and we just didn’t have that experience, but it’s certainly happening now,” Mr. Krogue said. “It’s just real in a way that it wasn’t.”
Lucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb. Reporting was contributed by Izzy Colón from Columbia, Mo., Brendon Derr from Phoenix, Rebecca Griesbach from Tuscaloosa, Ala., Danya Issawi and Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B. Mensah from Silver Spring, Md., and Mitch Smith from Chicago.