SIOUX FALLS, S.D. — In the before time, a time that feels so long ago, Kim Malsam-Rysdon didn't do on-camera press briefings.

It's not that she didn't want to. But being the secretary of the Department of Health in South Dakota wasn't exactly the world's highest profile job.

Yet on March 10, 2020, the TV cameras were watching as she joined Gov. Kristi Noem to announce the first COVID-19 cases and a death in South Dakota.

Malsam-Rysdon, as well as health system leaders, are now familiar faces of the pandemic response in South Dakota, now a year old. Their experience makes them highly qualified to take stock of the past year and ask: Is South Dakota now better ready for the next pandemic? What lessons has the state learned from COVID-19?

Granted, COVID-19 isn't finished. Variants of the virus have now appeared even as vaccines are rolled out. The battle isn't over.

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But both Malsam-Rysdon, and Dr. David Basel, a leader for Avera Health, say their organizations have learned much from the last year, and built a dense web of sometimes surprising relationships that will pay dividends into the future, whether there's another pandemic or not.

Learning on the fly

When a pandemic hits, it's time to get flexible.

That's one of the biggest takeaways for Basel, vice president of clinical quality for Avera Medical Group. Sioux Falls-based Avera Health is one of the state's largest healthcare system and its largest private employer.

Basel ticked off the ways the business of healthcare changed. Avera Health scrambled to turn its cancer center into a COVID-19 ward, convert rooms to negative-pressure rooms to prevent spread of the virus, shifted staff to needed jobs and moved patients -- and doctors -- to telehealth instead from in-person visits.

Later, amid the fall/winter COVID-19 surge in South Dakota, clinic staff learned how to handle more seriously ill patients than usual, brushing up their skill set.

"The overriding theme has been the flexibility that has been required through this last year In our own job descriptions," he said. "From that standpoint we are so much better prepared for the next pandemic, whatever that is."

State health and health systems had developed an influenza pandemic response plan in recent years. The planning helped prepare the state better than if a pandemic had arrived even a year before, Basel said.

“Certainly the COVID-19 pandemic put that preparation and those plans to the test," said Malsam-Rysdon. But unlike some states, in South Dakota, healthcare providers didn't face the same level of protective equipment supply shortages experienced elsewhere, she said -- just one example of where preparation paid off.

The state Department of Health quickly stood up what Malsam-Rysdon called a "really homegrown" COVID-19 data dashboard and added to it in following months.

"I think that’s really been a strong point of our response and something that we needed to develop," she said. "We didn’t have that back in March, and again, moving beyond COVID, it’s going to really benefit the state."

New relationships bloomed

When times are tough, you turn to friends. That's another big takeaway for both the state Department of Health and Avera Health.

"That first month of COVID, the number of people I put into my contacts on my phone, I bet you it was over 100 people both inside Avera and outside Avera, and I've continued to add people," Basel said.

The state Department of Health quickly found itself partnering with "not the usual suspects," Malsam-Rysdon said, such as businesses, schools and universities. Another huge, and unlikely ally: the South Dakota National Guard.

The guard was an integral part of the plan to quickly boost the number of available hospital beds for an expected COVID-19 surge. It also set up a team that could, in 24 hours, help staff a hospital if it found itself short of workers due to the virus, and helped with contact tracing and investigations, and is standing by to assist with vaccinations.

"Those partnerships have really opened our eyes about, again, the many capabilities we have in our state to get the job done and I think we’re just going to be better off as a result of it down the road," Malsam-Rysdon said.

Basel described the new web of relationships as linkages, not just numbers on a contact list but tried and trusted partners, where the relationships will pay dividends down the road responding to either a pandemic or more run-of-the-mill but still deadly concerns like cancer prevention, hypertension screening or diabetes control.

"Those relationships on the working level, you’ve been through so much together, you trust each other, you trust each others’ strengths, because we had to rely on each other," Basel said. "There’s very definitely paying dividends for a long time to come.”