SIOUX FALLS – Inside Jokerz Casino, one of many small gambling storefronts dotting this South Dakota city, Yvonne Jones sat before an electronic machine betting a dollar at a time.

It was a rare respite from thoughts of the COVID-19 pandemic, and Jones, who lives alone, was grateful. "This is more or less my outing," she said, noting that she kept hand sanitizer nearby. "If I didn't feel safe, I wouldn't be here."

But the casino attendant serving beers to the patrons around her was dubious.

"I did not sign up for making minimum wage and doing this," said the attendant, who wouldn't give her name for fear of losing her job. As she disinfected machines and made change for a man who walked well within 6 feet of her, she said she was stuck — feeling unsafe at work but also unable to quit because she feared she wouldn't get unemployment. "People that think everything should be open, why aren't they themselves dealing with the public?"

South Dakota's approach to handling the COVID-19 pandemic is drawing national attention after an explosion of cases in a local meatpacking facility. With no statewide stay-at-home order in place, some critics are questioning whether fewer restrictions on businesses is gambling with residents' health.

The outbreak, at the local Smithfield Foods pork plant, which employs 3,700 workers, was at one point called the biggest single source of cases in the country. Bad as it was, it did not prompt state or local government leaders to order people to stay inside or to even temporarily close nonessential businesses, as Minnesota and many other states have done.

Instead, state and local governments continued with guidelines limiting crowds in those businesses to 10 patrons or less at a time. In Sioux Falls, the state's largest city with more than 180,000 residents, most bars and restaurants have voluntarily switched to serving takeout only. But other businesses, including casinos, tanning salons, vape shops and even a few gyms and hair salons are welcoming a limited number of clients.

"It's been a balancing act between the economy and public health," said T.J. Nelson, spokesman for Mayor Paul TenHaken, who issued a "Safer at Home" proclamation encouraging residents to stay put.

"From Day One, our top priority has been public health, but we also have to recognize … we have to sustain our business community and be resilient and come out of this successfully when it's over and save as many lives in the process," Nelson said.

Case count surges

South Dakota saw a surge of cases in mid-April, with the overwhelming majority in the two counties — Minnehaha and Lincoln — that encompass Sioux Falls.

As of Thursday, the state reported 1,956 cases, with 1,746 of them in those counties. South Dakota ranked 12th among states for confirmed COVID-19 cases per 100,000 people, according to New York Times-compiled data, though it had only a total of 119 hospitalizations and nine deaths. A total of 1,064 were listed as recovered.

Earlier this month, the governor directed residents 65 and older and those with certain medical conditions in Minnehaha and Lincoln counties to stay home.

The Smithfield plant was hit with an outbreak that now accounts for 801 cases among employees and 206 among close contacts, according to the state Department of Health. Two employees have died, according to reports.

The company announced an indefinite plant shutdown on April 12.

Nancy Reynoza, founder of the nonprofit Que Pasa? Sioux Falls, which aims to create community diversity, said she's talked with many Smithfield employees who feel the plant didn't do enough to protect them.

"Just to have 1,000 people get sick from one place, that's not the pandemic," she said. "That's negligence."

A CDC report released Thursday suggested communication issues between the company and its workforce — more than 40 languages are spoken by plant employees — could have been a factor in the outbreak, but Reynosa said she doesn't buy that as an excuse.

"When you get hired by Smithfield you have to speak some level of English," she said. "The same way you teach an employee to do their work is the same way you teach an employee to protect themselves."

Smithfield did not respond Thursday to inquiries seeking comment.

Testing ground

As other states face mounting pressure to reopen businesses, South Dakota may serve as a testing ground for what works and what doesn't.

In general, businesses have incentive to keep their operations clean and safe for their customers, said Zach Neugebauer, chief executive of Year Round Brown, a local chain of upscale tanning salons that is taking a limited number of customers.

Neugebauer said his business is arguably safer for patrons than restaurants that serve takeout, where credit cards often exchange hands and people touch food and bags containing to-go orders.

Tanning customers can check in and pay remotely, then head straight to a small room where tanning beds have been sanitized, he said. At one location, workers could be seen cleaning the handles of the doors after a customer came in or out.

"Why wouldn't we let people walk into a private room when you can keep a six-foot social distance and not touch anybody?" Neugebauer said.

Saving lives comes first, he said, but people's livelihoods will matter in the long run, too, adding that he believes most South Dakota businesses and people have been acting responsibly.

"I don't fault anybody for trying to do the right thing," Neugebauer said. "We do have to have a balance … jobs to come back to."

Limiting crowd sizes hasn't been a problem at Evolve Fitness, said owner Brook VerMeer, who was about to hold a personal training session for a client in a sea of empty weight benches and exercise machines one recent afternoon.

Group exercise classes and other activities are now led virtually, she said, and she has loaned equipment including free weights to members to take home.

"Exercise is going to keep you healthy," VerMeer said.

While many large salons with open-air stations have closed, some smaller style proprietors are working limited schedules.

Tucked inside a newly built strip mall, hair stylist Sheila Lunstra has been cutting and coloring hair for about three or four longtime clients each day in a small room she rents. She got a coronavirus test a couple of weeks ago to make sure she wasn't going to infect any of them, she said. And she asks each of them about their possible exposure to the virus before they come in. Then she cleans thoroughly between each visitor.

Lunstra said it's a matter of trust with her clients, and she likes having the option of having some income.

"I want to keep this as normal as possible. It's kind of a mental health thing for my client and myself," she said. "I have never felt more appreciated than I do right now."

A few rooms over, stylist Emily Juve started taking a few trusted clients last week after taking two weeks off to stay clear of the virus. She said she is working just enough to pay for the room she rents while trying to keep up with food bills she and her husband now have with two teenage boys at home full time.

Drawing the lines between what should be allowed and what shouldn't isn't easy for anyone, she acknowledged.

"I would like the governor to tell us to shut down," she said. "Instead, I'm having to draw the line myself. My line is no new clients and having honest conversations with my clients about their health and safety."

Sparsely populated state

At Riddle's Jewelry, near the closed Empire Mall, manager Brent Reisenauer stood near glass cases full of precious gems with just a few customers darting in and out.

Though business is down, he said, customers have come in looking for engagement rings and anniversary gifts. The store also has been willing to sell online as well as deliver curbside, he said.

Gov. Kristi Noem and other leaders are in a tough position, he said, because South Dakota's counties are very different from one another, with vast stretches in the middle of the state sparsely populated.

"Half the counties in the state have zero cases. Why would you shut down a whole state?" he said. "We all have mortgages. We can't not work for the next 10 years. What is the answer? I don't know."

Reisenaur and others were quick to point out that, even locally, most of the cases were spread among packing plant employees, not in the community at large.

From the park around the picturesque rocky falls of the Big Sioux River downtown, the Smithfield plant sits in plain view to the north.

Kristi Eisenbraun soaked up the sunshine near the falls on a recent evening while trying to stay distant from the diverse sprinkling of people dotting the Falls Park around her. It was her first outing in several weeks, she said, because she feels extra vulnerable and is concerned about community spread.

"As a person with a disability, I kind of wish more things were closed just because I'm more susceptible," said Eisenbraun, who uses a wheelchair. "You don't know who has it."

While some people may not feel connected to plant workers, many of whom don't speak English, she said, plenty of people are connected through relatives and friends, day cares and apartment buildings. The virus doesn't discriminate and will find any host it can, she said.

"People don't take it seriously," she said, "until it happens to them."

Staff writer Matt DeLong and the Associated Press contributed to this report.