As the year draws to a close, thousands of Siouxlanders have tested positive for COVID-19 and the virus has claimed hundred of lives in the region. In most people, COVID-19 causes only mild symptoms, such as fever and cough. But for some, especially older adults and people with pre-existing health problems, the virus can produce more severe illness, including pneumonia.

In early March, area nursing homes locked down, hospitals began imposing visitor restrictions and churches cancelled services in effort to stave off the spread of the virus, which was first identified in the Chinese city of Wuhan in December 2019. Face masks, hand sanitizer and even toilet paper began flying off grocery and big-box store shelves, as Siouxlanders sought to hunker down and protect themselves.

The remainder of the games in the NAIA Division II Women's Basketball National Championship were cancelled abruptly on March 12 due to the virus, even though not a single case had been diagnosed in Woodbury County. Four days later, the City of Sioux City closed its facilities to the public, including City Hall, the Sioux City Art Center, Tyson Events Center and Sioux City Public Library.

The Sioux City Community School District shuttered its buildings for the school year on March 15, upon Gov. Kim Reynolds' recommendation. The next day, Reynolds declared a statewide public health disaster emergency that included limiting gatherings to 10 people and closing bars, restaurants, casinos and other businesses in response to the coronavirus outbreak. At the time, the state had just 23 confirmed cases of COVID-19.

Other impacted businesses included fitness centers, health clubs, gyms and aquatic centers. Prior to the governor's proclamation, AMC at Southern Hills Mall and Promenade Cinema 14 in downtown Sioux City announced plans to close their movie theaters.

Scores of Sioux City businesses were forced to quickly comply with the governor's order, which took effect at noon on St. Patrick's Day, ordinarily a busy time for many bars and restaurants. The Hard Rock Hotel & Casino in Sioux City shut down its 45,000-square-foot casino at noon that day. Unemployment in metro Sioux City skyrocketed to a record 9.3 percent in April as businesses and government offices laid off or furloughed workers in the wake of the closures.

Funeral services in Sioux City were postponed to a later date or proceeded with very limited attendance after the mandate was issued.

Some inmates at the Woodbury County Jail were released in an effort to prevent a COVID-19 outbreak at the facility, while the Sioux City Police Department announced it would be conducting fewer routine traffic stops in an effort to stem the number of infections in police officers. State and federal courts postponed some trials and hearings and urged attorneys to appear via telephone or video conference.

On March 20, the City of Sioux City suspended in-person public attendance at City Council meetings until further notice. Three days later, Sioux City hospitals postponed elective surgeries. That same week, the Warming Shelter closed its doors for the season roughly a month early over concerns that the virus would spread very quickly in the emergency shelter's tight quarters.

Siouxland District Health Department announced the first confirmed case of COVID-19 in Woodbury County on March 21, a woman between 41 and 60 years old.

Up to 60 patients a day began being tested for the novel coronavirus at a drive-thru testing site that opened March 25 on Siouxland Community Health Center's property. Patients remained in their vehicles while medical professionals dressed in light-blue gowns, gloves, masks and face shields, collected nasal swabs.

On April Fools Day, city officials shut down another facet of daily life in Sioux City, playgrounds and sport courts. But, parks and recreation trails remain opened for people to walk, jog and run.

During an April 8 interview with The Journal about the City of Sioux City’s response to the pandemic, Mayor Bob Scott said residents were doing a "great job" with social distancing and other measures to prevent the spread of the virus.

"I think if we can weather the next two or three weeks around here and the weather changes and it does get warmer, which they think will have an impact, we might come out of this in not too bad of shape, so hopefully the next two weeks will tell the tale," he said.

Seven months later, The New York Times would note in a story that although other places have had "bigger outbreaks, worse days and faster surges," few have experienced the "sustained pain" that the Sioux City metro has.

On April 20, as the number of positive tests for COVID-19 in metro Sioux City surged to 160, a top Tyson Fresh Meats official denied the company's flagship beef plant in Dakota City, Nebraska, was the main source for the COVID-19 outbreak.

"People are led to believe our plant is a vector of community spread, but that is not the case," Tyson group president Steve Stouffer said. "There is no way of knowing where our community members are getting this."

A source familiar with the situation at the plant later told The Journal that a total of 669 workers tested positive for COVID-19. Raymundo Corral, a frontline worker at the plant, was the first Woodbury County resident to succumb to the virus. The 64-year-old died at his Sioux City home on April 18.

The Sioux City metro skyrocketed to the top of the nation's coronavirus hotspots, recording daily triple digit increases in cases on April 23 and 24. The surge came as local public health officials, for the first time, appeared to link much of the outbreak to the Tyson Fresh Meats plant. Facing growing public scrutiny over the outbreak, Tyson Fresh Meats shut down the 4,300-employee facility for multiple days to deep clean the entire plant.

By May 8, Woodbury County's cumulative hospitalization rate had more than doubled the national average.

As part of their surge plans, MercyOne Siouxland Medical Center and UnityPoint Health -- St. Luke's opened intensive care units in other areas of the hospital and requested additional ventilators and personal protective equipment. To free up more ICU beds for COVID-19 patients, St. Luke's transferred some patients to other hospitals. A health care provider familiar with MercyOne, who spoke to The Journal on the condition of anonymity, described the atmosphere in the downtown hospital as "intense."

Reynolds announced on May 20 that COVID-19 cases had stabilized enough to allow indoor movie theaters, zoos, museums, aquariums and wedding reception venues to resume operations with restrictions. A week later, bars and other establishments that serve alcohol were permitted to do the same.

Also in May, Meridian Clinical Research in Dakota Dunes began conducting trials on Moderna's COVID-19 vaccine. Both Moderna's and Pfizer-BioNTech's shots are mRNA vaccines, which contain a piece of genetic code that trains the immune system to recognize the spiked protein on the surface of the virus.

Sioux City School District officials decided the 2020-21 year would begin Aug. 25, with approximately half the students attending school in person on Mondays and Thursdays, and the other half on Tuesdays and Fridays. Then, on Sept. 8, students in the district resumed full in-person instruction. Since then, various class sections have moved online and some buildings have had to close due to a substantial number of COVID-19 cases.

In early October, Sioux City hospitals began grappling with a growing second wave of COVID-19 patients and their administrators urged Siouxlanders to axe Thanksgiving celebrations with extended family members. The week of Nov. 9, Chad Markham, chief operating officer for St. Luke's, said hospitalizations were matching the spring surge.

"Any kind of gathering puts us at higher risk. I think it's time to reconsider and rethink those plans and, frankly, cancel them," he said.

Beth Hughes, president of MercyOne Western Iowa Region, said the downtown Sioux City hospital was seeing an increase in hospitalizations, but she said it hadn't quite reached the level of the spring surge. She acknowledged that hospital staff were tired, and, she implored the public to wear masks, social distance and avoid gatherings.

On Nov. 16, Reynolds announced additional COVID-19 mitigation measures, including requiring mask wearing when people are in an indoor public space and unable to social distance for 15 minutes or longer. Initially, Scott didn't think local authorities would be ticketing non-compliers. But, three days later, he said Sioux City Police officers would start issuing citations to individuals and businesses who failed to voluntarily comply.

Siouxland District Health Department Director Kevin Grieme made the long-awaited announcement on Dec. 14 that Woodbury County was slated to receive 1,950 doses of Pfizer's COVID-19 vaccine in the coming days, signaling light at the end of the tunnel. At the time, Woodbury County had 11,481 total cases of the virus and 145 COVID-19-related deaths, according to Iowa Department of Public Health statistics.

"Hopefully, some of (the vaccine) will be in Sioux City tomorrow and we'll start to give shots, hopefully, and maybe see this thing subside," Scott said during a City Council meeting later that day. "What a tragedy. We've (lost) over 300,000 lives in this country. It's just terribly unfortunate that we couldn't have done something quicker."

That Thursday, Joseph Liewer, medical director for emergency medicine at MercyOne, and Mary Jones, a critical care nurse, were the first of the hospital's employees to be vaccinated against the novel coronavirus. St. Luke's also began administering some of the first doses of the COVID-19 vaccine in Woodbury County to its frontline medical providers.

"I think the public should trust that it's gone through the rigorous analysis that it has. I think it's safe, and I encourage people to get it as soon as they can," Liewer said moments after receiving the vaccine.