The country’s top coronavirus hotspot is in Sioux Falls, South Dakota. The Smithfield Foods plant, as of last Wednesday, now tops both Chicago’s Cook County Jail and the USS Theodore Roosevelt because of the number of localized cases. 644 people with connections to the plant were infected, including 518 employees, as of Wednesday.

Nine days ago I wrote about this pork processing plant in South Dakota. At that time, 80 employees had tested positive for the virus, while the employees’ union said that 120 were confirmed to have the coronavirus. In response, the plant, which employs 3700 people, planned to shut down for three days. During that time, the plan included deep cleaning and sanitizing the processing plant and also installing plexiglass to enhance social distancing practices.

The number of South Dakota residents who have tested positive for the coronavirus is now more than 1,100 and more than half of those cases have a connection with the pork processing plant in Sioux Falls. As employees became sick, the plant remained open. Governor Kristi Noem is not declaring a stay-at-home order despite the request for it from Sioux Falls Mayor Paul TenHaken. She said such an order wouldn’t have made a difference and the plant is part of the critical infrastructure business.

“What we are doing each and every day by getting up and using personal responsibility and taking actions at the local and state level, it is working,” Noem said. “We are flattening our curve in South Dakota.”

“This plant here is incredibly important, not just to Sioux Falls, not just to South Dakota, but to our nation. It provides our food for us,” Noem said.

Noem said the Department of Health does a high level of contact tracing with people who test positive for COVID-19 and the state is isolating people in their homes and at hotels, KELO-TV reported.

Governor Noem is taking a hard stance on refusing to issue a stay-at-home order in South Dakota. Her job as governor is to determine what is the best way forward for her state. The company has now shut down indefinitely. Noem says she’s working with federal leaders and company officials to get it back up and running. She also announced a comprehensive trial of hydroxychloroquine to see if it is effective in treating COVID-19.

There are several other trials being conducted elsewhere. Noem said Tuesday that the South Dakota trial, which will include 2,000 patients, has already begun after the state received 1.2 million doses of hydroxychloroquine from the federal government.

South Dakota’s death toll remained at six on Tuesday, with no new deaths reported in the state. Reported hospitalizations from the disease increased to 45. Of all reported cases, 261 people have recovered.

The CDC is currently assessing conditions and developing an action plan needed to safely reopen the plant. It has been closed for more than a week.

The Centers for Disease Control and Prevention had staff in Sioux Falls on Thursday touring the Smithfield Foods, Inc. plant. That step comes three weeks after the first COVID-19 case involving a Smithfield employee was determined on March 24.

Noem said Thursday that the state expects to have a report from the CDC in the coming days, and that it will be released to the public. The governor also said she’s been in close contact with the plant’s CEO as well as U.S. Agriculture Secretary Sonny Perdue.

The Sioux Falls plant counts for as much as 4% to 5% of pork production in the country. In North Carolina, Smithfield’s Bladen County facility continues to operate. It is the world’s largest pork processing plant. An employee has tested positive for the coronavirus at the plant in Tar Heel, North Carolina. This happened just days after Smithfield closed several other plants.

Smithfield closed three meatpacking plants this week, starting with a large facility in Sioux Falls, South Dakota. The company said Thursday that it would close two other plants in Cudahy, Wisconsin, and Martin City, Missouri, that rely on the Sioux Falls processing plant. The domino effect is happening now, according to Smithfield CEO Kenneth Sullivan, pointing to the bottleneck of the food chain.

In a news release, Smithfield CEO Kenneth Sullivan said, “The closure of our Martin City plant is part of the domino effect underway in our industry. It highlights the interdependence and interconnectivity of our food supply chain. Our country is blessed with abundant livestock supplies, but our processing facilities are the bottleneck of our food chain.

“Without plants like Sioux Falls running, other further processing facilities like Martin City cannot function. This is why our government has named food and agriculture critical infrastructure sectors and called on us to maintain operations and normal work schedules,” he said.

It’s not just the supply chain of pork products that is being disrupted. Two of America’s largest beef packing companies closed down and will remain closed until April 24. JBS USA in Greeley, Colorado employs 6,000 people. Its Souderton, Pennsylvania, beef production facility closed before the Colorado plant. National Beef Packing Co. closed its Tama, Iowa, facility until April 20.

Questions have been raised about Smithfield, owned by the Chinese company WH Group Ltd since 2013, under its CEO, the billionaire Wan Long. It is the largest pork producer in the world. The workers, like others who work in the food industry, are deemed essential workers and continue to show up for work, if possible. They don’t have the ability to remain at home and still bring in a paycheck. The jobs are considered low-paying ones. The BBC has an in-depth piece on the spread of COVID-19 in the food processing industry.

The workforce at Smithfield is made up largely of immigrants and refugees from places like Myanmar, Ethiopia, Nepal, Congo and El Salvador. There are 80 different languages spoken in the plant. Estimates of the mean hourly wage range from $14-16 an hour. Those hours are long, the work is gruelling, and standing on a production line often means being less than a foot away from your co-workers on either side.

The BBC spoke to half a dozen current and former Smithfield employees who say that while they were afraid to continue going to work, deciding between employment and their health has been an impossible choice.

“I have a lot of bills. My baby’s coming soon – I have to work,” said one 25-year-old employee whose wife is eight months pregnant. “If I get a positive, I’m really worried I can’t save my wife.”

Meat shortages are occurring in some spots across the country due to disruptions in the food supply chain. Experts are confident that the problems will correct themselves in the next couple of weeks.

The names of Cudahy, Wisconsin and Martin City, Missouri were corrected from the original version of this article.