inspectors would be allowed to wear masks if the meatpacking plants' owners gave the federal employees permission to do so. Inspectors were expected to supply their own masks. A month later, after publication of the risk for spreading the coronavirus, the USDA at last started giving its inspectors masks. Noem had said that the plant was in full operation as an essential food manufacturing facility. Forty-eight of Smithfield's workers were hospitalized. On April 6, Noem issued an executive order that said people "shall" follow guidance from the Centers for Disease Control and Prevention; she also ordered everyone over age 65 in Minnehaha and Lincoln counties to stay home for three weeks. Noem did not mandate social distancing or the wearing of face masks at a July 3 event at Mount Rushmore with Trump present. Health experts warned that large gatherings without social distancing or mask-wearing posed a risk to public health. Noem doubted scientific recommendations on the usefulness of masks. In an opinion piece in the Rapid City Journal, she defended her views, citing analysis by the Association of American Physicians and Surgeons, a group known for promoting pseudoscience. The Association of American Physicians and Surgeons had called vaccination the equivalent of "human experimentation." COVID-19 patients hospitalized on October 22 reached a record high of 355, including 75 in Intensive Care Units. South Dakota's two largest hospital systems rescheduled elective procedures to increase available space and personnel to accommodate the surge. In the absence of a statewide mask mandate, hospital systems urged people to wear masks while in the company of those outside their own households. Sioux Falls Mayor Paul TenHaken advised his constituents, "Wear a dang mask." Sixteen weeks after Trump's executive order that provided enhanced weekly unemployment benefits of $300 as part of the U.S. federal government response to the pandemic, Noem opted out of the program, citing a low state unemployment rate. South Dakota was the only state to refuse the assistance. Its jobless rate in June was 7.2 percent, up from 3.1 percent in March, though down from 10.9 percent in April. Acceptance of the funding required the state to augment the benefit by $100 unless other jobless assistance allowed the match to be waived. In February 2020, Noem announced her opposition to a bill prohibiting schools and universities from requiring students to get vaccinated. In May 2021, she signed an executive order prohibiting government facilities