BISMARCK — With no signs that the COVID-19 outbreak in North Dakota is easing up, doctors in the state are desperately petitioning local leaders and residents to get on board with mask-wearing.

Physicians and health officials have promoted masks, social distancing and hand-washing for months, but with mounting deaths in nursing homes, hospitals teetering on maximum capacity and record infection rates, North Dakota’s medical community is sounding the alarm.

Sixty-five pediatricians in the state signed an open letter sent to Gov. Doug Burgum on Tuesday, Oct. 13, asking him to institute a mask mandate. They warned that “until there is an effective and safe vaccination, masking is all that stands in the way of North Dakota and a public health disaster this winter.”

A separate group of more than 100 doctors published a letter last week urging residents to comply with mask guidelines, but they stopped short of calling for a statewide mask requirement.

North Dakota is one of about 15 states that has not put a mask mandate in place. Burgum has repeatedly rejected the measure, saying that residents should be trusted to act responsibly and wear face coverings voluntarily. Burgum and other officials have noted that many North Dakotans have opted against mask-wearing.

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The Republican governor has also said the state is relying on local leaders to make decisions.

Burgum met on Wednesday, Oct. 14, with 14 mayors from the state’s largest cities to discuss local pandemic responses a day after leaders from Fargo, West Fargo, Grand Forks, Minot and Bismarck signed onto an open letter imploring residents to wear masks.

Grand Forks Mayor Brandon Bochenski, who personally opposes a mask mandate, said there was no consensus in the meeting about issuing a requirement. Burgum noted Wednesday that some mayors have lobbied for a statewide mandate, though he declined to name them.

Fargo Mayor Tim Mahoney, who did not directly answer whether he favors a mandate, said the city would "push hard" to encourage mask use among residents and businesses.

"If people don't start respecting the disease, we're heading back to economic shutdown," Mahoney said.

North Dakota’s field medical officer, Dr. Joan Connell, said residents need to open their eyes to the dire reality and wear masks in public, whether the practice is compulsory or strongly recommended.

“The core issue is that there are a few people in our state who feel like their individual rights to not wear a mask and not have to follow a quarantine and not isolate supersede the rest of our rights,” Connell said. “You might value personal rights and the Constitution, and so do I, but I also respect life. I don’t know why those can’t occur concurrently.”

Connell, who once publicly advocated for a local mask mandate in the Bismarck metro area, said the crucial next step will be getting all North Dakotans to see how they can benefit humanity by wearing a face covering. The doctor said there needs to be stronger support for mask-wearing, social distancing and quarantining from local and state leaders because the tone they strike can persuade their constituents to take proven precautionary measures.

“I am at the point of pleading with leaders who have really stood up for personal rights to look at the situation now, including the financial consequences of these choices, and reassess their decisions and what they’re recommending to their followers,” Connell said. “We all have to be role models and have consistent messaging for the public to buy in.”

Dr. Joan Connell serves as North Dakota's field medical officer and as a pediatrician at CHI St. Alexius Health in Bismarck. (Photo courtesy of CHI St. Alexius)
Dr. Joan Connell serves as North Dakota's field medical officer and as a pediatrician at CHI St. Alexius Health in Bismarck. (Photo courtesy of CHI St. Alexius)

Connell declined to name specific politicians who have failed to promote masks and social distancing, though she noted that Burgum has not undersold the severity of the outbreak as some critics have alleged.

The still-growing outbreak has taken a painful toll on the state in the last two months, and Connell said the winter months could bring more suffering.

That prognosis could be even grimmer if residents continue to reject public health guidelines, she said. Continued widespread transmission of the virus will bring higher insurance premiums, a lack of access to health care and more “unnecessary deaths” in the doctor’s estimation.

Doctors say state ignored their advice

Even as health care workers have staked their positions more publicly in the last week, many doctors said they have been urging the state to implement a more aggressive pandemic response for months.

Multiple members of the state’s Physicians Advisory Group vented frustration that state leadership never heeded their advice. Until it was disbanded by former State Health Officer Andrew Stahl in early August, the committee of several dozen doctors advised the Department of Health on its pandemic response.

“There was a lot of frustration because I think it was very clear to a lot of us that some simple measures needed to be done, but nothing was being done,” said Dr. Jeffrey Sather, chief of staff at Trinity Health in Minot, of the advisory committee. “I think the feel of the group, was, you know, we were asked to advise, and then none of the advice was taken.”

Sather also lamented that state leaders have prioritized political expediency over the recommendations of medical experts, noting that the doctors group pushed the health department to install a statewide mask mandate months ago.

“We have a government — starting out with our president, all the way down — that does not want to impose that on the public,” he said. “It seems to become much more political than science-based. And rather than doing what’s best for the overall population, we seem to be doing what’s politically popular at the moment, and it certainly is popular to defy reason and push for just individual rights.”

And while Sather acknowledged that most North Dakota residents have “not been responsive” to masking and social distance guidelines, he pointed the finger higher in the state’s chain of command. Citing misleading reports on the availability of hospital beds, he argued that the department has failed to adequately inform the public about the urgent situation in the state’s health care system.

Dr. Jane Winston, a geriatrician who recently retired from her practice at Sanford in Fargo, also questioned why Burgum, rather than medical professionals, has taken such a central role in directing the state’s pandemic response.

“(Burgum) is talking about COVID math, he’s looking at all the numbers, but then he says there’s all these other factors,” she said. “Every day I see those death numbers. I mean, oh my God. It is just astounding.”

Winston questions the level of medical guidance that the state has received since it dissolved the physicians committee two months ago, calling operations at the Department of Health “amateur hour.” She argued that interim health officer Dirk Wilke, who serves as the department's chief operating officer, is underqualified to steer the department through the worst of the pandemic and called on the state to reinstate an advisory panel of health experts from across the state.

“We’re not talking about parking tickets here — we’re talking about people dying,” she said.

Some contributors to the Physicians Advisory Group were hesitant to push the state for a measure as extreme as a mask mandate, said Dr. Casmiar Nwaigwe, an infectious disease specialist at Trinity Health in Minot and a member of the committee. But Nwaigwe, an avid proponent of a mandate, said he urged his peers not to make political calculations, maintaining that health care workers should not temper their demands to the state.

“Ultimately it’s up to the powers that be to decide what they want to do,” Nwaigwe said. “As a scientist, as a doctor of health and as a public health practitioner it would be a dereliction not to tell them what it is right to do.”

With the virus continuing to spread at an unmitigated pace, Sather predicted that things will get much worse in North Dakota before getting better. The state’s hospital staffing crisis has added new strain to ambulance transport, he said, and contributed to a “spiral of decreasing ability to care for people” that could lead to more cases, more hospitalizations and more deaths heading into the winter.

“I think what we’ve seen change over the last two months will continue, if not get even worse, over the next two months,” Sather said.

Clarification: An earlier version of the story incorrectly stated that interim State Health Officer Dirk Wilke is an attorney. He holds a law degree from the University of North Dakota, but he is not an attorney.