LAKOTA, N.D. — Doris Karas has worked at Lakota Drug and Gift Pharmacy, tucked along a small-town main street in the heart of Nelson County, for more than 20 years. This last one has been a bit different.

"At the beginning, it looked really scary, but now everybody's kind of laying back, not really wanting to wear their masks,” she said recently. As of last week, the pharmacy still requires them, she said.

But now, more people are getting their COVID-19 vaccines. And Nelson County, with a population of about 3,000, is a statewide leader; according to a New York Times database, it is the most vaccinated county in the state, with more than half of all residents fully vaccinated. It’s a remarkable feat of public health and a harbinger that things, soon, will change.

Of North Dakota's 53 counties, three top the 40% plateau, including Nelson (51%), Cavalier (43%) and Rolette (41%). Twenty-two counties have vaccination rates between 30% and 40%, and 21 counties are between 20% and 29% vaccinated.

Seven North Dakota counties have vaccination rates lower than 20%, with Slope County — in the southwest corner of the state — ranking last, at 7%.

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As COVID’s grip loosens on American life, there’s growing pressure to take off the mask, leave the hand sanitizer at home and cram back into crowded restaurants. That's not just in Nelson County, but all over the country.

Questions about how much longer Americans have to keep up the pandemic routine are creeping into the national conversation in a way they didn’t just a few short months ago, with the CDC announcing in recent weeks that fully vaccinated people can do a whole list of new things. Fully vaccinated people, for example, don’t have to wear masks outdoors unless they’re in a large crowd of people they don’t know.

RELATED: Read more about the CDC guidelines for vaccinated persons

For Americans who have shrugged off the virus — against the warnings of public health officials — that might not change much. But for tens of millions more, those guidelines are a peek at a rapidly shifting status quo that likely will soon see millions re-emerge from quarantines and lockdowns.

Julie Ferry, the public health administrator at Nelson-Griggs District Health Unit in McVille, N.D., is the chief public health official in the area. She offered a broad rule for getting back out into public: Once you’ve been vaccinated, you can get out and do things again.

But, she said, be smart about it.

"Is there spacing in the restaurants, or are we all crowded in a beer garden this summer for a celebration?" Ferry offered. The same would hold true for a movie theater or a crowded mall or a question about masking. If in doubt — or if it seems like it’s still a safer idea — keep distanced and keep the mask on.

Ferry is loath to be much more precise, because it’s still so hard to know what the summer will look like. And it’s true that, despite rising numbers, there’s still widespread vaccine hesitancy in North Dakota. On the western side of the state, there’s a lingering, incorrect impression that vaccines are unusually unsafe; in many counties, the vaccination rates trail the state as a whole significantly.

RELATED: 'Vaccine hesitancy' takes hold in western North Dakota, threatening herd immunity

Ferry said her staff was able to beat back those hesitations by building on relationships in the community. It also helped that vaccines were trickled out first to emergency responders, who went back to communities around the county.

“The percentage of Nelson County getting vaccinated, I'm not sure I can explain what the higher percentage is. I know we've encouraged people to get vaccinated, we've done a lot of Facebook posts. We've answered a lot of questions one-on-one,” she said. "We have worked hard to build relationships throughout my career with these different entities. I don't presume to tell a fireman how to do their job. I trust the fireman. The fireman trusts me to do my job."

Vaccine hesitation can be a hard thing to crack, because it’s also following political patterns. A New York Times analysis published in April found that states with higher shares of Trump voters have more vaccine hesitancy and lower vaccination rates.

Ferry, though, has kept encouragement to get the shot strictly apolitical.

"As a public health nurse, I don't really care if you're a Democrat or a Republican. I want you to get vaccinated," Ferry said.

Many politicians are getting their vaccines already, helping publicly advertise their efficacy. North Dakota’s Sen. John Hoeven and Rep. Kelly Armstrong, both Republicans, were vaccinated by late March. At that time, the office of their GOP colleague, Sen. Kevin Cramer, said he would be getting his first shot of either the Pfizer or Moderna COVID-19 vaccine in April.

Brad Hooey is the mayor of Lakota. He got his vaccine in March and he’s hoping he can lead by example. He knows people are wary to get the shot — of being “guinea pigs,” as he puts it, in a quick rollout of a relatively new and untested treatment. But he said he’s relishing in a newfound freedom.

"I believe in freedom of choice. And I choose to get vaccinated,” Hooey said. “I feel more secure about going out and seeing people now. I'm not scared about contracting disease or even giving one. I feel more secure. I feel healthy."

North Dakota's vaccination rate

Following is North Dakota's county-by-county vaccination rate as of April 28, according to a New York Times database. Of North Dakota's 53 counties, Nelson County (51%) has the highest vaccination rate; Slope County (7%) has the lowest.

  • Adams, 34%; Barnes, 38%; Benson, 21%; Billings, 12%; Bottineau, 35%; Bowman, 23%; Burke, 24%; Burleigh, 30%;
  • Cass, 37%; Cavalier, 43%; Dickey, 36%; Divide, 28%; Dunn, 13%; Eddy, 37%; Emmons, 22%; Foster, 37%;
  • Golden Valley, 19%; Grand Forks, 34%; Grant, 12%; Griggs, 36%; Hettinger, 24%; Kidder, 21%; LaMoure, 34%; Logan, 22%;
  • McHenry, 27%; McIntosh, 28%; McLean, 29%; McKenzie, 11%; Mercer, 25%; Morton, 26%; Mountrail, 23%; Nelson, 51%;
  • Oliver, 16%; Pembina, 35%; Pierce, 31%; Ramsey, 38%; Ransom, 39%; Renville, 24%; Richland, 34%; Rolette, 41%;
  • Sargent, 39%; Sheridan, 26%; Sioux, 23%; Slope, 7%; Stark, 20%; Steele, 34%; Stutsman, 33%; Towner, 34%; Traill, 33%;
  • Walsh, 33%; Ward, 27%; Wells, 28%; Williams, 15%.