Renae Moch is the public-health director for the city of Bismarck and Burleigh County, N.D.



a woman drinking a glass of wine: White House coronavirus response director Deborah Birx, left, talks with North Dakota state and local government and medical leaders during a roundtable discussion at Bismarck State College on Oct. 26. (Mike McCleary/The Bismarck Tribune/AP)


© Mike Mccleary/AP
White House coronavirus response director Deborah Birx, left, talks with North Dakota state and local government and medical leaders during a roundtable discussion at Bismarck State College on Oct. 26. (Mike McCleary/The Bismarck Tribune/AP)

As covid-19 surges across the country, one state stands out. In North Dakota, infections are, alarmingly, occurring at more than six times the national rate. How is the disease spreading so quickly through a small, rural state? And what lessons can North Dakota offer as we head into a winter season that Anthony S. Fauci, the country’s leading infectious-disease expert, has warned will bring “a whole lot of hurt”?

Part of me wishes I didn’t have answers to these questions. But as the lead public health-official for the city of Bismarck and Burleigh County, N.D., I’m sadly familiar with the ways our state has failed to take this deadly virus seriously and what it means for our communities.

When the virus swept across the United States in March, North Dakota was one of only seven states that did not issue a stay-at-home order. Residents initially followed mitigation measures, but as businesses reopened and life returned to normal, adherence relaxed — and resentment surged. The cut-out hearts in windows and the “we’re all in this together” mentality gave way to social media posts, email messages and phone calls where I was accused of being a tyrant, a socialist, a Nazi — of lying about covid-19’s dangers to instill fear and of taking away people’s personal freedom.

With this attitude, it’s not surprising that the Bismarck City Commission’s attempts to implement a mask mandate in September failed. Instead, they decided to “wait and see” and follow the state’s “guidelines and recommendations” focusing on “personal responsibility.”

The problem, of course, is that personal responsibility isn’t working. North Dakotans are carrying on with their lives as if the pandemic doesn’t exist. This is especially true in the Bismarck metro area, which has the highest number of active cases in the state.

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Burleigh County, where Bismarck is located, has seen cases increasing since mid-July, with a noticeable spike in the past two months. We saw a surge in September among the 20-to-29 age group, which included students coming back to start college. That quickly spilled into the broader community.

Covid-19 has invaded long-term care facilities, even with robust weekly testing. Social gatherings have taken place without precautions. Weddings with hundreds of guests, no masks, no socially distanced seating, self-serve buffet lines and packed dance floors have occurred regularly and resulted in large outbreaks.

The virus is everywhere, affecting every profession and demographic. We see high case counts among health-care workers, in congregate living facilities and among hospitality workers — but the outbreak isn’t limited to these occupations. Entire offices that do not have prevention protocols in place are being wiped out by the virus.

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Contact tracers have become overwhelmed. The North Dakota Department of Health recently announced the discontinuation of contact tracing, asking people who test positive to reach out to their own close contacts to notify them to quarantine. This change has likely added to covid-19’s spread across the state.

Deaths have more than doubled in the past month, and hospitals are at capacity. Rural hospitals are especially challenged. Typically, their critically ill patients are transferred to larger cities in North Dakota, which have better-resourced care facilities. But as even our larger hospitals are swamped, patients from rural areas have been sent out of state for care. Families are left behind, wondering if their loved ones will recover and return home or remain hospitalized out of state and die alone.

Health-care workers are being pushed to the brink caring for patients with no relief. Jeffrey Sather, medical director for Trinity Health’s Emergency Trauma Center in Minot, N.D., said recently that when he asks his colleagues how they’re holding up, they reveal a dreadful truth: “I have to watch someone suffocate to death, every day, and sometimes several times a day.”

This leaves all of us on the front lines of this pandemic wondering what it will take for people to finally change their behavior.

Astonishingly, there are still no statewide mitigation measures being enforced in North Dakota, leaving the task of stopping covid’s spread to local leaders. After a grueling six-hour meeting last week, the Bismarck City Commission voted 3 to 2 to approve a “pandemic mitigation strategy” requiring masks in public places and limiting social gatherings. The catch: There is no penalty for non-compliance. So while this is a step in the right direction, it won’t be enough to curb the contagion.

What our situation demonstrates is that individual cities and counties cannot stop this pandemic themselves. North Dakota’s efforts should be coordinated and led by the state, with support from the federal government. We need a statewide mask mandate with strict enforcement measures, increased lab capacity to provide timely testing, and better contact tracing and education on isolation and quarantine. These measures are working elsewhere; there’s no reason not to apply them in North Dakota.

Last week, White House coronavirus response coordinator Deborah Birx toured Bismarck and described our mitigation efforts as the worst of any of the places she’s visited. It was a depressing reminder of our state’s failures. I can only hope our approach to this disease improves quickly — before our winter of hurt arrives and too many more North Dakotans pay the ultimate price.

Read more:

The Post’s View: The coronavirus emergency is worsening by the second. We must take immediate action.

Leana S. Wen: It’s time to rethink how we celebrate Thanksgiving

Letter to the Editor: If fighting the pandemic is ‘not a job for government,’ what is?

Megan McArdle: Winter could mean a resurgent pandemic. We have to try — or dark days lie ahead.

Michael Kotlikoff and Jack Lipton: How to fix our covid-19 testing debacle? Create a Biomedical National Guard.

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