BISMARCK — Several prominent doctors and medical professionals have endorsed an extension of North Dakota’s statewide mask mandate as the measure’s expiration date draws closer. Still, an unyielding faction of political conservatives contend, in defiance of medical studies, that widespread mask-wearing is not a viable strategy for slowing the spread of COVID-19.

Gov. Doug Burgum announced on Nov. 13 that residents would be required to wear a face covering in public areas when social distancing is not possible. The Republican, who previously opposed issuing a mandate, said major strains on North Dakota hospitals due to staffing shortages and rising COVID-19 cases led to his change of course on the issue.

The monthlong mandate and several restrictions on public-facing businesses are set to expire Monday, Dec. 14. Burgum spokesman Mike Nowatzki would not comment on whether the measures will be extended or allowed to expire, but he noted that the topic will be addressed at the governor’s press conference on Wednesday, Dec. 9.

The state’s health care workers fall overwhelmingly on one side of the mask question. They say the mandate has proven effective and allowing it to expire in mid-December would compromise the gains North Dakota has made in the battle against COVID-19 over the last month. Furthermore, they note the state’s hospitals are still stressed by high admissions, and pulling out of the mandate would be premature.

“To keep making progress, especially with vaccines right around the corner, we should keep doing the things that have been successful,” said Dr. Joshua Ranum, a physician at West River Health Services in Hettinger.

Fifty-six pediatric doctors and nurses, including state Field Medical Officer Dr. Joan Connell, signed onto a letter asking Burgum to extend the mandate for at least two months. The letter, published last week, cites increased mask-wearing in North Dakota and the nearly 50% drop in the state’s active COVID-19 cases since mid-November.

General mask-wearing seems to have climbed in the weeks leading up to the governor’s mandate announcement, and many doctors said the state should hold the mandate to sustain the current trend. Nearly 88% of North Dakotans said they wear masks in public on recent Facebook surveys performed by Carnegie Mellon University, up marginally from 83% the day the mandate was issued and from 70% at the start of October.

The 'fear factor'

Medical experts say the higher degree of mask-wearing and steep drop in active cases can be attributed to several different factors, including government intervention in matters of public health and behavioral shifts among residents.

State epidemiologist Grace Njau said local mask mandates put in place weeks before the statewide order likely contributed to curbing the spread of the virus in urban areas like Fargo, Grand Forks and Bismarck.

An increasing “fear factor” in the weeks leading up to the mandate announcement due to rapidly climbing COVID-19 cases and deaths also likely prompted more cautious behavior and mask-wearing, said Dr. Parag Kumar, a Bismarck pediatrician.

But experts agree the statewide mask requirement has almost certainly played a role in impeding the virus.

Kathleen Swanson, a nursing professor at North Dakota State University, called the drop in infections since the mandate “startling” and noted a definite correlation between the mask requirement and the state’s recent improvements.

Preliminary data indicate that the virus is not reproducing at the same rate it once did in more than 60% of North Dakota counties, Njau said.

Connell said the Dakotas provide a sort of case study for mask mandates. North Dakota saw a decline in its rate of positive cases after it implemented a mask requirement, where South Dakota, which has no mandate, has seen cases fall at a much slower rate.

Dr. Casmiar Nwaigwe, an infectious disease doctor at Minot’s Trinity Hospital, said the recent reversal in North Dakota’s COVID-19 trends, stemming in large part from the mask mandate, could not have come sooner for his institution. Minot became a central hot spot of the virus in North Dakota last month and stretched the staff at Nwaigwe’s hospital to the extreme, at one point claiming close to 140 hospital staffers to quarantine.

“We had nowhere else to go. We had to bend the curve one way or the other,” Nwaigwe said. “There was just no other way — Trinity would have broken.”

Although North Dakota’s active cases have fallen sharply, rates of virus-related hospitalizations and deaths — often considered lagging indicators of an outbreak — remain among the highest in the nation, according to the Centers for Disease Control and Prevention .

The state is “definitely not out of the woods yet,” Ranum said, and ending the mandate now would be the equivalent of “giving up advantages on the front line for the sake of political expediency.” He added that the full effects of Thanksgiving gatherings may not be visible yet.

Connell said possible super-spreader events, like Christmas celebrations and winter sports competitions, are just around the corner, and the state needs to continue being aggressive with mitigation efforts.

Mixed feelings

Extending the mandate is not universally popular. State Rep. Rick Becker, R-Bismarck, said Burgum should allow the mask requirement to expire because there’s no strong evidence that mask-wearing has an effect on slowing the spread of COVID-19. Becker, a plastic surgeon, added that the virus must go through a natural progression wherever it takes hold and people can do little to stop it.

Epidemiological studies have found that widespread mask-wearing cuts down on the transmission of the virus, according to the CDC.

If Burgum does choose to extend the mandate, he would have some support from lawmakers within his own party. House Majority Leader Chet Pollert, R-Carrington, said he has mixed feelings about the mask requirement but he believes the mandate should be extended for now and possibly rescinded if infection rates continue to drop.

The governor will also have to decide whether to extend occupancy restrictions on certain businesses.

North Dakota's restaurants and bars are currently required to limit on-site service to 50% of their normal occupancy, while capping the number of patrons served at 150. The establishments also must be closed to on-site service from 10 p.m. to 4 a.m.

Event venues and ballrooms are limited to 25% of normal maximum occupancy.

Connell said the business restrictions likely help slow the spread of COVID-19, but she noted it’s a very difficult task weighing that against the suppression of residents’ livelihoods.

Njau said she hasn’t been able to tease out the impact of the business limitations independently, so she couldn’t comment on their effectiveness.

Becker, who owns two bars in Bismarck, said Burgum was arbitrarily picking on restaurants and harming his constituents by stifling their places of employment. He urged the governor to reconsider the measures.

Ranum said he feels for the impacted business owners, but notes that restaurants and bars have been “major drivers of cases.”

“I don't think you can go back to 100% occupancy right now, but if cases continue on the present trend and a major post-Thanksgiving spike doesn't show up in the next week, then a loosening of restrictions should happen,” Ranum said.