BISMARCK — The North Dakota Department of Health announced a new extreme measure to slow the spread coronavirus on a day that saw the single highest increase in confirmed cases.

State Health Officer Mylynn Tufte announced a new order Saturday, March 28, that requires travelers returning from international travel or 23 hard-hit states, including California, Arizona, New York and Florida, to self-quarantine for 14 days.

The order originally applied to residents who have returned to North Dakota in the last 14 days and those who will return in the future, but the department announced an amendment Sunday morning, March 29, that removes the quarantine requirement for people who have already returned.

The amendment also exempts essential workers, including health care workers, law enforcement and first responders, from the quarantine requirement. The department is now asking returning travelers in this category to limit interactions with other and monitor themselves for symptoms over the next two weeks.

Local law enforcement and the State Highway Patrol will enforce the order on those to which it still applies, Tufte said. Violators can be charged with a Class B misdemeanor, which could result in 30 days in prison, a $1,500 fine or both. Tufte also said residents should report their recent travel history to health department online.

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On Saturday, the department confirmed a single-day high of 26 new cases of COVID-19, the illness caused by coronavirus. A total of 94 people in the state have tested positive for COVID-19, the illness caused by the virus, but the department's website lists 18 people as having recovered from the illness.

Seven of the new cases come from Cass County, which now has the second most of any county in the state at 18. New cases have also been reported in Ward, Stark, Morton, Burleigh, Barnes, McLean, Mercer Mountrail, Divide and Sioux counties. However, Gov. Doug Burgum has previously said that the cases are reported based on patients' mailing addresses, rather than their actual location in the state.

Sixteen patients remain hospitalized with the illness, and Burgum announced Friday a Cass County man in his 90s was the state's first fatality.

A Mandan nursing home confirmed one of its residents tested positive for COVID-19 after returning from a local hospital. The resident of Good Samaritan Society Sunset Drive was initially put in isolation with a fever and then taken back to the hospital after the positive test. Sanford Health, which is a partner in running the nursing home, said it notified all residents of the facility and will take extra measures to monitor those who may have been exposed.

A total of 3,107 tests for the virus have been reported to the state, and 18 counties have at least one known case of the illness. Nearly half of the positive tests have come from Burleigh and Morton counties, which includes the Bismarck-Mandan area, but cases have recently been climbing in Cass County.

Adjutant General Alan Dohrmann also spelled out the state's planning Saturday for a worst-case surge in cases and hospitalizations. He said the state's 55 hospitals are looking at ways to expand the number of COVID-19 patients they can handle, but staffing and equipment limitations mean there are currently only about 2,100 hospital beds, including about 183 intensive care unit beds. Hospitals may be able to internally ramp operations up to about 2,400 beds, and with a significant boost in resources from the state, the health care system could operate around 4,800 beds.

Dohrmann said the state is currently planning for the most dire circumstances in which dorms and other facilities at North Dakota State University in Fargo and Bismarck State College could be used as temporary hospitals. Representatives from the U.S. Army Corps of Engineers will come to the state next week to help evaluate the logistical implications of taking such a dramatic step, but Dohrmann said the move could add more than 4,000 additional beds to the state's capacity. The state would almost certainly have staffing shortages in this scenario, he said.

The state currently has 408 ventilators ready for use throughout the state, Dohrmann said. The machines, which mechanically deliver breaths to someone who cannot breathe, are often critical in saving COVID-19 patients and have been in short supply worldwide since the pandemic began spreading.

Burgum said a statistical model predicted the state could see between 600 and 1,300 known cases in three weeks, but mentioned that he has "very low confidence" that the model is completely accurate given the small amount of data collected in the state. He said since current testing is a slow indicator, there could already be 1,000 cases in the state.

The state arrived at a potential inflection point in the fight against the virus on Thursday when community spread overtook travel as the most common source of exposure. Community spread means the virus was not contracted through travel or exposure to a known case and implies that someone else in a community has the illness but has not yet been tested. The governor said Saturday residents should operate as though the virus is in their community and take measures to avoid contact with other people.

Burgum also announced Saturday that all 175 public an private school districts in the state had filed "distance learning" plans, which may include virtual education, with the Department of Public Instruction. If the plans are approved, schools will teaching students on Wednesday, April 1. Nearly 50 submitted plans have already been approved by the department and the governor's office.

Meanwhile, many North Dakotans are struggling to keep their heads above water as hundreds of businesses across the state have laid off or furloughed workers due to the virus' stranglehold on the global economy. Job Service North Dakota received nearly 18,000 claims for unemployment benefits over the last 10 days. The staggering figure makes up nearly 4.5% of the state's civilian workforce, according to the federal Bureau of Labor Statistics.

President Donald Trump signed Friday a $2 trillion stimulus package designed to aid American businesses and workers struggling with the economic consequences of shutting down much of the country's business activity.

Every state now has at least 50 confirmed cases of the illness — New York State has been hit the hardest, with more than 44,000 known cases and more than 500 deaths. Minnesota has 441 known cases and five deaths, and South Dakota had announced 68 positive tests and one death as of Saturday evening. The Dakotas have among the lowest numbers of positive tests in the country.

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