FARGO — The rate of positive tests for coronavirus infection in Cass County once was more than three times the state rate, but has fallen sharply and now modestly exceeds the state rate.

At the outset of the coronavirus pandemic in March, Cass County's positive rate among those tested for the virus was 9.6%, compared to the statewide rate of 2.8%, said Tammy Miller, Gov. Doug Burgum's chief of operations.

Cass County's most recent 14-day rolling average was a 2.54% positive rate, compared to 1.8% for the state overall, Miller told fellow members of the Red River Valley COVID-19 Task Force during a briefing on Wednesday, July 15.

"So a big congrats to the task force and the community for your success," she said. Miller credited the task force's strategy, the centerpiece of which was a shift from mass testing to targeted, repeat testing of vulnerable groups, with driving the numbers down.

Although there once were concerns among some that Cass County was holding the rest of the state back in reopening North Dakota's economy, that is not the case, Miller said.

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"Cass County is not slowing our state's restart," she said. "Cass County is making great progress."

As North Dakota's most populous county, Cass emerged early on as the pandemic's epicenter in North Dakota, once accounting for 70% of the state's COVID-19 cases. As of cases reported Wednesday, Cass's 2,522 cases comprised 55% of the state's total.

North Dakota has been at a risk level of green since May 29, the second-lowest of five levels outlined in the state's "smart restart" plan for reopening businesses, Miller said.

That level allows schools and businesses to reopen — although officials continue to urge people to take precautions, including maintaining a safe distance from others, maintaining hand hygiene and wearing masks indoors when adequate distancing is not possible.

"We've been in the green zone for a while, but the mission is not over," Miller said, echoing a message from local officials during the briefing, who noted that cases have started to climb again after declining in late May and June.

People should continue practicing "coronavirus etiquette" to help contain the virus, she said.

Fargo Mayor Tim Mahoney and others noted that several cities in Minnesota have adopted mask-wearing mandates, including Minneapolis, St. Paul, Edina, Minnetonka, Mankato, Rochester and Duluth.

"The enforcement is always the tricky part," he said. In Duluth, masks are required to enter restaurants and bars, retail businesses, gyms, entertainment venues and to use public transportation, he said.

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Failure to wear a mask in Duluth is not a criminal violation. Instead, patrons are asked to leave and if they don't comply are subject to trespassing and a business could lose its license, Mahoney said.

North Dakota officials, including Burgum, "strongly recommend" wearing masks indoors when distancing isn't possible, but have refrained from imposing mandates.

There is a growing body of scientific evidence that mask-wearing is an effective way to prevent transmission of the virus, said task force member Dr. Paul Carson, an infectious disease specialist and public health professor at North Dakota State University.

A Missouri study found that two hairdressers had COVID-19 and continued to work, but did not transmit the virus because they and their patrons wore masks, he said.

A study published in the Canadian Medical Journal found that a man who had the virus and coughed throughout a 15-hour flight from China to Canada didn't transmit the virus because he wore a mask.

Although North Dakotans sharply curtailed travel after the pandemic struck in March, travel has returned to pre-pandemic levels, considered a gauge of more lax social distancing. "We're not hanging tough at home like we were," Carson said.

In Cass County, the average age of those who test positive for the virus has dropped sharply, from 45 to 35, said Brenton Nesemeier, a field epidemiologist for the North Dakota Department of Health in Fargo.

Although younger people are less likely to become seriously ill, they also form a big part of the workforce and therefore could spread the virus to vulnerable populations, including the elderly, he said.

Also, younger people have more active social lives, bringing them into contact with others. "That just leads to more people who have to be quarantined, more people we have to contact and follow up on," he said.

If people are conscientious about taking precautions, Nesemeier said, "We can hammer down the virus," and more quickly return to the normalcy everyone craves.