FARGO — Public health officials who grappled with an outbreak of the coronavirus at GPK Products that infected at least 10 employees recommended that the plant shut down for 14 days.

The recommendation, outlined in a May 13 email obtained by The Forum, was made by a state of North Dakota epidemiologist who was working to contain the outbreak at the north Fargo plant, where an estimated 200 employees manufacture plastic pipe products.

But company management rejected the health official’s request, even though some infected employees had continued to work — and one employee who contracted COVID-19 died May 31, a little more than two weeks after the request to shut down was spurned.

The case illustrates the state’s heavy reliance on employers’ voluntary compliance in taking recommended steps to contain the contagious virus and highlights the vulnerable position employees are in, according to a leading North Dakota labor advocate.

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North Dakota’s disease control director conceded that the state ordinarily issues guidance — not requirements — in dealing with workplace exposures to infectious diseases like the coronavirus.

Five GPK employees who were infected with the coronavirus had continued to work at the plant, according to the email from epidemiologist Laura Cronquist to colleagues at the North Dakota Department of Health.

“Since they’ve had five cases work while infectious over the past 14 days with no known exposures outside the workplace, I strongly recommended closing for our recommended 14 days with no known exposures outside the workplace,” Cronquist wrote.

RELATED: Plant worker quit due to coronavirus safety concerns, lack of action from company and state

“The company president told me in no uncertain terms that he has no intention of doing so,” she added. “He did say that they will try to increase ventilation throughout the building, encourage the use of masks, continue to screen employees prior to beginning their shifts, and increase the frequency of cleaning and disinfecting.”

GPK President Bradley Keller said the company’s refusal to close the plant was because it is an essential business. He declined to discuss the decision further, or answer other questions submitted by The Forum via phone and email, saying he would not discuss matters involving employees with COVID-19.

North Dakota’s “smart restart” plan does not define essential workers or distinguish essential from nonessential workers, but recognizes federal guidelines defining an essential worker, a health department spokeswoman said.

Cronquist’s email was forwarded to Tammy Miller, Gov. Doug Burgum’s chief operating officer, who followed up with Mylynn Tufte, who resigned abruptly on May 27 as state health officer, the top position at the North Dakota Department of Health.

"Let me know what you recommend,” Miller told Tufte. “Do we need an order?”

Tufte replied, “I do have that authority as SHO (state health officer)” and included a state law that gives the health officer authority to order disease control measures including immunizations and decontamination.

An order to close public events or places of business, however, would require health officials to seek a judge’s approval.

The Forum wasn’t given access to any follow-up emails. The email exchange was included in documents provided in response to a request for written communications involving Tufte around the time of her departure, and health officials later said the documents discussing GPK shouldn’t have been released because they cannot comment on an individual business.

Fargo-Cass Public Health conducted a workplace assessment at GPK and made safety recommendations, according to a statement from the agency, but the response did not indicate whether any follow-up steps were taken to ensure adherence. The Red River Valley COVID-19 Task Force also was involved, in an advisory role.

One of the infected GPK employees, a woman in her 60s, developed COVID-19 and died May 31 of respiratory distress and pneumonia, according to a family member. The Forum is withholding the worker’s name at the family’s request.

In the end, neither state nor local public health officials ordered the plant to close.

Guidelines with no teeth

Mike Nowatzki, a spokesman for the governor’s office, said the GPK outbreak was one of three Fargo businesses at the time experiencing similar numbers of infected employees, and the plan was for each company to shut down for 72 hours to conduct deep cleaning and inspection, test all employees and evaluate reopening options.

Miller, who served on the Red River Valley COVID-19 Task Force, was consulted because she was involved in “mitigation and remediation efforts with local companies at that time,” Nowatzki said in an email. “As the pandemic evolved and more was learned about COVID-19 transmission, prevention and mitigation, there was increased cooperation with businesses to help them safely reopen or remain open, with employee and customer safety always the primary consideration.”

But a former GPK employee, Kalyn Bjorgum, said only one department at the plant shut down for cleaning for one day, and other areas of the plant were not shut down for cleaning. Bjorgum said he quit his job in May, before the death of a co-worker, because of concerns that the company was not doing enough to ensure employees’ safety.

Landis Larson, president of the North Dakota AFL-CIO, the state’s leading labor organization, said the GPK outbreak demonstrates the lack of teeth in the state’s approach to protecting workers from infectious diseases.

“A lot of the guidelines are just suggestions,” he said. “They’re not solid rules that they have to follow.”

Even in cases with union representation, workers have had to prod employers to take safety precautions against COVID-19, usually only after the workers’ concerns were made public, Larson said.

“So I can only imagine what it’s like in the non-union places,” he said.

Many workers who don’t have a union behind them are afraid to speak out about their health and safety concerns for fear of losing their jobs, so many problems never surface publicly, Larson said.

The refusal by GPK Products to shut down after at least 10 workers tested positive is an illustration of the shortcomings of unenforceable guidelines, Larson said. Employers should want to protect their employees, but the state should step in when workers are left unsafe, he said.

“If it’s all voluntary, that’s not much,” Larson said. The AFL-CIO and other labor unions are pushing for Congress to add communicable disease standards for the Occupational Safety and Health Administration, or OSHA, to enforce.

Under current law, OSHA requires employers to provide a safe and healthy work environment, but does not have specific provisions for infectious diseases, he said.

'Not every business is going to cooperate'

Kirby Kruger, director of disease control at the North Dakota Department of Health, said health officials would need an order from a judge to close a business that refused to do so voluntarily, action that hasn’t been sought so far in the pandemic.

Instead of seeking shutdown orders, health officials work with businesses to help reduce the spread of disease, an approach Kruger acknowledges relies heavily on voluntary adherence.

“The more we can do that without mandates the better off we are in the long run, I think,” Kruger said.

Still, he acknowledged, “Not every business is going to cooperate. Many of them do, but not all of them do all the time.”

By contrast, state health officials did step in with an order — directed at employees — in response to a large outbreak at a manufacturing plant in Grand Forks.

In April, Tufte issued an order requiring all employees of LM Wind Power in Grand Forks to quarantine away from the manufacturing plant for 14 days. Violators faced up to 30 days in jail and a $1,500 fine.

Although employees were subject to the order, the mass quarantine effectively shut down the plant for the duration.

The order came when more than 120 workers had tested positive for the coronavirus, and health officials determined that the infection was spreading outside the plant to the surrounding community at a time when there were few cases around Grand Forks, Kruger said.

“Increased transmission poses a substantial threat to the public health and the health care system,” the order said. “Quarantine is necessary and the least restrictive alternative to protect and preserve the public health and to reduce the significant burden on the health care system.”

Although state health officials haven’t yet sought an order to close a business due to the pandemic, that action remains available, Kruger said.

“That’s always a tool that’s always in the back of our mind,” he said. “Maybe not in the back of our mind, it’s an option.” The option would be considered, he added, if officials “truly believe” there is a risk to public health.