BISMARCK — Manitoba will enter a monthlong lockdown with mandatory business closures and travel restrictions after leaders in the Canadian province determined the extreme steps were necessary to curb a climbing COVID-19 case count.

Just across the border, doctors in North Dakota say the state is fighting a far more severe outbreak with its hands tied behind its back. Republican Gov. Doug Burgum has declined to close businesses or issue stay-at-home orders in any hard-hit counties, defying his administration’s own guidelines.

“We are at the point where just doing piecemeal things may not get us out of this mess. We may need to adopt something that is very drastic and slowly dig ourselves out,” said Dr. Casmiar Nwaigwe, an infectious disease specialist at Trinity Health in Minot. “Lockdown should be one of the options — completely locking down everything and slowly reopening.”

North Dakota’s worst-in-the-nation outbreak is in a different league than Manitoba’s recent surge in COVID-19 cases and deaths. The state has twice as many active cases and nearly six times as many virus-related deaths as Manitoba despite having a little more than half the province’s population. North Dakota also has more residents hospitalized with COVID-19, adding to the extreme pressure felt by hospitals battling severe staffing shortages.

But conservative Manitoba Premier Brian Pallister solemnly announced in Winnipeg on Tuesday, Nov. 10, it was time for the province to take extraordinary but “essential” measures to preserve health care capacity and protect vulnerable residents.

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The new restrictions halt in-person dining at restaurants and mandate the closure of churches, gyms, barbershops, libraries and movie theaters, though schools remain open. Social gatherings and travel to and from northern Manitoba will be forbidden when the rules take effect on Thursday, and residents can be fined more than $1,000 for violating the orders.

Dr. Brent Roussin, the province’s chief public health officer, said the orders are a “circuit-breaker” for the virus that will help residents and businesses return to some semblance of normalcy in the near future.

Dr. Brent Roussin, Manitoba's chief public health officer, speaks at a press conference earlier this year in Winnipeg. Screenshot via Manitoba Government YouTube account
Dr. Brent Roussin, Manitoba's chief public health officer, speaks at a press conference earlier this year in Winnipeg. Screenshot via Manitoba Government YouTube account

North Dakota’s neighbor to the east is also taking new steps to impede the virus. Democratic Minnesota Gov. Tim Walz announced Tuesday the state will implement restrictions on social gatherings and curfews on in-person dining at restaurants.

Walz implored Burgum and South Dakota Gov. Kristi Noem to put in place more effective virus mitigation policies as the pandemic rages throughout the region.

"Cities and counties across North Dakota have recently adopted additional mitigation measures, including masking measures in our two largest counties bordering Minnesota, and we will continue to collaborate as neighbors with Minnesota in both testing and treating patients from across the border," said Mike Nowatzki, a spokesperson for the governor's office.

Nowatzki added that, while North Dakota is always evaluating response strategies like those deployed in Minnesota and Manitoba, "states will only be successful at slowing the spread if individuals exercise personal responsibility" by social distancing, complying with mask guidelines and steering clear of large gatherings.

Burgum has stuck to his guns on an approach that minimizes government intervention and relies on residents and businesses to make responsible choices for themselves. The governor has repeatedly rejected the idea of issuing a statewide mask mandate, though he has recently expressed support for mask requirements put in place by local governments in most of the state’s biggest cities.

Many North Dakota counties meet two of the three main criteria for the "critical risk" level on the state’s official COVID-19 color gauge, but Burgum has never moved a county to the red-coded status. The highest risk level would come with mandatory business closures and a stay-at-home order.

The color-coded key for North Dakota's COVID-19 risk level system. Screenshot via state of North Dakota website
The color-coded key for North Dakota's COVID-19 risk level system. Screenshot via state of North Dakota website

When asked earlier this week why the state isn’t following its own criteria, Burgum said without offering evidence, “we now know that shutting down the economy doesn’t necessarily slow the spread” of COVID-19.

The governor’s assertion directly contradicts a case study of Delaware published last week by the Centers for Disease Control and Prevention that found state-mandated stay-at-home orders and mask requirements, coupled with contact tracing, contributed to massive reductions in COVID-19 cases, hospitalizations and deaths.

And as North Dakota’s deaths, hospitalizations and new cases have reached exponential growth in the last two weeks, a new consensus has emerged among doctors in the state. They say the situation now calls for drastic action.

“If I had the ears of the governor, that’s what I would tell him to do — shut everything down and reopen it slowly,” said Nwaigwe, who likened North Dakota’s current situation to the outbreaks that spurred statewide lockdowns in New York and New Jersey during the early months of the pandemic.

Dr. Jane Winston, a recently retired Fargo geriatrician, said that doctors contributing to a physicians’ group run by the North Dakota Medical Association have increasingly come on board with the idea of mandatory business closures.

“The jig is up,” Winston said. “We’ve all said to (Burgum) now, I think everybody who communicates in this group says that we’re at the point where we need a lockdown.”

And while some other doctors shied away from the term “lockdown,” they emphasized the necessity of actual enforcement mechanisms to ensure widespread compliance with masking and social distancing.

Dr. Paul Carson said he would not recommend the full-scale lockdown of the early weeks of the pandemic in North Dakota. However, the infectious disease specialist, who has advised Burgum on the state’s pandemic response, said there are just a handful of “arrows in the quiver of public health,” and the state has only fired a few of them up to this point.

Carson said the state needs to take more direct action that could include enforcing early curfews on bars and restaurants, limitations on the size of gatherings, mask mandates with financial penalties and even the closure of all non-essential businesses. Pointing to an ongoing study from the University of Washington, Carson noted that North Dakota has some of the lowest mask compliance of any state in the country and has lapsed in its social distancing practices over the last few months.

Dr. Paul Carson is an infectious disease specialist and public health professor at North Dakota State University. Special to The Forum
Dr. Paul Carson is an infectious disease specialist and public health professor at North Dakota State University. Special to The Forum

The Fargo doctor said he would not call for an end to in-person K-12 classes, or even a halt to university campus meetings, but he stressed the need for implementable penalties on safety violations in order to get North Dakotans on board.

Dr. Jeffrey Sather, the chief of staff at Trinity Health in Minot, said North Dakota mirrors New York City’s situation in April, when the city imposed “almost martial law” to wrangle the outbreak.

“They shut down businesses completely,” Sather said. “So to think that we’re going to have a surge and it’s just going to go away like it did in New York — it’s just going to keep getting worse and worse here because we are not shutting anything down.”

Sather stressed that he is not necessarily calling for the same extreme measures deployed in New York, but he reiterated the positions of other doctors that enforceable precautions must be put in place to stem the spread.

“I don’t think anybody wants a total lockdown, but I think we want strict guidance around it,” Sather said. “I realize this is a tough political thing, but until we curb how we’re acting and reacting to this as the public, this is going to continue to get worse.”

If North Dakota keeps banking on appeals to individual responsibility, Nwaigwe argued, it will endanger many more people who have taken all of the right precautions.

“If we are not going to enforce it, then this is just going to be like the wild, wild West,” he said.

Readers can reach reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com and reporter Jeremy Turley at jturley@forumcomm.com or on Twitter at @jeremyjturley.