FARGO — The West Fargo Sheyenne Mustangs were the top-seeded team in the boys Class A basketball tournament and hours from playing in the semifinals when the announcement was abruptly made that the tournament was halted.

It was Friday, March 13, and the coronavirus pandemic, which until then was creeping ominously toward North Dakota’s borders, was just gaining a foothold in the state — and the enormity of the crisis was becoming clear.

On the same day, President Donald Trump declared a national emergency and Gov. Doug Burgum followed with a declaration for North Dakota. In response to panic buying, stores were announcing limits on purchases of hand sanitizer and disinfectant wipes.

North Dakota’s first confirmed coronavirus infection, a man in his 60s from Ward County, was announced on March 11.

Two days later, as sports venues in Fargo were filled with athletes and spectators, the Class A boys and girls basketball tournaments were postponed as a public health precaution.

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“At that point it was a big unknown what was happening,” said Tom Kirchoffner, the Mustangs’ boys basketball coach. He gathered his team in the high school’s gymnasium to break the news that the tournament was on hold.

Just days earlier, the NBA suspended play and the NCAA “March Madness” basketball tournament was canceled, so the decision by the North Dakota High School Activities Association wasn’t a big surprise, Kirchoffner said.

“You knew something was going to happen,” he said. “It was just a question of when.”

North Dakota faced mountains of uncertainty and unanswered questions in the first days of the pandemic.

Also on March 13, Fargo and Cass County halted sandbag production after surpassing their goal of filling 225,000 bags. Fortunately, the metro area was spared overlapping disasters; the Red River crested below major flood stage a couple of weeks later.

The state’s low population density and inland remoteness from the coasts, which were hit first by the coronavirus, initially seemed to give North Dakota a protective shield.

But the state recorded its first death from COVID-19 on March 26, when 93-year-old Roger Lehne, a Navy veteran, succumbed to the illness at the Fargo Veterans Affairs Medical Center. His wife, who was hospitalized separately with COVID-19, learned of her husband’s death from a video call by her niece.

In the weeks and months since, deaths continued to climb steadily, now exceeding 1,450, a number higher than the official death toll of 1,378 from the Spanish influenza pandemic of 1918-19.

More than 100,700 North Dakotans are known to have been infected by the coronavirus — or one in every 7.5 residents. Because so many never develop symptoms, the actual number is much higher — up to 62%, well on the path to herd immunity, according to a team of Columbia University researchers.

For a time last fall, North Dakota’s per-capita case rate and death rate were the highest in the world, and hospitals warned that they were almost running out of staffed beds in intensive care units.

Despite its remote location, sparse population and advance warning for preparation, North Dakota would not be spared.

'A very sobering moment'

One of the biggest worries officials confronted was whether hospitals would have enough beds if the pandemic produced waves of COVID-19 patients.

The whole point of the lockdowns, including capacity limitations on bars and restaurants and the temporary closure of personal care businesses, was to slow the spread and “bend the curve” to prevent hospitals from being overrun.

In early April, an eerily empty Fargodome was converted to a standby field hospital. National Guard soldiers placed 200 cots in orderly rows and prepositioned medical supplies in the event it became an overflow hospital.

That never became necessary. Fortunately, about two miles to the south, preparations were made to allow up to 400 beds at Sanford Broadway Medical Center to become a special COVID-19 hospital.

Two-hundred beds were set up in the Fargodome for use as a field hospital in case coronavirus patients overwhelm medical centers in the metro area. David Samson / The Forum
Two-hundred beds were set up in the Fargodome for use as a field hospital in case coronavirus patients overwhelm medical centers in the metro area. David Samson / The Forum

The beds were available with the opening of Sanford Medical Center three years earlier. The bigger challenge was staffing the beds with nurses, respiratory therapists, doctors and others.

Invisible to the public, an intense amount of collaboration and joint planning was taking place among hospital administrators, state health officials and others to make sure that the health system didn’t collapse.

At the beginning of the pandemic, incident command centers were set up at Essentia Health and Sanford Medical Center — and remain in place today.

“We tried to plan for the worst and hope for the best,” said Dr. Richard Vetter, Essentia’s chief medical officer. Essentia had contingency plans to erect tents on the parking lots outside its hospital if necessary.

Linnea Testa, a traveling registered nurse from New Hampshire, works with COVID-19 patients at Sanford Broadway Medical Center in downtown Fargo. David Samson / The Forum
Linnea Testa, a traveling registered nurse from New Hampshire, works with COVID-19 patients at Sanford Broadway Medical Center in downtown Fargo. David Samson / The Forum

But before that dire step would have been taken, Essentia would have converted clinical space into bed space, he said. Neither contingency proved necessary.

Sanford also explored options for expanding capacity beyond its availability of beds — and quickly discarded the idea, said Bryan Nermoe, president of Sanford Medical Center Fargo.

After a Sanford team went to the Fargodome to make plans for caring for patients there, the team decided it should do everything possible to avoid that scenario.

“I think that was a very sobering moment,” Nermoe said. “We quickly came to the conclusion we’d be far better off using, to the extent possible, our facilities.”

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At the height of the pandemic, which peaked in mid-November, Sanford had 116 COVID-19 patients in its special care unit at Broadway Medical Center and 40 patients on ventilators. Statewide, North Dakota's peak COVID-19 hospital census was about 360 patients.

Besides a huge shift to telehealth services, the pandemic spurred other innovations in care delivery. Essentia and Sanford launched home monitoring for COVID-19 patients who didn’t have to be hospitalized, freeing beds for sicker patients.

Essentia’s “hospital at home” model included home visits from nurses that, along with monitoring, could be used in the future as a way to avoid building more hospital beds, Vetter said.

Public health workers were the “boots on the ground” to implement the state’s pandemic response plan, working closely with local health providers.

“There were always ongoing conversations,” said Desi Fleming, director of Fargo Cass Public Health. “There was always that uncertainty.”

Bethany on 42nd employees undergo drive-thru testing for COVID-19 before the morning shift at the senior living center on April 22, 2020, in south Fargo. David Samson / The Forum
Bethany on 42nd employees undergo drive-thru testing for COVID-19 before the morning shift at the senior living center on April 22, 2020, in south Fargo. David Samson / The Forum

A COVID-19 test swab is collected as snow falls Oct. 22 during Family HealthCare’s testing event in downtown Fargo. Alyssa Goelzer / The Forum
A COVID-19 test swab is collected as snow falls Oct. 22 during Family HealthCare’s testing event in downtown Fargo. Alyssa Goelzer / The Forum

There was no playbook to consult for how to confront a new disease. “Our numbers got kind of out of control for a while,” she said. “The challenge was living real-time science.”

By late September, when case numbers began to spiral higher, North Dakota’s major hospitals were faced with a grave shortage of staffed intensive care beds. As of Sept. 29, for instance, the state’s inventory of staffed ICU beds had dwindled to 22.

The shortage was especially acute at Altru Health System in Grand Forks, which had no open ICU beds, and in Bismarck, where the two hospitals had two open ICU beds between them.

At the urging of public health officials who were alarmed at the pressures the health systems were facing, Fargo Mayor Tim Mahoney issued a citywide mask mandate order on Oct. 19. Other cities quickly followed suit, and a statewide mandate came in November.

But strains on the state’s hospitals continued to mount throughout the fall, as new cases mushroomed. Active cases reached their peak of 10,426 on Nov. 13. Days later, Nermoe warned that if infection trends continued unabated, hospitals would have to alter the kind of care people had become accustomed to receiving.

“When you look at the horizon, we need to hit this hard and we need to hit it now to turn this around,” Nermoe said.

Or, as Fleming put it recently, “We just needed more buy-in from people.”

Members of the Red River Valley COVID-19 Task Force watch a multimedia campaign promoting mask-wearing on Oct. 2 at Fargo City Hall. David Samson / The Forum
Members of the Red River Valley COVID-19 Task Force watch a multimedia campaign promoting mask-wearing on Oct. 2 at Fargo City Hall. David Samson / The Forum

Special delivery

A FedEx delivery van pulled up outside Sanford Medical Center around 7 a.m. on Dec. 14 with a special delivery: 3,400 doses of vaccine, the first to be received in North Dakota.

Doses were promptly administered to nurses, doctors and other front-line health care workers at Sanford as the vaccination campaign got underway. As the one-year anniversary approached, 23% of North Dakotans and 21% of Minnesotans had received at least one dose.

Public health officials and health providers are urging people not to declare victory, but to remain diligent in taking precautions. But there’s wide agreement that, as more and more people are vaccinated and the weather turns warmer, the pandemic should subside through spring and approach something resembling normal by late summer or fall.

North Dakota, whose per-capita case and death rates were the highest in the nation for a time last fall, now rank at or near the bottom. Mahoney has said he’s likely to allow Fargo’s mask mandate to expire on March 22 if current trends continue.

Melodi Krank administers the Fargo area's first COVID-19 vaccine to Dr. Avish Nagpal at Sanford Medical Center in southwest Fargo on Dec. 14. David Samson / The Forum
Melodi Krank administers the Fargo area's first COVID-19 vaccine to Dr. Avish Nagpal at Sanford Medical Center in southwest Fargo on Dec. 14. David Samson / The Forum

“We have to play it safe,” and continue to be vigilant, Fleming said. Lately, her staff has been working a more normal schedule. But, she added, “We’re still definitely in pandemic response.”

Cass County, which emerged as an early pandemic hot spot, assembled a task force that used a targeted approach, focusing testing, contact tracing and other measures on vulnerable populations, such as the elderly, especially those living in nursing homes.

“Cass County should be a case study in how to do things,” McDonough said. “They did so much better than the rest of the state.” Cass County’s COVID-19 death rate was 0.91% — lower, except for Grand Forks County’s 0.77% rate, than the state’s other major urban centers.

Fargo’s mask mandate, he said, “saved hundreds of lives across the state” by setting an example many other cities followed.

If North Dakota had followed its neighbors in Minnesota and Montana, and adopted a statewide mask mandate in July or August, McDonough estimates that 600 lives could have been saved.

A critical lesson learned from the pandemic — the worst public health crisis in more than a century — is that testing and contact tracing alone are inadequate, he said. Control comes through preventive measures, he added, such as mask wearing and distancing.

“There’s so many lessons learned from this pandemic,” McDonough said, provided they aren’t ignored.

Meanwhile, a year after seeing their hopes dashed when the Class A basketball tournament was abruptly halted, Kirchoffner’s Mustangs are once again favored to win the championship.

Being deprived of their title shot last season was disappointing, he said. “There was no resolution. It was just left open at the time.” But the players understood.

“Some people have lost their lives, some people have lost their jobs,” he said. “There’s bigger things than basketball.”