BISMARCK — Recommendations from the U.S. Centers for Disease Control and Prevention now call for vaccinated people to mask up in public indoor areas in Fargo, Bismarck and Minot but not in Grand Forks or Moorhead.

The inconsistencies in the modified mask guidelines announced last week are rooted in a multi-colored map maintained by the national health agency that shows levels of COVID-19 transmission on a county level.

In counties with a "high" or "substantial" level of transmission — shaded in red and orange, respectively — officials say vaccinated residents should don masks in public indoor places, but vaccinated residents of counties colored in yellow or blue can still set aside face coverings.

The agency continues to call on unvaccinated people 12 and older to seek the jab and continue masking indoors until fully immunized.

An update with transmission levels from the last week of July landed Fargo and the Twin Cities alongside Bismarck as areas of substantial spread. The agency moved Minot up to the highest level of spread.

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The U.S. Centers for Disease Control and Prevention advises residents of counties colored in red and orange to wear masks in public indoor settings. As of Wednesday, Aug. 2, 2021, the areas with higher levels of COVID-19 transmission include Fargo, Bismarck and Minot. Screenshot via CDC
The U.S. Centers for Disease Control and Prevention advises residents of counties colored in red and orange to wear masks in public indoor settings. As of Wednesday, Aug. 2, 2021, the areas with higher levels of COVID-19 transmission include Fargo, Bismarck and Minot. Screenshot via CDC

Residents and visitors to Fargo, Bismarck, Minot and much of western North Dakota have an elevated risk of exposure to COVID-19, according to the agency's map. Vaccinated folks in Grand Forks and Moorhead should be relatively safe from breakthrough infections for now, but transmission levels can jump quickly.

Prior to last week, the CDC had endorsed shedding masks for vaccinated Americans in nearly all settings, but officials said the rapid spread of the highly infectious delta variant of the coronavirus and the possibility of vaccinated people spreading it necessitated a return to masking. The frequently changing national infection map has turned increasingly red in recent weeks — nearly 60% of the nation's counties are deemed to have "high" levels of transmission.

North Dakota has begun to see a delta-induced uptick in cases, and local health experts warn the state could be susceptible to a surge in infections since only about 45% of the population is fully vaccinated against the virus. Many residents refused to wear masks even when the state mandated them during last year's peak in infections.

Republican Gov. Doug Burgum acknowledged last week that COVID-19 case rates are low but increasing in the state and encouraged residents to get vaccinated, which he called "the best defense against COVID-19, including the Delta variant."

Burgum also said he will not require state employees to wear masks and noted that "local entities are best suited to consider CDC guidelines based on local conditions, including case rates, positivity rates and available hospital capacity." Lawmakers passed legislation earlier this year that bans the governor and other statewide officeholders from issuing mask mandates after Aug. 1.

Dr. Paul Carson, an infectious disease specialist who teaches at North Dakota State University, said last week those who have not been vaccinated or previously infected are "highly likely" to come down with COVID-19 in the near future, and the consequences, even for young people, could be severe.

Officials from the U.S. Centers for Disease Control and Prevention say vaccinated people from counties with higher levels of COVID-19 transmission, pictured in red and orange, should wear masks in public indoor spaces. Screenshot of CDC website taken on Wednesday, Aug. 2, 2021
Officials from the U.S. Centers for Disease Control and Prevention say vaccinated people from counties with higher levels of COVID-19 transmission, pictured in red and orange, should wear masks in public indoor spaces. Screenshot of CDC website taken on Wednesday, Aug. 2, 2021

Health experts are only beginning to understand the long-term effects of COVID-19, which afflict a significant portion of previously infected people and can include heart problems, chronic fatigue, brain fog and joint or muscle pain, Carson said.

The doctor urged unvaccinated residents to get the jab before any major outbreaks occur, noting that the risk of the virus far outweighs the rare and often minor side effects of the vaccine.