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Why are active COVID-19 cases dropping in North Dakota? The answer's not that simple

There's no singular explanation for the state's drop in active cases, state epidemiologist Grace Njau said, but a combination of mask policies and late adoption of virus mitigation measures likely led to the recent good fortune.

3D print of a SARS-CoV-2—also known as 2019-nCoV, the virus that causes COVID-19—virus particle. The virus surface (blue) is covered with spike proteins (red) that enable the virus to enter and infect human cells. National Institutes of Health

BISMARCK — After three months of worsening pandemic conditions and steeply climbing COVID-19 case counts, North Dakota has seen a nearly 50% reduction in active infections over the last several weeks.

The recent decline means the state is no longer leading the nation in new cases per capita over the last week — that undesirable title is now held by Minnesota, according to the Centers for Disease Control and Prevention . South Dakota has surpassed its northern neighbor in COVID-19 deaths per capita. The Peace Garden State ranked at the top in both metrics as recently as last week.

North Dakota is far from out of the woods, and the state still has one of the worst COVID-19 outbreaks in the country. A bump in cases following the Thanksgiving holiday could reverse the latest positive trend — the effect of family gatherings and travel over the last week wouldn't likely be noticeable in the COVID-19 data just yet. But state epidemiologist Grace Njau is cautiously optimistic.

There's no singular explanation for the state's drop in active cases, Njau said, but a combination of mask policies and late adoption of virus mitigation measures likely led to the recent good fortune.

Republican Gov. Doug Burgum announced a statewide mask requirement on Nov. 13, but in the weeks leading up to the change, a patchwork of city, county and tribal mask mandates formed as local leaders took the matter in their own hands.


Fargo Mayor Tim Mahoney issued a mask mandate on Oct. 19, and leaders in West Fargo , Grand Forks , Minot and Bismarck followed suit shortly thereafter. Njau said epidemiologists observed a decline in the estimated rate at which the virus spread a few weeks after local mandates passed in Cass County and the rest of the state.

Njau added that the "alarming" rates of COVID-19 cases, hospitalizations and deaths in October and November may have given residents a "wake-up call" if they had previously neglected mask-wearing and social distancing.

The state's hospitals are still struggling with severe staffing crunches, and available hospital beds are scarce. Many nurses have been sidelined by the virus in recent months, and medical centers have been seeing higher-than-normal admissions.

"The added stretch to our healthcare workers and health care systems may also have brought the reality home," Njau said in an email.

Njau noted that a drop in tests administered over the last week could also be contributing to the decrease in the known active cases.

She added that more than 300 residents are still hospitalized with the virus, and the fast pace of deaths hasn't subsided. Health officials say residents must remain diligent in following mitigation measures and refraining from social gatherings until conditions improve.

Virus deaths continue to mount

The North Dakota Department of Health on Wednesday, Dec. 2, announced 12 COVID-19 deaths but another overall drop in active cases.


The deaths came from all over the state, including two from Burleigh County and one each from Cass, Foster, Grant, Griggs, McLean, Ransom, Stark, Stutsman, Walsh and Ward counties.

The department says 966 North Dakotans have succumbed to the illness since March. November was by far North Dakota's deadliest month of the pandemic, with 388 COVID-19 deaths.

At least 563 of the state's deaths have come in nursing homes and other long-term care facilities. There are about 350 infected nursing home residents in the state, and a dozen facilities have double-digit active cases in residents, including The Meadows on University in Fargo, which has 24 infected residents.

Over the last three weeks, active COVID-19 cases have steadily declined from more than 10,000 on Nov. 12. Now, 5,236 North Dakotans are known to be infected with the virus. Active cases have decreased every day for more than a week.

There are 301 residents hospitalized due to the illness, down 18 over the last day. Thirty-eight residents with the virus are in intensive care.

On Wednesday, the health department reported 486 new cases, including:

  • 92 from Cass County, which includes Fargo. The county has 1,040 active cases.
  • 112 from Burleigh County, which encompasses Bismarck. The county has 794 active cases. Another 24 new cases came from neighboring Morton County, which includes Mandan.
  • 64 from Ward County, which includes Minot and has 531 active cases.

About 9.2% of the 5,258 residents tested as part of the latest batch received a positive result, and an average of 11.9% of those tested in the last two weeks got a positive result. Like active cases, the state's positivity rate has decreased in the last two weeks.
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Jeremy Turley is a Bismarck-based reporter for Forum News Service, which provides news coverage to publications owned by Forum Communications Company.
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