North Dakota is currently fighting the COVID-10 pandemic with one hand tied behind its back. The failure to mount an effective public education effort to increase the public’s use of protective methods has resulted in an alarming surge of cases this summer. The possibility exists of a catastrophic epidemic this fall with multiple deaths among grandmas and grandpas and a return to stay-at-home orders. Many health care providers and school personnel are likely to become ill. The following measures are recommended to mitigate this possibility.

  • North Dakota’s leaders need to set an example. It is not best to “do as I say and not as I do.” Anytime a leader is on TV or at a meeting, the leader should be wearing a mask, even if they are maintaining a 6-foot distance. The governor can request this or issue an executive order.
  • A massive public education effort must begin immediately using TV, radio, newspaper, billboard and online media. North Dakota’s political, religious, entertainment, media and sports leaders should be part of this effort. Leaders from all regions and segments of our state should be asked to participate.
  • A goal should be set that 90% of North Dakotans be wearing masks or heavy neck gaiters by Sept. 1 and observation and telephone surveys of the state including regions be conducted. The results of these surveys should be made available to the public.
  • The governor should implement a state-wide mask order by Sept. 1 or sooner with appropriate exemptions for those unable to wear masks: young children, those with medical or mental health conditions.
  • North Dakota’s opaque and confusing risk categorization needs to be revised. The North Dakota Department of Health states that our state is in the green, low-risk zone. On July 16, North Dakota was listed in the orange zone (2nd highest) by Harvard’s COVID-19 Tracking Site. On July 29, the Trump administration listed North Dakota as 1 of 21 states in their “Red Zone,” states with large increases in COVID-19 infections. On July 30, a then record high of 168 COVID-19 cases were reported in North Dakota. On July 31, there were 1,103 active COVID-19 cases in the state, over 5 times the 213 cases recorded for June 22. On Aug. 7, there were 181 cases reported and the total active cases were 1,240. I don’t feel that I live in a low-risk community nor a low-risk state.
  • Health care providers have been and continue to be exposed to and become ill from COVID-19. Every effort should be made to increase the availability of N-95 masks to these providers and surveys of their use should be done and made available to the public. The number of health care providers ill from COVID-19 should be tracked and made available to the public to assist the public’s adoption of mask wearing. Our health providers need to be safe so they are there for us if we get ill.
  • Elementary, secondary and higher education students, staff and visitors should be required to wear a mask during school activities. Exceptions should be made for those with autism, sensory disorders, behavioral conditions, anxiety, neurological, respiratory or cardiovascular conditions if mask wearing causes an adverse response.
  • N-95 masks, if supplies are adequate, should be made available to school staff with COVID-19 risk factors such as pregnancy, diabetes, cardiovascular, respiratory, neurological conditions, impaired immunity and other chronic health conditions. This may be difficult to accomplish due to persistent shortages of Personal Protective Equipment.
  • Schools should be strongly encouraged to start instruction with a hybrid model: staggered schedules with a combination of in-person and remote learning. This will help reduce class size and school bus ridership. Exceptions should be provided to those students adversely impacted from a staggered schedule. If the expected surge in COVID-19 does not occur, shifting to more in-person education could be accomplished later in the fall. Some rural schools with small class and bus ridership size may be able to safely start in-person school if mask usage is high.
  • Consideration of providing school breakfast and lunch in the classroom or greatly staggered lunch times to avoid crowding. Masks can’t be worn when eating so distancing and handwashing will be important.
  • Public health staffing needs to increase to provide timely testing, contact tracing and public education. The number of public health staff participating in COVID-19 efforts needs to be tracked and the results released to the public.
  • A unified approach in our divided county is needed to confront the COVID-19 pandemic. It is all hands on deck. Public education is needed to counter the misinformation. State politicians need to be leaders and set the right example. Health care leaders need to stand up and request that politicians take the right course.

Winter is coming and it is not only the snow and wind that North Dakota needs to fear and prepare for. It is COVID-19.

McDonough served with the North Dakota Department of Health from 1985 to 2000 and has been a practicing pediatrician since 1980.

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