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North Dakota Senator Kevin Cramer wears a mask as he addresses the media. SAUL LOEB/Getty Images
  • North Dakota’s COVID-19 mortality rate is one of the worst in the world at 107 deaths per 100,000 people, according to the Centers for Disease Control and Prevention (CDC).
  • Part of the reason that the mortality rate is so high is that much of the state population is highly susceptible to severe disease.
  • Making matters worse, the state is also experiencing a shortage of nurses — and has only recently received aid from the U.S. Air Force.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.

On Nov. 9, North Dakota Gov. Doug Burgum announced that from Oct. 19, COVID-19 cases surged from just 5,000 to more than 10,000.

“It took us 7 months to get to 5,000, and it took us 3 weeks to get over 10,000,” he said during a press conference.

North Dakota’s COVID-19 mortality rate is one of the worst in the world at 107 deaths per 100,000 people, according to the Centers for Disease Control and Prevention (CDC).

Harvard epidemiologist Dr. Eric Feigl-Ding posted an analysis by the Federation of American Scientists on Twitter that found North Dakota is actually at the top of the list for worst COVID-19 mortality rates in the world right now, with more than 18 deaths per million people.

As of Nov. 20, there are more than 70,000 confirmed cases and 824 deaths due to COVID-19 in North Dakota, according to the most recent data from The New York Times. Nearly 400 people are currently hospitalized.

It’s only now, after months of refusing to institute a statewide mask mandate, that Gov. Burgum relented, according to a Nov. 13 press release from the Office of the Governor.

“This decision, as most decisions, represents a calculation of relative risk versus benefit,” Dr. Charles Bailey, medical director for infection prevention at St. Joseph Hospital and Mission Hospital in Orange County, California, told Healthline.

“I would not be in a position to second-guess this decision as there are risks to lockdowns,” he added.

He explained that the possibility of delayed diagnosis and treatment of serious non-COVID-19 illnesses, negative effects on mental health and family dynamics, and several other factors all likely influenced the governor’s pandemic response.

Part of the reason that the mortality rate is so high is that North Dakota’s population is highly susceptible to severe disease.

“North Dakota has a highly vulnerable population of Native Americans who are on average reported to be five times more susceptible to mortality than their white counterparts,” said Jeremy M. Levin, D.Phil, chairman of BIO, and CEO and chairman of OVID Therapeutics.

Making matters worse, the state is also experiencing a shortage of nurses — and has only recently received aid from the U.S. Air Force.

“With hospitals projecting a surge in COVID-19 patients in the coming weeks, we’re deeply grateful to the Department of Defense and FEMA for granting our request for additional resources to help save lives and alleviate the immense pressure on North Dakota’s hospitals and long-term care facilities,” Burgum said in a statement.

Levin said even as COVID-19 surged in much of the United States, officials in North Dakota didn’t do enough preparation for their own surge.

“The state did not prepare significantly for COVID and has a very limited medical resource to deal with the surge of cases,” Levin said.

People living in North Dakota “initially followed advice to socially distance, wear masks, and practice hand hygiene,” said Dr. Robert Glatter, emergency physician at Lenox Hill Hospital in New York City.

However, once the pandemic slowed with summer, and “as businesses began to reopen and life started to return to normal, compliance lessened,” Glatter said. “And people developed resentment toward the mitigation measures and government control.”

The cooperation and community spirit of togetherness that was apparent early on in the pandemic then devolved to anger and public mistrust that the government was “trying to take away personal freedom and liberties,” he added.

According to Glatter, “misinformation and disinformation” about the dangers of the virus flooded social media, leading to fear “that the government would take away people’s liberties and personal freedom.”

As a result, he said, when the city tried to implement a universal mask mandate, it was unsuccessful.

“There was a subsequent shift from following the state’s guidelines to a sentiment of ‘wait and see’ and ‘personal responsibility’ for health and safety,” Glatter said.

These sentiments were accompanied by shunning of government oversight for health and well-being.

Asked whether the recent Sturgis Motorcycle Rally in South Dakota might have played a role in North Dakota’s surging case load and deaths, Bailey said it was a possibility.

“Such gatherings are potential ‘superspreader events,’” he said. “But it would not be possible to be certain as there are always multiple elements at play, including other small gatherings, demonstrations, rallies, school, and job reopenings.”

“The Sturgis Motorcycle Rally was a factor in spread of the virus throughout the Dakotas,but also throughout the US with cases reported in 11 additional states,” Glatter said.

He said the rally itself has been linked to at least 260 cases in 12 states and one confirmed death in Minnesota, and generated billions of dollars in healthcare costs, based on a recent study.

On Nov. 9, the state’s interim State Health Officer Dirk Wilke, JD, amended an order to allow healthcare workers with asymptomatic infections to continue working in the state’s COVID-19 units at hospitals and nursing homes.

The order has been widely criticized for putting patients at risk.

Bailey said, however, that with limited resources, it may make sense to allow healthcare workers to continue to work even if they test positive. Additionally, he said they can take measures to keep patients safe.

“Risk mitigation measures in the hospital could protect patients from COVID spread in this emergent contingency scenario. Healthcare worker to patient spread of COVID is very unlikely,” Bailey said.

Levin said with a vaccine approved by the Food and Drug Administration (FDA) and coordinated planning between state and federal authorities — including a transition plan for President-elect Joe Biden — North Dakota can get through this crisis.

“Without a transition plan in place between the White House and Biden team, the effect on mortality will be delayed,” Levin said. “Unnecessary deaths will likely occur.”

“What is clear is that individual cities and counties can’t effectively stop the pandemic,” Glatter said, who confirmed a state-led effort is necessary along with support from the federal government.

“A statewide mask mandate combined with strict enforcement measures is urgently needed,” he insisted. “This must be combined with enhanced lab capacity to implement timely testing, contact tracing, and education about isolation and quarantine protocols.”

Glatter also said these “sound public health measures” are working well in multiple other states, and there’s ample reason “to believe they could also be effective in North Dakota.”

After resisting mask mandates and restrictions to slow the spread of COVID-19 for months, North Dakota now has one of the worst COVID-19 mortality rates in the world.

Experts say that many factors may have played a role in the state’s current crisis. However, a statewide mask mandate and strict enforcement measures are needed to improve the situation.

They also say continuing delays in transitioning to a Biden White House will likely delay efforts, causing further, unnecessary deaths.