FARGO — North Dakota’s attitude in the early days of the coronavirus pandemic exhibited cocky confidence that the state’s remoteness would spare its residents from the worst of the plague.
That tendency was displayed in a meme that became popular on social media: “North Dakota: social distancing since 1889,” a reference to the year of statehood paired with a black-and-white photograph of a bleak prairie landscape with no people in sight.
Months later, when North Dakota found itself coping with the highest rate of coronavirus cases and deaths in the country, a rising death toll and its hospitals running low on staffed beds, the mood had changed.
By then North Dakota had become the brunt of jokes, as captured in another popular social media meme: a map of the state labeled “North Dacovid.”
The pandemic was slow to pick up momentum in North Dakota and was largely centered at first on the Fargo area. But by fall, cases were exploding all over the state.
On Nov. 5, the COVID Tracking Project announced that North Dakota had reached 2,000 cases per million population, a record in its data for any state. On the same day, North Dakota reported 29 deaths, a new record, and 9,224 active cases, another new record.
Three weeks earlier, on Oct. 18, North Dakota’s 870 infections per million people “set an unprecedented peak in the US pandemic and around the world,” Eric Topol, a physician and scientist, tweeted.
North Dakota became a place inspiring a mixture of sympathy and ridicule.
The pandemic didn’t hit the state in force until late July, months after ravaging coastal cities like Seattle, New York and Boston, providing plenty of forewarning and time to prepare.
Also, the state’s remote location and largely rural makeup, with people spread apart over wide open spaces — the state has 11 people per square mile, less than 12% of the U.S. average, 92.9 — provided advantages that would seem to protect against a worst-case scenario.
A variety of factors — a mixture of cultural and political attitudes, as well as the health profile of residents — help to explain the seeming paradox, according to experts.
North Dakotans pride themselves on their self-reliance, but the individualistic streak that runs deeply through the state’s culture can be a detriment when dealing with a public health crisis that requires a strong community response.
“If there’s a problem, it’s your fault, is often the perception in North Dakota,” said Tanis Walch, an associate professor of public health at the University of North Dakota.
That self-sufficiency and fierce sense of independence is often an asset, but can make people stubbornly resistant to complying with a requirement to wear a mask or recommendations to avoid large gatherings, she said.
Although Gov. Doug Burgum ordered businesses that provide personal services in close quarters — such as barbershops, salons and tattoo parlors — to close for several weeks early in the pandemic, before testing capability ramped up, the state has largely remained open for business.
Unlike many states, including Minnesota, North Dakota never imposed a stay-at-home order, an approach that Walch sees as consistent with the state’s values.
“We need everything open,” she said. The engrained attitude of overcoming adversity means North Dakotans are determined to prevent the coronavirus from dominating their lives; they are triumphing over the pandemic by refusing to surrender their sense of normalcy.
“We are winning,” Walch said. “What are we winning? The worst COVID rate in the country. It’s embarrassing how bad it is in North Dakota.”
A native of Winnipeg, Walch lived in East Grand Forks, Minn., before moving to Fargo in 2014, where she still resides with her family. She’s impressed with the generosity and neighborliness of North Dakotans — but hasn’t seen those traits on display during the pandemic.
“North Dakotans would give their shirt off their back to help their neighbor,” she said. “And right now, we need North Dakotans to continue that generosity and friendship by not gathering in groups, wearing masks, washing hands, and not eating or drinking in restaurants and bars.
“We need North Dakotans to stay home, and really limit the number of people we interact with. Thanksgiving is coming up, and it is terrifying me that people are going to gather in large groups, and the spread is going to get much, much worse.”
Maybe North Dakotans don’t realize just how bad the pandemic in their state has become, she said. If North Dakota’s infection rate for a two-week period ending Nov. 5 were applied to New York City, it would equate to 17,000 active cases — worse than the 12,274 New York City recorded on its worst day, she said.
“So we are much worse than New York City was on their absolute worst day,” Walch said.
'A sign of weakness'
Political views also help to explain the high infection rate plaguing North Dakota.
A survey in June found that mask-wearing habits appear to be associated with voters’ preferences in the presidential election. The poll by NBC News and the Wall Street Journal found that voters who said they always wore a mask in public planned to vote for Democrat Joe Biden at a rate 2½ times greater than those who planned to vote for Republican President Donald Trump.
An analysis by The Associated Press found that counties with the worst coronavirus surges voted overwhelmingly for Trump. Among 376 counties with the highest per-capita number of new cases, 93% voted for Trump, according to the analysis. Support for the president was higher than in counties that were less severely affected.
The connection between political leanings and attitudes about mask-wearing and other precautionary pandemic measures is “absolutely” a factor in North Dakota, where Trump captured 65% of the vote in the Nov. 3 election, said Mark Jendrysik, a professor of political science at UND.
“Certainly, President Trump has made it clear wearing masks is bad, a sign of weakness,” he said. Trump’s messages convey that wearing a mask is “at best optional, at worst a sign you are giving in to the virus, allowing it to dominate your life.”
Conservatives, who are prevalent in North Dakota, also seem more skeptical that the pandemic poses a serious threat to public health, Jendrysik said. “Clearly there are people who think this is overblown,” he said.
Not until Friday, Nov. 13, did Gov. Doug Burgum issue a statewide mask mandate.
In the days before the announcement, Jendrysik said Burgum's lack of a mandate suggested the Republican was in a political bind. “I think he probably made a rational calculation,” politically, Jendrysik said.
The outbreak was slow to reach many rural areas, which also bred complacency, he said. “A lot of people convinced themselves it was an urban thing.”
Unlike a flood, when communities rally together to hold back a surging river, the pandemic is a very different crisis, which helps to explain why people are reacting so differently, Jendrysik said.
“This is a very slow-moving crisis, and it’s very random in who gets affected,” he said.
'An abiding resentment'
Tom Isern, a history professor at North Dakota State University, believes earlier crises that swept North Dakota have hollowed out rural areas in a way that diminished their social cohesion, which is reflected in the state’s ineffective pandemic response.
“We’re ill equipped to deal with this,” he said. The farm crisis and severe drought that struck in the 1980s accelerated the population loss of rural areas.
“It’s created sort of an every-man-for-himself attitude,” Isern said. “It does lead to a looking inward — me and my family, me and my circle. I believe some of what some call social capital has been lost.”
The distrust of public health experts and authorities stems from a disdain for cosmopolitan elites and the “Eastern establishment,” he said.
“We have sort of an abiding resentment of the metropolis,” Isern said.
The result is a diminished ability to organize a response and a resentment for others who want to organize a response. Before Friday, Burgum had repeatedly urged mask-wearing, social distancing and other measures, but said much of the responsibility rests with individuals and local communities.
“I think that kind of explains the incapacity of the governor to deal with this,” Isern said.
Still, he acknowledges that weekly newspapers are filled with examples of communities rallying to help their neighbors, such as helping to harvest a farmer’s crops.
“I don’t mean to say it’s dead,” he said.
A sense of exceptionalism
Unfortunately, faith in science and political views have mixed during the pandemic in a way that causes some to be skeptical of studies showing that masks prevent the spread of the virus, said Carrie Anne Platt, an associate professor of communication at NDSU.
The polarized political environment seems to mean some people simply refuse to heed experts’ advice to wear masks and avoid large gatherings, said Platt, who spoke in support of a mask mandate in Fargo.
That skepticism is understandable given the mixed messages on masks, even from leading health authorities, including the Centers for Disease Control and Prevention, which now recommends masks, she said.
“In North Dakota we perceive ourselves as somewhat exempt from what is going on,” an attitude that could stem from the state’s sense of exceptionalism, she said.
In her view, masks have become a potent symbol, a way of displaying deeply held political and cultural beliefs.
“It’s a statement to not have the mask on, not necessarily a statement that I want to hurt other people,” she said. “Identity seems to be a component.”
Finally, the health profile of North Dakota’s population could help to explain why the pandemic hit so hard in the state.
As Burgum has noted, two-thirds of residents have a chronic condition, which makes them more susceptible to illness. Sixty-five percent of residents are overweight, one in five is a smoker and slightly more than one in four have high blood pressure, according to the UND Center for Rural Health.
That’s more than the 60% of adults in the U.S. who have a chronic disease, according to the Centers for Disease Control and Prevention. So much of the state's population is vulnerable.
As someone who wears a protective mask even outside, Walch stands out in her Fargo neighborhood. During Halloween, she and her children felt out of place while trick-or-treating.
"We were the black sheep of the neighborhood," she said. North Dakota nice, a trait residents like to ascribe to themselves, doesn't always extend to masks.
Readers can reach Forum News Service reporter Patrick Springer at 701-241-5522.