Home https://server7.kproxy.com/servlet/redirect.srv/sruj/smyrwpoii/p2/ Health https://server7.kproxy.com/servlet/redirect.srv/sruj/smyrwpoii/p2/ After months without a mandate across the country, why did North Dakota finally get one?

After months without a mandate across the country, why did North Dakota finally get one?

But as hospitals moved to their maximum capacity, Burgum consistently rejected a mandate, even when he asked residents to wear masks. The governor’s belief in North Dakota’s “personal responsibility” seemed so strong that until last week, doctors seemed resigned to the reality that the policy many of them had called for might not have a viable shot in North Dakota.

Then Burgum turned. In an executive order issued late Friday night, Nov. 13, the governor introduced a series of new mitigation measures, including a state mandate for a mask – with a provision for punishment for violation and curfew at 10pm in all bars and restaurants in the state.

The solution is rejoicing in the medical community even while some doctors complained that it came so late.

“I fully support the mandate when it was made on November 1

3,” said Dr. Stephen McDonough, a former North Dakota Department of Health official who publicly called for a nationwide mandate in mid-August. But McDonough, who estimates that a term on Sept. 1 could save up to 500 lives, added that the news was shocking, as the governor had spent so many months downplaying the state’s risk. “There was too much talk. The situation was much more serious than it was discussed,” he said.

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Burgum’s office did not respond to numerous requests for comment on this story.

The mandate was a welcome surprise to North Dakota doctors, many of whom criticized Burgum’s pandemic response and expressed confusion about where he got his medical signals. Dating in late July, the governor’s office cited Dr. Joshua Wynn, dean of the University of North Dakota School of Medicine, and Dr. Paul Carson, an infectious disease specialist at North Dakota State University, as leading advisers on the state pandemic.

However, the Forum’s reports found that the two doctors had not been consulted on the possibility of a state mandate or other mitigation strategies during the autumn jump until the last week of October. At the time when Win and Carson were invited to discuss new state responses with senior government officials, North Dakota was leading the country in new per capita cases and deaths for nearly two months. In the three weeks between their meetings and the announced term, the active number of viruses in North Dakota erupted in exponential growth.

For more than a month and a half, North Dakota has gone through its deadliest section of the pandemic without medical expertise at the top of its health department. This vacancy – combined with Burgum’s reluctance to take extraordinary steps to stem the spread of the virus – has caused confusion among North Dakota doctors about how much medical guidance the governor receives and whether he listens.

The state’s cycle of three different major health proposals – Milin Tufte, a nurse who resigned in May, Dr. Andrew Stahl in August and Dr. Paul Mariani after a two-week stay in September – seems to suggest a rift between the governor’s pandemic response and recommendations from the medical community, a unit proposed by Mariani in an official declaration of resignation, noting that Burgum’s decision to revoke the quarantine order made his continuation of the position “untenable”.

Following Mariani’s departure, the health department is headed by its former chief operating officer, Dirk Wilke, who has a degree in business, law and communications but no medical training. Most often, the state names four North Dakota doctors as primary advisers to the pandemic: Dr. Joan Connel, a Bismarck pediatrician and field physician in the state, Dr. Guy Tangedal, a Bismarck geriatrician, along with Win and Carson.

Several times during the deadly period of the last month, Burgum has expressed the support of his medical advisers, insisting that both he and the health department have more than enough medical experience. But some prominent doctors have commented that this medical contribution is not reflected in the results.

“There has been frustration among the medical community with what actually applies to medical advice,” said Dr. Andrew McLean, a professor of psychiatry at UND and a member of the State Medical Advisory Committee, adding that it was unclear whose contribution was heard in the state’s response strategy. “There were many different voices, some through official channels, others through informal ones, but it was not clear who had the governor’s ear (s) and who had the health director’s ear.”

Burgum was also outspoken about his disagreements with public health experts during last month’s wave, admitting at a news conference in early November that his medical advisers had insisted he “soften sooner”. While the governor said he and these councilors shared a common goal, he acknowledged that they disagreed on exactly how to achieve it. “Are you getting there with the heavy hand of the state or a strong reliance on individual responsibility?” He asked, alluding to his own resistance to mandates to comply with masks or business operations. “These are two maybe different approaches. At the end of the day, it all comes back to me.”

In October, Burgum’s repeated rejection of the mandate became a widespread disappointment in the country’s medical community. On October 13, sixty-five North Dakota pediatricians signed an open letter calling for a mandate and warning against a “public health disaster this winter,” while other prominent doctors said the state had ignored their recommendations. Three weeks later, as the North Dakota crisis drew national attention, Bismarck-Burley Public Health Director Renee Moh turned to the Washington Post to call for a state mask mandate, arguing that the strategy for “personal responsibility “obviously came out short.

So far, at the end of October, Burgum’s office has not consulted with Carson or Wynne about plans for a state mask mandate or other answers in the last months since the outbreak, according to Forum interviews with the two doctors. Although Burgum cited the two public health experts as key resources in the state’s response to COVID-19, Carson said he had previously only met with state chief operating officer Tammy Miller and members of the health department to discuss testing strategies, contact tracking and nursing home policies. He has not met directly with the governor or has been involved in discussions about other possible pandemic response strategies.

Wynn, who serves in three different public health positions in the state government, noted that none of his roles explicitly called on him to consult with the governor’s office on limiting the pandemic. But like Carson, Wynn said that while he had many conversations with Miller and health officials in recent months to test, track contacts and even disguise policies on university campuses, those conversations did not focus specifically on new strategies in the whole country as a mask mandate.

That changed Halloween week. As the federal government intervened to close nursing homes in North Dakota, and White House Crown Coordinator Dr. Deborah Birks visited North Dakota, senior government officials gathered for a series of ad hoc meetings with Win and Carson. For three sessions in the last week of October, the two doctors worked with members of the executive to develop potential mitigation strategies in a meeting to discuss these options with Burgum himself. Carson noted that one of the available options essentially runs the same course, but stressed that he “does not consider this a viable option at all.”

That same week, several municipalities issued their own mandates, creating a full set of directives around the country. Burgum praised local decisions, but remained firmly in opposition to direct action from his office.

In early November, the number of cases reached what Carson called the “exponential growth” phase. But by this time, the NMSU professor had almost given up hope of a mask mandate in North Dakota. In interviews and emails with the Forum in the days leading up to his term, Carson said he feared his talks with the governor’s office on the pandemic strategy had passed.

“I really doubt there will be more calls or interaction about other measures to be taken in the state,” Carson said a week before Burgum announced the new mandate across the country. “We gave this advice and so far it has not been used. I don’t think it will be talked about anymore.”

In the weeks between Burgum’s meeting with Carson and Win and his announcement of the term, the country’s COVID-19 trajectory took an even sharper rise. Calling the outbreak a “runaway train,” Carson urgently stressed the need for more direct intervention. “I think it’s an unacceptable compromise to keep the business as usual,” he said during the forum.

In the last week of October and the first two weeks of November, North Dakota jumped from less than 6,000 active cases of COVID-19 to more than 10,500. During the same period, more than 100 people were hospitalized with the virus and the state registered another 198 deaths. case of the virus.

Then, on November 9, Burgum announced a move as a last resort, releasing COVID-positive health workers to stay in work in an attempt to deal with the crisis with hospital staff. For many in the state’s medical community, it was a bridge too far away. The decision drew national attention as it was criticized by two unions of nurses in North Dakota. The major hospital systems have also said they do not intend to implement the new policy. And taking that step, Connell claims the state has asked its nurses, doctors and primary care staff to make a huge sacrifice, even after rejecting so many of their calls for preventive action.

“Healthcare providers are expected to play their part,” Connol said before announcing his mask mandate. “This is from the independent man to the state to the local politicians. We expect everyone to make sacrifices.”

But within five days of that controversial decision, facing new levels of national control and an open objection by health workers, Burgum finally turned around, approving a nationwide feasible mask mandate and other mitigation measures on Friday. The particular combination of interventions that Burgum eventually announced was among the best options worked with Wynne and Carson during their meetings in late October.

“I think this is the right initial combination of measures to be tried,” Carson said after the announcement, saying he was extremely pleased with the final implementation of the steps and noted that he would look for signs of their effects over the next two to four years. weeks. “If we don’t see a leveling trajectory, then we need to do more,” he said.

Readers can contact Forum Reporter Adam Willis, a report on the U.S. Corps, at awillis@forumcomm.com.

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