South Dakota welcomed hundreds of thousands of visitors to a massive motorcycle rally this summer, declined to cancel the state fair and still doesn't require masks. Now its hospitals are filling up and the state's COVID-19 death rate is among the worst in the world.
The situation is similarly dire in North Dakota: The state's governor recently even moved to allow health care workers who have tested positive for COVID-19 to continue working if they don't show symptoms. It's a controversial policy recommended by the U.S. Centers for Disease Control and Prevention in a crisis situation where hospitals are short-staffed.
And now, after months of resisting a statewide mask mandate, North Dakota Gov. Doug Burgum changed course late Friday, ordering that masks be worn statewide and imposing several business restrictions.
“Our situation has changed, and we must change with it,” Burgum said in a video message posted late Friday. Doctors and nurses “need our help, and they need it now.”
North and South Dakota now face a predictably tragic reality that health experts tell USA TODAY could have been largely prevented with earlier public health actions.
Pandemics require people to give up some of their freedoms for the greater good, University of British Columbia psychiatry professor Steven Taylor told USA TODAY. In conservative regions like the Dakotas and elsewhere in the world, it's common to see pushback like an “allergic reaction to being told what to do,” said Taylor, author of "The Psychology of Pandemics".
But months of lax regulations have contributed to a growing public health crisis in the Dakotas.
The rates of infection and deaths per capita in South Dakota and previously restriction-free North Dakota are what Dr. Ali Mokdad would expect to see in a war-torn nation, not here.
“How could we allow this in the United States to happen?" asked Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “This is unacceptable by any standards.”
North Dakota's COVID-19 death rates per capita in the past week are similar to those in the hardest-hit countries in the world right now – Belgium, the Czech Republic and Slovenia – according to New York Times data. That data as of Saturday also places South Dakota's per capita deaths among the world's highest rates.
And there's nowhere in the U.S. where COVID-19 deaths are more common than in the Dakotas, according to data published by The COVID Tracking Project.
It's a situation “as bad as it gets anywhere in the world," Dr. William Haseltine told USA TODAY.
Mokdad pointed to a number of factors that have made both North and South Dakota vulnerable to the virus' spread. He cited higher rates of preexisting conditions and economic inequality in the region, in addition to health care that lags behind the U.S. standard.
But the lack of regulation from the states' leaders is an ongoing and fixable problem, Mokdad said.
Haseltine, president of ACCESS Health International and author of My Lifelong Fight Against Disease, blamed politicians – especially South Dakota Republican Gov. Kristi Noem – for ignoring public health measures that have curbed the spread of the virus elsewhere in the world.
Noem has cast doubt on whether wearing masks in public is effective, saying she would leave it up to the people to decide. She has said the virus can’t be stopped.
Burgum, also a Republican, had pleaded with people to wear masks and praised local towns and cities that have ordered masks be worn. He had avoided requiring masks and refused to enforce limits on social gatherings and business occupancies until late Friday.
The new mandate requires residents to wear face coverings in indoor businesses and indoor public settings, as well as outdoor public settings where physical distancing isn’t possible. The directive goes into effect Saturday and will last until Dec. 13.
