Why Was North Dakota the ‘COVID Death Capital of the World?’

By Laura Simmons

laurasimmons2025@u.northwestern.edu

Dr. Stephen McDonough researched why North Dakota had the highest COVID death rate and cases in the fall of 2020. His investigation accumulated into a 1,000-plus page book titled “The Power of a Question: Why North Dakota Developed the Greatest COVID Outbreak in the World and How Community Heroes Turned It Around.”

COVID cases are on the rise, and, although McDonough is hopeful that vaccines and natural immunity will prevent a major outbreak, he wishes that North Dakota will be able to learn from its past COVID mistakes so it can be prepared for a possible future epidemic.

“I was quite alarmed on the approach that was being taken in the state during 2020, but I didn't expect us to have as bad an outcome as we did, so I wanted to find out why that happened,” McDonough said.

In the book, McDonough blamed North Dakota’s “light touch of government and individual responsibility,” approach to the virus that was against mask mandates, instead focusing on testing and contact tracing.

McDonough was the first physician to publicly call for a statewide mask mandate with a letter to the editor on August 16, 2020. Initially, McDonough thought his letter was a failure, but eventually it led to 65 pediatricians signing an open letter to Gov. Doug Burgum on October 13, asking for a state mask mandate.

“That’s when the dominoes finally started to fall,” McDonough said.

On Oct. 19, 2020 Fargo’s Mayor Tim Mahoney issued a mask mandate. A day later Minot followed suit. On October 27, the Bismarck City Commission voted, after a 6 hour meeting, to move forward with a mask mandate. Just a day prior, Dr. Deborah Birx, the White House coronavirus task force coordinator, said Bismarck had the worst mask usage she’d seen.

Finally, after being reelected, Burgum issued a statewide mask mandate on Friday, November 13 at 10 p.m. Although McDonough estimates mask mandates saved about 400 lives and over 1000 hospitalizations, he estimates 300 to 500 COVID deaths would have been prevented if the governor had issued a mask mandate in July when it was initially proposed by the the NDDoH [North Dakota Department of Health] COVID Physician Advisory Committee.

However, not everyone was happy with the state mask mandate, including Julie Neidlinger who spoke at the October 27 Bismarck City Commission meeting where she said mask mandates restrict freedom and liberty and she shared data which she said showed mask mandates don’t work.

Neidlinger said despite many of the citizens making sacrifices to attend and speak at this meeting, no one seemed to be listening. Instead, experts were scheduled to speak after each citizen to refute what they were saying, according to Neidlinger.

“They don't even take us seriously,” Neidlinger said. “We're like an annoyance to them. Like a mosquito.”

Neidlinger said this was the “pinnacle” moment that led to her distrust in the medical industry.

“I have no trust in [the medical industry] anymore because they kept calling us names and they kept dismissing us as stupid people who couldn't understand it,” Neidlinger said.

Neidlinger later said she wishes experts would start addressing the new data coming out regarding the efficacy of mask use. She then brought up a recent meta analysis study that concluded there was no “clear reduction in respiratory viral infections with the use of masks.”

On September 2, 2023 CNN asked Dr. Anthony Fauci about the study, quoting from The New York Times’ opinion article.

“When you're talking about the effect on the epidemic or the pandemic as a whole, the data are less strong,” Fauci said in the CNN interview. “But when you talk about as an individual basis of someone protecting themselves or protecting themselves from spreading it to others, there's no doubt that there are many studies that show that there is an advantage.”

Today, House Bill 1323 prevents the North Dakota government from issuing a mask mandate. The bill became law on April 27, 2021 after the senate overrode Burgum’s veto.

McDonough also attributed North Dakota’s high COVID cases to poor leadership.

“A physician on the NDDoH COVID Physician Advisory Committee recommended a statewide mask mandate on July 23, 2020, but the public information officer for the NDDoH refused to include that in the meeting minutes,” McDonough wrote in his book. “On July 30, 2020, the NDDoH COVID Physician Advisory Committee voted unanimously 17-0 requesting that the governor declare a statewide mask mandate.

“At their next meeting, on August 6, 2020, the NDDoH informed the committee that the committee had been disbanded. After the NDDoH’s censuring and then disbanding of the NDDoH COVID Physician Advisory Committee on August 6, 2020, the North Dakota State Health Officer resigned on August 19, 2020 effective September 1, 2020.

“From then to May 1, 2021 (8 months) or over 243 days, a physician headed the NDDoH for only 12 days or 4.9 percent of the time during which North Dakota became the COVID death capital of the world.

“When the Trinity Health medical leaders informed the state medical association Physician Advisory Group of their plans to have a November 3, 2020 news conference and tell how bad things were, a member of the executive branch reportedly contacted Trinity Health and requested them not to do so.”

“Decision makers and policy makers if they didn't like the advice they were getting from the experts, they either marginalized the experts or they got rid of them,” McDonough said.

McDonough said the doctors on the advisory commission were some of the best in the state and to disband them while the pandemic was worsening was “blatant incompetence.” At the time, this received little media attention. McDonough said some reporters were aware of it, but they couldn’t get anyone to talk.

Later, Burgum received backlash and made national news for allowing asymptomatic nurses with COVID to work in the hospital.

The High Plains Reader reached out to the governor's office twice. They did not respond.

Decision makers and policy makers also downplayed the severity of COVID, according to McDonough. For example, McDonough wrote that the North Dakota COVID Risk Metric, created by the NDDoH, consistently underestimated the true risk and severity of the pandemic, and contributed to COVID denial along with the governor’s upbeat news conferences.

“You can’t be green, low risk, and have the highest case rate in the United States,” McDonough said.

Physicians and nurses told the director of Bismarck/Burleigh public health Renae Moch how badly hospitals were being affected by COVID. However, hospital administrators prevented their employees from sharing this with the public.

Moch was told administrators didn’t want to share the true effects of COVID in the hospitals because “they were in the same hot water as everybody else.” Therefore, they’d be accused of scaring people and causing panic and they’d be scrutinized for not having more competent management. Furthermore, hospitals didn’t want to lose revenue from people not coming in for preventative care and preventative surgeries because of COVID.

“The consequences of speaking the truth in a community with plenty of right-wing extremists was harassment and no one received more vitriol than what Renae Moch experienced,” McDonough wrote.

Moch, who was supportive of mask mandates, experienced verbal and written harassment attacking her appearance and expertise, demanding her to be fired, and accusing her of lying and fear mongering.

Moch was not the only one. Bismarck City Attorney Jannelle Combs was also the target of social media harassment along with a campaign to get her fired for enforcing local COVID precautions. Combs reported the harassment to the police. McDonough wrote that the harassment came from a “right-wing extremist” group called North Dakota Freedom Defenders.

Julie Neidlinger was an admin of the now defunct North Dakota Freedom Defenders Facebook group. Neidlinger did not participate in the harassment and said harassment is never appropriate.

However, she said both sides experienced poor treatment at times. Neidlinger shared a story of how a stranger yelled, cursed and accused her niece, who wasn’t wearing a mask, of killing his grandma. When Neidlinger went to her dentist, she overheard the receptionist saying she hates those who don’t wear masks and wishes they would die.

Later, when the vaccines came out, Neidlinger said many would lose their jobs if they didn’t get the vaccine. She said she knew a couple of doctors who quit because of that. She also shared the story of a young girl who had always wanted to be a nurse but had to figure something else out because she didn’t get the vaccine.

“It created a group of people and it gave them a label of some sort, whether it was right wing extremists or anti-vaxxer or ignorant, stupid, whatever,” Neidlinger said. “And they made them this ‘other.’ The government, city officials, county officials, state officials federal, they made it okay to create a whole group of people as less valuable. You can keep them out of your store, you can accost them, you can confront them, you can swear at them, you can do all these things, and it's okay because you're doing a good thing when you do that. That's what happened. And that is not okay. That is not acceptable. Ever.”

McDonough also faulted misinformation and right-wing extremists for driving North Dakota’s high COVID cases. He estimates the anti-science death toll was about half of the COVID deaths: 500 saved if a mask mandate had been implemented in July and 1000 deaths were vaccine preventable.

McDonough hopes North Dakota can learn from its mistakes and be prepared for a possible future epidemic. But he is not optimistic.

“There should have not been a need for my book to be published because if the North Dakota Department of Health and Human Services were doing their job, they would have already produced something like this: analysis of what happened and what the lessons learned are,” McDonough said.

The High Plains Reader reached out twice to the NDDoH but received no response.

In the event of a future epidemic, McDonough said leaders should tell the truth, do the right thing, and look after and protect the most vulnerable.

“North Dakota leaders in the future need to do much better but it is very debatable that they will,” McDonough wrote in his book.