FARGO – Boasting miles of open prairie and a fiercely independent populace, North Dakota contentedly refrained from statewide stay-at-home orders or mask mandates for months as COVID-19 spread across the country.

With a relatively low case rate, many here saw little need for aggressive measures to confront the pandemic.

But after an autumn surge catapulted the state into the nation's top COVID-19 hot spot, with the most cases and deaths per capita, some cities decided to take action, Fargo included.

"Truly, when we became number one in the nation, that has to be troubling to anybody. We've got to do something," said Fargo Mayor Tim Mahoney, who used his emergency powers to order up a mask mandate two weeks ago in North Dakota's largest city. "We're number one NDSU football team. … We love that. … But we never wanted to be number one COVID state in the nation."

As the coronavirus crisis marches deeper into the Upper Midwest, and case rates surge in neighboring states, residents of Fargo and other cities across North Dakota are finding themselves living with a host of new precautions and safety measures. Mask policies are popping up, a hospital is supplementing its staff with contract nurses from out of town, and public health systems have been so overwhelmed that the state recently asked COVID-positive residents to conduct their own contact tracing.

Still, people here are deeply divided on how seriously they should take their troubling national ranking and how they should respond to it. Some state and local leaders, in fact, have been reluctant to make safety measures enforceable.

Gov. Doug Burgum, a Republican, has made impassioned pleas for complying with recommendations. He recently issued new guidance for counties considered high-risk. Rather than closing nonessential businesses, his guidelines include keeping occupancy at 25% with a cap of 50 people and urging mask requirements. There are also state publicity campaigns, including one asking people to "mask up."

"We're working really hard to just try to get people to comply voluntarily," said Kirby Kruger, director of disease control for the North Dakota Department of Health. "We've [been] trying to get that information out on the science behind the masks, allowing our citizens to make an informed decision on where they want to go."

But some public health experts believe mandates are more effective than recommendations, and that rules that vary by county are part of a broader problem.

"We've seen the failure of a patchwork approach to suppressing the pandemic," said Dr. Thomas Tsai, a researcher with the Harvard T.H. Chan School of Public Health. "Given that people are traveling city to city, or county to county, I think it's important to have at least a statewide coordination and arguably even a regional coordination across states."

Walking a 'tightrope'

In Fargo, a city of 125,000 residents that sits across the Red River from Minnesota, Mahoney has been watching both state and local trends.

As of Saturday, North Dakota ranked first in new COVID-19 cases and deaths per capita over the past seven days with 122.7 cases and 1.3 deaths per 100,000 people, according to data collected by the New York Times.

State data showed the rate of positive tests in North Dakota stayed low over the summer, Mahoney noted, and was often under the 5% goal set by the World Health Organization. But recently, it jumped, and over the past two weeks hovered around 12%.

"That really makes you go, like, 'Holy cow there's a lot of community spread right now,' " said Mahoney, a surgeon who was elected mayor in 2015 and who has tried to balance politics and public health.

Brittany Boeddeker, who manages three Beans Coffee Bar locations in the city, said she thinks the recent case surge is making the pandemic feel real for more people now, even though many are still divided on safety measures. She can see it among her customers. "Everyone has their own opinion on everything," she said.

At the modern and sleek downtown shop, vigilant customers have questioned whether ink pens used to sign receipts have been sanitized, she said. At the shop along a busy commercial corridor on University Drive, customers lamented that they couldn't use chairs piled up in the corner to reduce capacity, complaining there was no place to sit.

"It's just emotionally and physically exhausting trying to walk this tightrope of keeping safe and keeping the stores open," Boeddeker said to a co-worker.

Mahoney's recent mask mandate specifically states that there is no penalty for noncompliance, "although these measures are being mandated with the strongest possible recommendation."

Mahoney had opposed an earlier city commission proposal that would have allowed for enforcement, saying he didn't want to tie up police with calls about mask avoiders. Under the current mandate, customers can be asked to leave businesses, he said, and police can still be called for trespassing or other offenses.

That mandate follows an earlier "directive" by Mahoney encouraging residents to use masks. But few did so, he said, so he deliberately put the word "mandate" in the recent order's language knowing it has an emotional effect on people's compliance.

Mandating compliance

As cities around the state considered implementing mask measures, residents opposing the idea have said they don't believe masks slow the virus and have questioned the credibility of the death statistics, believing most COVID-attributed fatalities are actually caused by underlying illnesses.

In Fargo, where Mahoney said the average age of residents is 31, attitudes on the issue may be partly influenced by the fact that younger people generally don't suffer more serious complications from COVID-19.

Jane Winston, a recently retired doctor specializing in geriatrics, said, "I certainly don't find that attitude of 'They would have died anyway' to be appropriate."

Part of a now-disbanded Physician Advisory Group that counseled state leaders on the pandemic, Winston said science shows that masks help. And while she's pleased with Fargo's mandate, she thinks the state needs to take a stronger lead. Even in young people, she pointed out, medical researchers are just starting to learn about long-term effects.

Wess Philome, a local activist and day trader, pointed out the virus' outsized effect on people of color and people in low-wage jobs who can't afford to take time off work. "We could see it coming," he said of the surge. "Our leadership isn't forceful enough."

Last week, Todd Fuller, who recently recovered from COVID-19, sat at the Herd and Horns Bar and Grill, a business that he partly owns near North Dakota State University that has been hit hard by the cancellation of college games.

Fuller's symptoms, including a cough, chills, body aches and sweating, were strong for a few days this fall, he said. But he soon felt fine again, just like dozens of other people he knows who also have recovered.

"I think we need to get back to normal. … I think we're scaring the hell out of people," he said, adding that his middle school-aged children are suffering, too, with distance learning.

Fuller, 40, said he understands that the elderly and people with underlying conditions are more vulnerable. That population includes his own father, who has ALS but did not contract the virus despite unknowingly spending time with family members who had it.

If he dies, Fuller said, "in my opinion … he's going to from ALS," not COVID-19.

Leading by example

Mahoney said some business owners have thanked him for the mask mandate, allowing them to blame the need for masks on the mayor, not their individual businesses.

At Bjornson's convenience store and gas station in Fargo, cashier Leah Rodriguez stood behind plexiglass wearing a mask as patrons popped in and out for bottled drinks and cigarettes — many of them without masks despite a sign on the door saying they are required.

"The first day we had the mask mandate, people threw fits," she said, with patrons calling it "stupid" and "not helping anything."

It will take time for people to get used to the idea, she said, and so far she feels safe.

"We don't need to enforce," she said, "but lead by example."

At the VFW in West Fargo, a city that strongly pushes masks, bartender David Joergensen said managers tried to follow guidelines by removing some bar stools and spacing out tables, but patrons moved chairs where they wanted.

"Unfortunately, it became impossible to enforce," he said.

A lot of customers don't wear masks when they walk in the door, he said, and sometimes they ask why he chooses to wear one. "I just tell them to make some customers feel more comfortable," he said. "I try to do what I can do."

Staff Writer Christopher Snowbeck contributed to this report.

Pam Louwagie • 612-673-7102