North Dakota, according to The New York Times, has had the worst outbreak of COVID-19 per-capita in the country, with 1,373 cases reported over the last week. Nurses around the region, specifically through Lake Region Public Health, have watched how COVID-19 has spread throughout the region and what problems it brings to each area

The Coronavirus has been spreading through North Dakota since March after the first case was reported in Ward County on March 11. While the state has been able to avoid a major outbreak in the spring and summer, the fall and winter have turned into a different situation.

North Dakota, according to The New York Times, has had the worst outbreak of COVID-19 per-capita in the country, with 1,373 cases reported over the last week. Nurses around the region, specifically through Lake Region Public Health, have watched how COVID-19 has spread throughout the region and what problems it brings to each area.   

"We're seeing a persistent and alarming increase in the community spread in positive cases," Lake Region Public Health Ramsey County RN Annette Groves said. "Our goal is to keep our schools open, keep our long term care and acute care facilities functioning because they're maxed out. We can't afford our health care systems to break down." 

Ramsey County recorded 30 new positive cases Tuesday according to the North Dakota Department of Health (NDDOH), seeing the active case county in the county bump up to 127.4. Since early November the county has had a daily positivity rate of over 10 percent, putting them into the "high risk" classification. 

One problem the county has run into is in the capacity of health care systems in the physical room of the buildings and staff. CHI St. Alexius Hospital Devils Lake is nearing capacity while other facilities around the region are being spread thin as well. There is a high concern for those who need care that are COVID-19 positive, but the same resources are still needed for non-COVID-19 related situations.  

"We have to have places for cardiac events, car crashes, and other emergency health issues to have time-sensitive care," Groves said. "If we don't mitigate what is happening community-wise, we're not going to be able to continue." 

According to Groves, a lot of the spread in Ramsey County is coming from public facilities that are not social distancing or not using a face mask, specifically in the food and beverage industry. Action has been taken to limit the possible spread of COVID-19 in restaurants and public facilities as the executive order issued by the governor limits restaurant attendance to 25 percent of allowed capacity. 

However, outside of public facilities, there is still a spread of COVID-19 amongst group gatherings, publicly and privately. Another alarming trend that Groves said was that many close contact cases have begun to turn into positive COVID-19 cases. 

Across the lake, Benson County has remained stagnant in it's spread of COVID-19, however, not in a good way. The county avoided an alarming spread of COVID-19 for a while until the fall where Benson County became one of the hot spots in the state. Lake Region Public Health Benson County RN Shelly Aabrekke said when things start to improve, cases rise again.  

"Things haven't changed," Aabrekke said. "When cases are falling off, we're getting new cases again. We're just staying at the same level." 

The lack of individual action to go get tested and continued congregation has led to Benson County's situation. For the entire month of November, Benson County has held an average of 72 positive cases in the county, resulting in a 14 percent positivity rate throughout the month. 

"Some people aren't getting tested and it's being spread," Aabrekke said. "The other thing is there is still congregating going on. Until they stop getting together, start wearing a mask and social distancing, it's going to continue to spread." 

Back in October when Benson County Athletics was planning on returning to play after Leeds High School went remote for two weeks due to positive COVID-19 cases in the school, Aabrekke vouched for the continued postponement of sports as it would worsen the spread. Also included in governor Burgum's executive order was the postponement of all winter sports activities to Dec. 14. Aabrekke said she believes the postponement will help limit the spread of COVID-19 in the county as she had concerns for the winter season.

"I was very concerned with basketball coming into effect in the next couple of weeks," Aabrekke said. "This now gives us some time for those numbers to hopefully die out and reduce the spread. Hopefully, it's not being spread from parents to students to another student to another parent and so forth." 

With limitations to the pace of 'normal' life to prevent the spread of COVID-19, there has been some backlash from individuals in each community to not wear a mask or abide by social distancing measures. Groves said while it isn't a problem, they have come across some situations where people are not willing to comply.  

"We have run into the verbal comments at times regarding the disbelief of masking up being a strategy to mitigate disease spread, along with the 'it's my right to cover up my face' comments," Groves said. "We understand that there are community members that cannot mask because they are physically or behaviorally unable to wear a mask." 

"However, those who can and should be wearing a mask should take responsibility for the venerable, as we should be every day, with or without a pandemic."  

Groves and Aabrekke have seen the impact of the virus first hand and how it impacts each person. In doing contact tracing, Aabrekke said she has seen individuals the are COVID-19 positive having a mild cold to it debilitating others.  

As Benson County continues to bend the curve and move out of its consistent phase of decreasing than increasing, the skepticism mentality has the mentality of being in a rural area and not being able to contract the virus has almost vanished. People in the area have begun to see the impact of COVID-19 in those around them and have realized the seriousness of the virus. 

"In the beginning, everywhere in North Dakota was seeing an increase and Benson County was at zero cases for a long time," Aabrekke said. "Now that it's starting to hit more people, and the word is getting out of how bad people are getting the virus, they are changing their views. It's something that shouldn't be taken lightly." 

There is strong support from health officials around the region for the government orders put in place by the state of North Dakota, Ramsey County, and Devils Lake. Not only are health officials hoping that the orders will decrease the infection and mortality rate in the state, but allow health care systems to get back on their feet and offer even more care to those who need it. 

"I do believe we have this [the executive order] as a tool to reduce morbidity and mortality," Groves said. "We have positive information coming from vaccine manufacturers and new data is coming in every day. We've got a strategy in place with this executive order that is going to give us time to get to another tool in our arsenal, which would be vaccine availability." 

 Moving deeper into winter, which has been predicted to see COVID-19 cases increase, even more, Aabrekke said she wants people to know, specifically in Benson County, that county health workers need the community's help.  

"This has drawn out a long time for everybody, not just the general public, but public health and health care workers," Aabrekke said. "I know everybody is tired, but so are we. If we get everybody's assistance in doing their part, this can go away faster." 

In Ramsey County, Groves advises the public to keep everyone in mind when making individual decisions. 

"Please do everything in your daily decision making to keep yourself and everyone around you safe," Groves said. 

Jack Williams covers Lake Region sports and general news for The Devils Lake Journal. Contact him via email at JGWilliams1@gannett.com, on Twitter @jackgwilliams, or phone at 701-662-2127.