Post #890: North Dakota acts, using the now-standard playbook.

Posted on November 14, 2020

My last two posts were about the situation in the Dakotas (and much of the upper Midwest), where some governors simply would not take significant actions to reduce spread of COVID-19.

For North Dakota, infections were spreading so fast that (by my estimate) they were going to achieve herd immunity (70% of the population having been infected) by the end of the year.  Merely by keeping up the current rate of infection.  (See just-prior post.)

That seemed like a wonderful natural experiment, and I applauded the people of North Dakota for leading the way.  They would be able to show the entire world just exactly how a policy of “let ‘er rip” (a.k.a. rapid transition to herd immunity) would work out.

Sacrifice in the pursuit of knowledge is a noble thing.  As long as it’s somebody else’s sacrifice.

But, unfortunately, instead of pursuing this natural experiment to its conclusion, they’ve decided to follow the standard Republican-state drill.  (Apologies to sane Republicans like cousin Larry.)  Which is:  Take no significant actions until hospitals are full.  And then, once the hospitals are full, like clockwork, they put all prior rhetoric down the memory hole and start doing what public health experts recommend.

And that’s what happened yesterday in North Dakota.  The Governor of North Dakota announced a mask mandate.  It only runs for one month.   It exempts religious services.  As with Virginia’s mask mandate, there is potentially a stiff fine for non-compliance, but no specified means of enforcement.  (See Post #881).

And it fits the pattern, emphasis mine:

"The order, signed by interim State Health Officer Dirk Wilke, takes effect immediately and runs through Dec. 13. It is intended to help alleviate hospitals overwhelmed by virus patients, a news release from the governor said.

“Our doctors and nurses heroically working on the front lines need our help, and they need it now," Burgum, a Republican, said in a video message announcing the measures.

Source:  Fox News

Per the Washington Post, North Dakota was down to its last nine staffed ICU beds. 

The order does more than just mandate mask use.  It follows the now-standard set of tools for containing spread, including reduced hours and capacity limits for restaurants and bars, and curtailment of extracurricular activities (including) sports at schools.  So it is, in fact, a near-textbook example of following existing public health guidelines for COVID-19 containment.

The exemption of churches may or may not be due to legal issues.  Purely from a public health standpoint, it makes no sense, as churches have been significant sources of super-spreader events throughout this pandemic (see Post #679).  For this and other reasons, some experts place church services just below bars for riskiness (see Post #811, qualitative ranking of COVID-19 transmission risk).  Presumably churches in ND have the good sense to curtail singing (Post #708), even if they don’t have the sense to require masks themselves.

Now a bit of realpolitik:  A policy triggered by hospital capacity limits is simply CYA.

First, we need to admit that the standard Republican-state strategy toward COVID-19 is to get serious only after the hospitals are full.  That has been revealed so often that this clearly should be treated as an explicit policyIt’s not some frequently-repeated accident.  It’s the way health care policy actually functions in most Republican-run states.

So let’s just say that, out loud, and walk it around a bit, to see how it functions, as a policy.

“I propose a policy of containing COVID-19 by imposing mask mandates and other mandatory measures based solely on hospital capacity.  The policy rule is to impose such measures only after hospitals are full of COVID-19 patients, and the state is running out of ICU beds.”

Is that a good policy?  Does it minimize total economic or health damage from COVID-19?

I’m pretty sure that it does not minimize damage from COVID-19.  State hospital capacity is arbitrary, in the sense that hospitals and ICU beds weren’t built for the purpose of treating COVID-19.  The capacity that a state has is an artifact of total disease burden plus propensity-to-hospitalize within a state.

In other words, the trigger point for this policy has no logical relationship to COVID-19 whatsoever.

So what is this policy?  It’s C-Y-A, pure and simple.  It’s a way for Republican governors to say “it’s out of my hands”.  It’s a way for them to remain true to political principles, and let external events force their hand.  As such, it should be self-evident that this policy has nothing to do with any rational cost-benefit analysis.  It’s just a way to avoid having to take the blame for making a tough-but-needed decision.

It’s clearly not a policy that has been optimized with some forethought.  It’s clearly not even a good policy.  It’s just a way for Republican governors to maintain political correctness within their own orthodoxy and keep their hands clean.

And, to my next point, this approach of allowing hospital capacity to dictate timing of COVID-19 policy interventions should almost certainly lead to higher spikes in infection rates.  That, compared to a policy that (e.g.) imposing mandates and other measures in a more measured and continuous fashion.

But maybe this time it’s different.

Seasonality of human coronaviruses (other than COVID-19) in Stockholm, Sweden.  Source:

Potential impact of seasonal forcing on a SARS-CoV-2 pandemic DOI: Publication Date: 16.03.2020 Swiss Med Wkly. 2020;150:w20224 Neher Richard A., Dyrdak Robert, Druelle Valentin, Hodcroft Emma B. Albert J.

But this time, maybe that wait-until-the-hospitals-are-full policy is going to come back and bite them.  Maybe the experience of US Midwest states this winter will be qualitatively different from that of (e.g.) US Southern states this summer.  Maybe it’ll look like the green line above. 

Maybe this time you can’t stop it with a weak mask mandate and eliminating school sports for a month.  Maybe this time the factors that drive up the green line above are alive and well and working their magic in the upper Midwest.

I’ll say it one more time.  The reason for seasonality of flu in temperate climates is low humidity.  The lower the humidity, the more easily respiratory  viruses spread.  In the lab, COVID-19 shows the same attributes that make flu seasonal, including longer airborne survival times in dry air.  Areas with cold, arid winters and poor COVID-19 public hygiene are in for a very rough ride. And that pretty much describes the high plains states and the eastern slope of the Rockies.

So I suspect that, in this case, the standard Republican strategy of “wait until the hospital are full” is going to turn out to be an exceptionally poor one.  And we’ll know that the first time we see stories of bodies in reefers (Post #888).  Better late than never, and all that.  But better still not to be late.

I have never been so glad to that Virginia has a tradition of reasonably sane state government  And it’s a great time to have an M.D. for governor.