As many as 38,000 Grand Forks County residents could test positive for a novel coronavirus by mid-January, city health workers estimate.

Assuming countywide infection rates hold steady, the 4,600-plus positive tests of unique individuals recorded as of Nov. 1 would double to about 9,500 by the 25th, then again to 19,100 by Dec. 18, and again to 38,200 by Jan. 10 -- about once every 23 days, according to a prediction put together by Grand Forks Public Health staffers.

“The way that the spread is going to continue, right now, is going to be on a very kind of exponential type level,” Michael Dulitz, the health department’s COVID-19 data and analytics leader, told the Herald on Wednesday. “So, we’re going to see case counts increasing rapidly based off of the situation we’re at right now, if things don’t change.”

That “doubling rate” is one way epidemiologists study the spread of a virus, but the prediction put together by city workers that relies on that rate might not necessarily come to pass if, for instance, the county is already near the top of another spike similar to the one that happened as UND students returned to class in August , Dulitz said.

“As quickly as it started, it seemed to trail off,” he said. “So, at some point, there will be kind of a turn in what we’re looking at, case-wise. We just don’t really know where that’s going to happen right now. And that’s the part that’s difficult to predict.”

But that, ultimately, would be a function of residents’ behavior, according to Joshua Wynne, who is the dean of UND’s school of medicine and health science, the university’s vice president for health affairs and North Dakota’s chief health strategist.

“Since people transmit the virus to other people, the way that it levels off is when we don’t have as much transmission from people to people,” Wynne said. “It does not do it magically.”

At the outset of the pandemic, the strategy, broadly speaking, was widespread testing, contact tracing and quarantining people who tested positive, but, if the virus continues to spread at its current pace, those techniques will only be “moderately” effective, according to Wynne, who explained that should prompt a renewed focus on wearing masks, washing hands, practicing social distancing and limiting the size and frequency of in-person interactions.

“We still need to do testing and contact tracing and so forth,” Wynne said. “That’s necessary but not sufficient. When we’re in this environment, we really need to do the other things.”

County to consider a mask mandate

Over the past month, Grand Forks County’s COVID figures have been trending -- sometimes sharply -- in the wrong direction : Active cases have risen from 199 on Oct. 1 to 1,056 on Nov. 4, and the proportion of all coronavirus tests that comes back positive has risen from about 4.5% to 12% in that same timeframe.

City leaders put together a localized risk assessment tool earlier this year, and that gauge indicated that the virus poses a “severe” risk countywide, based on the number of new cases and tests per capita, the percentage of tests that are positive, the number of new cases recorded in the county and a self-assessment by Altru Health System administrators of their hospital’s capacity.

Altru stretches to accommodate

Altru reported it has expanded into extra beds as the hospital sees an increase in COVID-19 patients requiring hospitalization, according to a statement released on Wednesday, Nov. 4, by Annie Bonzer, manager of marketing communications at Altru Health System in Grand Forks.

"We can accommodate up to 50 patients with COVID as our staffing resources allow," Bonzer said. "This number will remain fluid as we flex to accommodate the needs presented to our hospital. We must remain accessible to all patients – those with COVID-19 and those with other needs, especially emergent needs, such as stroke, heart attack and trauma. It is imperative that the community understand they should continue to access appropriate care when they need it."

An influx in testing demand is stressing Altru's curbside testing, with those appointments being scheduling out to as much as 48 hours.

"With this, we are seeing patients with less severe COVID-19 symptoms present to our emergency department," said Bonzer, noting that four Express Clinic locations are available for care and testing and are accessible on a walk-in basis. "We encourage the community to utilize these locations so the emergency department remains accessible for those with more severe care needs."

As of the morning of Wednesday, Nov. 4, Altru reported 36 COVID-19 patients in the hospital, including six in the ICU.

Older population stressed

And, perhaps most troublingly, the number of COVID-19 cases recorded per capita among Grand Forks County residents aged 60 and older has risen considerably over the past month. That age group is particularly vulnerable to the effects of the virus.

“It just doesn't seem right that you lived through the Great Depression then World War II and the Korean War, and then the rest of the population doesn't take care of you during this crisis,” said County Commissioner Tom Falck.

The health department’s prediction spurred Grand Forks County commissioners to weigh a countywide mask mandate that would be fundamentally similar to a citywide one approved by Grand Forks City Council members early last week.

The Herald interviewed Falck and four of the county’s five other commissioners on Wednesday, and each interviewee said they would support a mask requirement in the county, albeit one that doesn’t carry a penalty, which Commissioner Bob Rost said the county is not legally able to enact.

Those four commissioners were also in agreement that people should voluntarily be wearing masks. While mask usage has increased, it isn’t always the case throughout the county.

“I do believe in individual responsibility, but it doesn't seem to work very well in North Dakota, actually,” said Commissioner Dave Engen.

The city government’s mandate, which it enacted early last week, also carries no meaningful enforcement mechanism, but Dr. Joel Walz, the city and county’s public health officer, could issue a mandate that carries legal ramifications for violating it.

Enforcement questions

If the health officer enacts a countywide mandate with any teeth, Grand Forks sheriff’s deputies would be among those tasked with enforcing it.

Sheriff Andy Schneider said such an order would affect his department as much as the public demanded it to, but he worried that it could inundate his department with new calls.

“If we continue to carry out our normal response to calls for service that we already have on a daily basis and receive a high volume of calls for persons not wearing masks then we will be overwhelmed. If nobody called reporting persons not complying, we wouldn’t be affected at all,” Schneider said in an email Wednesday afternoon. “Any law that is an ‘absolute’ that directly impacts every single individual in the community (including juveniles) that perceives high contention from a large portion of the community would likely overwhelm our abilities.”

He added that he was not indicating the extent to which his deputies would enforce a hypothetical mask mandate in the county.

North Dakota Century Code allows local health officers to issue any order to mitigate the spread of a contagious disease. According to state law, violation of such an order is a Class B misdemeanor -- the same offense level as something like a DUI -- and carries a maximum penalty of 30 days in jail and a $1,500 fine.

But Haley Wamstad, Grand Forks County State’s Attorney and legal adviser to the commission, said it would be unusual for a defendant to be sentenced to the maximum penalty.

It’s more likely that law enforcement will issue warnings to offenders, she said. Those who are cited are more likely to receive probation than jail time.

Still, Rost noted that a Class B misdemeanor, nonetheless, goes on a person’s criminal record.

“To me, that’s extreme,” said Rost, noting that violating a mask order doesn’t equate, in his mind, to a DUI.

If the hypothetical mask mandate is passed, neither the county commission nor the state health officer would have a say in changing the penalty level. The penalty is written into North Dakota Century Code, which means it can only be changed by state lawmakers.

The number of people who are thrust into the criminal justice system because of a mask mandate would be entirely up to law enforcement, Wamstad said.

“I would hope that law enforcement would use it as an opportunity to educate the public and not utilize a citation as the first action that they look to take,” she said. “I certainly think if any governing body wishes to enact any type of mandate, it's in the interest of gaining compliance and not bogging down the criminal justice system in any way.”

Donald Hager, the presiding judge in North Dakota’s Northeast Central Judicial District, said Wednesday that he foresees a county mask mandate having an extremely minimal impact on the local courts and jail.

Defendants charged with Class B misdemeanors are not held in jail and are, instead, issued a court summons. All court appearances in Grand Forks are held via Zoom.

“The bottom line is it’s not going to overrun us,” Hager said.

But that’s not necessarily true for the rest of the Grand Forks County criminal justice system, he said.

“Obviously, it's going to affect law enforcement because they have to cite them, and it’s going to affect the state's attorney because they're going to have to charge them out,” he said. “But I mean, we already have the heaviest caseload in the state to start with per judge. We’re already there as the most undermanned court in the state, so if they want to add more to it, we’ll just do what we have to do.”