Clarification: This story should have noted that Wyoming and Nebraska have quarantine exceptions for public schools similar to North Dakota’s statewide exception, and that Iowa makes such an exception for businesses and schools. We regret the oversight. (Added 4:30 p.m. Oct. 7)
BISMARCK — Some public health experts are harshly criticizing North Dakota's new quarantine exception, saying the relaxed guidelines could cause the state to lead the U.S. in COVID-19 spread by an even larger margin.
The new guidelines say that people who came into close contact with a positive case will no longer need to self-quarantine as long as both parties were wearing a mask. The definition of a close contact remains the same — a person who spends at least 15 minutes within 6 feet of someone who tests positive for COVID-19 — but now the state says the close contact no longer needs to quarantine as long as everyone was wearing a mask "consistently and correctly the entire time."
Though public health officials around the country agree there's significant evidence that wearing masks curbs the spread of COVID-19, The Forum of Fargo-Moorhead consulted with experts who said it is a step too far to suggest masks will eliminate the need to self-quarantine.
"This is the worst case of pseudoscience I've ever seen," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said of the new quarantine exception. "This is highly dangerous to public health, especially in North Dakota."
The decision was made in part so students, parents and school staff could "have a more positive school experience," said Gov. Doug Burgum at an Oct. 1 press conference. Having students quarantine for 14 days after coming in contact with a positive case is chaotic, and this approach is easier and will lead to more mask wearing, Burgum said.
Instead of a quarantine, North Dakota officials say people who think they were in close contact with a positive case while each party was wearing a mask should "self-monitor" themselves and get tested if they exhibit symptoms.
These new guidelines are not in line with what the Centers for Disease Control and Prevention recommend, though North Dakota public health officials made the decision anticipating that the CDC would soon make a similar policy change, said Dr. Joan Connell, the state's Department of Health field medical officer.
"The science is getting increasingly supportive of this, and at some point they're going to change this policy," Connell said, adding that she's not aware of the health department reaching out to the CDC to see if it plans to update quarantine guidelines, but instead the health department is "hoping it will happen."
The Department of Health analyzed multiple peer-reviewed studies regarding the effectiveness of masks, and based on the studies "it is suggestive" that people will not need to quarantine if all parties were wearing masks correctly, Connell said. All the evidence supporting the efficacy of masks is enough to support this policy change, she said.
North Dakota continues to have the most COVID-19 cases per capita of all 50 states, according to the New York Times.
There's no doubt the CDC has changed its guidelines as the medical field works to better understand COVID-19, but as of right now there's not enough evidence to make policies saying that people do not need to quarantine if they were close contacts and wearing masks, said Nasia Safdar, medical director of infection control at University of Wisconsin Health.
"It is highly recommended that people use them (masks), but for the purposes of quarantining I don't think we can say that as a blanket (statement), 'You don't have to quarantine,'" Safdar said.
The CDC has not backed guidelines like the one North Dakota implemented last week, Safdar said, because there is variation in how face coverings are constructed, and because of this it is hard for scientists to know how well they work.
In addition, wearing masks should not be a substitute for quarantine, Safdar said. A combination of the two is the most effective way to curb coronavirus spread and substituting one for the other could make people vulnerable to the virus.
"They both have additive effects, so for it to be maximally effective you really need to do both masks and physical distancing," she said.
North Dakota's new quarantine exception, Burgum said Oct. 1, "is a common sense approach that's going to create an actual incentive for people to wear a mask and face coverings." This guidance does not apply to people who live in the same household as a positive case or in health care settings.
Connell said the decision to implement the new quarantine exception was solely based on science and not the fact that by loosening the quarantine guidelines, North Dakota's schools will need to quarantine fewer students.
However, Burgum and state Superintendent Kirsten Baesler have highlighted how the move will allow more students to pursue in-person learning, rather than the distance learning they would have done while in a 14-day quarantine.
“Mask use among students, teachers, administrators and school support personnel not only promotes public health, it can reduce the number of quarantines necessary if there are close contacts with someone who is infected with the virus,” Baesler said in a statement Tuesday, Oct. 6.
Schools statewide are expected to receive shipments of cloth masks specifically for low-income and at-risk students. The state will disperse almost 160,000 masks to public schools.
Though some experts say North Dakota's new quarantine guidelines are dangerous, Connell said it's important to point out that North Dakota is in a "unique situation," because the state is struggling to get residents to comply with quarantine and isolation orders. Many do not wear masks in public, so providing this incentive could encourage people to follow guidelines to reduce the spread of COVID-19.
"We need to look at all the variables to determine what is going to result in the best outcome for our citizens," Connell said.
Nebraska and Wyoming have similar quarantine exceptions for public schools. In Iowa, Gov. Kim Reynolds also implemented a quarantine order for schools and businesses that says close contacts do not need to quarantine if all parties were wearing masks, and the Iowa Public Health Association called on the governor to provide scientific evidence that supports the new guidance.
"Masks, contact tracing, and quarantine are all established best practices in the control of infectious disease outbreaks. They work in concert to protect communities. None supersedes nor negates the need for the others," the IPHA said in a statement.
Nebraska, Wyoming and Iowa also have some of the highest rates of COVID-19 per capita in the nation, according to the New York Times.
North Dakota schools have already begun adopting the loosened guidelines. Bismarck Public Schools announced Monday that it will review the district's already-identified close contacts to see if both parties were wearing masks at the time.
The district said if masks were worn and the close contact is asymptomatic, the close contact can go back to school. It will continue to contact trace and determine whether masks were present at the time of interaction.
Changes to North Dakota's messaging about quarantining are concerning and confusing and could lead to less mask wearing and more COVID-19 cases, said Jeremy Youde, a global health politics and policy researcher and dean of the University of Minnesota Duluth's College of Liberal Arts.
Youde said historically in other disease outbreaks, the best outcomes are achieved when people receive a clear message about what to do from their government.
"This just makes it that much harder for people to know what they should be doing and what are the appropriate steps you should be taking to try to protect yourself and protect other people in the community," Youde said.
Readers can reach Forum reporter Michelle Griffith, a Report for America corps member, at firstname.lastname@example.org