BISMARCK — The COVID-19 pandemic has battered North Dakota over the past two months.

The state that benefited from geographic isolation and a widely dispersed population in the beginning of the worldwide outbreak has seen active COVID-19 cases increase nearly eightfold since the beginning of July.

North Dakota now leads the country with the most new cases per capita over the last seven days, according to a recent White House report. The New York Times also lists the state as having the most new cases per capita over the past two weeks.

Local news reports have publicized this fact and, in response, Gov. Doug Burgum has played down the state's designation as a nationwide hot spot. But the question remains: is North Dakota's COVID-19 outbreak really the country's most severe?

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There's no simple answer — it all depends how you measure a pandemic, said state epidemiologists Grace Njau and Ben Schram.

Schram said new COVID-19 cases per capita is a valid metric, but it wouldn't be appropriate to look at any one statistic in a vacuum.

Instead, epidemiologists consider a wide variety of metrics to gauge the spread of the virus, including active cases per capita, tests per capita and the percentage of tests that come back positive. Those three statistics are the basis of the new way Burgum's administration is determining a county's COVID-19 risk level.

Hospitalizations and deaths also are crucial indicators, but they lag behind case data and may come "too late in the game" to be used in policy decisions, Schram said.

As a metric, new cases per capita also has an inherent shortcoming in that it doesn't account for the number of tests performed, Njau said. A state that tests more residents is bound to find more positives, which also increases its new cases per capita.

Leaders in each state have a great deal of autonomy in how they address the pandemic, and that means there are 50 unique approaches to testing for the virus. Even from one Dakota to another, the testing strategies differ significantly.

North Dakota Gov. Doug Burgum wears a mask during an interview in Bismarck on Thursday, Sept. 3. Jeremy Turley / Forum News Service
North Dakota Gov. Doug Burgum wears a mask during an interview in Bismarck on Thursday, Sept. 3. Jeremy Turley / Forum News Service


Burgum, a former tech executive who says he values data-driven decision-making, has emphasized testing from the outset. North Dakota has completed more than 500,000 tests for the virus and ranks among the top states in testing per capita. Njau also noted North Dakota's testing strategy is designed to find as many positives as possible because the state directs tests to where there are most likely to be undiscovered cases.

Meanwhile, South Dakota Gov. Kristi Noem hasn't given as much priority to testing. Her state has completed only about 216,000 tests and ranks near the bottom of the per capita leaderboard.

Since the amount of testing varies wildly by state, an "even playing ground" doesn't exist for comparison purposes, Njau said. In other words, it's very possible South Dakota or another state that does less testing than North Dakota could have a worse outbreak and not know it.

However the outbreak is measured, Njau and Schram agree that North Dakota's numbers are worrisome. The epidemiologists say residents need to follow guidelines such as social distancing, mask-wearing and hand-washing to prevent the virus from further spreading through the state.

Njau added that "young people are currently the face of the virus in North Dakota," and they especially should take more precautions.