As COVID-19 surges across the country, one state stands out. In North Dakota, infections are, alarmingly, occurring at more than six times the national rate. How is the disease spreading so quickly through a small, rural state? And what lessons can North Dakota offer as we head into a winter season that Anthony Fauci, the country’s leading infectious-disease expert, has warned will bring “a whole lot of hurt”?

Part of me wishes I didn’t have answers to these questions. But as the lead public health-official for the city of Bismarck and Burleigh County, N.D., I’m sadly familiar with the ways our state has failed to take this deadly virus seriously and what it means for our communities.

Ranae Moch is the public-health director for the city of Bismarck and Burleigh County, N.D.

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