ND Health Officer Resigns, Third of 2020
Dr. Paul Mariani left amidst quarantine order rescindment
The North Dakota Department of Health has been plagued this year by the many abrupt changes in leadership. Mylynn Tufte, who was appointed as State Health Officer by Governor Doug Burgum in February 2017, was in that position when COVID-19 cases were first confirmed in North Dakota in early spring. She and other joint information center team members developed travel orders, hygiene guidance, health care preparations and more to minimize COVID-19’s impact in the state. On April 10, 2020, Tufte signed State Health Officer Order #2020-06, which related to measures to slow the spread of COVid-19. It required “all persons in the state of North Dakota who have been identified by the Department of Health as a household contact of an individual who has tested positive for [COVID-19].” Household contacts were defined as individuals who have/may have been exposed to someone who’d tested positive living in the same household.
The order required these household contacts to remain under quarantine for 14 days after their last contact with the COVID-positive individual. The punishment for failing to comply, as stated in Section E: Failure to Adhere to Order, would mean “a person is guilty of a class B misdemeanor.”
(Note: under North Dakota Century Code, anyone who fails to adhere to any State Health Officer Order is guilty of a class B misdemeanor.
At the end of May 2020, there was an announcement made that Gov. Burgum had accepted Tufte’s resignation. The resignation was abrupt, her resignation summing up her decision prompted by “a desire to return to the private sector.” Burgum appointed Dr. Andrew
Stahl as Interim State Health Officer immediately thereafter.
Dr. Andrew Stahl resigned his position in August and returning to his clinical practice. “I want to thank Governor Burgum for the opportunity to serve as interim state health officer. It has been a very challenging and rewarding position," Stahl said. "COVID-19 has changed how we operate and has changed the practice of medicine in a huge way. I’m looking forward to continuing my plans to return to clinical practice and am thankful for the opportunity to serve.”
“We are deeply grateful for Dr. Stahl’s tireless dedication and service to the state of North Dakota during this incredibly challenging time,” Burgum said. “We wish Dr. Stahl all the best as he returns to his clinical practice.”
A September 3 release by the Governor’s Office announced that Burgum had appointed Dr. Paul
Mariani as the new Interim State Health officer and that he would join the Health Department on September 14.
During a morning press briefing on September 23, Burgum stated that the previous order requiring household contacts to remain quarantined for 14 days had been amended to include ALL individuals identified by the NDDoH as close contacts (anyone within 6 feet of a positive individual for more than 15 minutes). In the order, Dr. Mariani specifies the same reasonings for the amendment that Tufte had in April.
“The State Health Officer reasonably believes the subject persons [all ) people] have been exposed to [ COVID-19] due to close contact with an individual who has tested positive for [COVID-19]. As a result, the subject persons pose a substantial threat to public health as they may be infectious, or may become infectious,
and be able to transmit the disease to other people, even with mild symptoms. Quarantine is necessary and the least restrictive alternative to protect and preserve the public health and to reduce the significant burden on the health care system. [14 days since last contact with positive individual].”
In the event someone failed to adhere to the or
der, the punishment was the same as issued with the April order: class B Misdemeanor.
“We want to make sure that we’re being really clear about the importance of quarantine,” Burgum said during Wednesday’s briefing. “We’re asking that positive cases and their close contacts follow the isolation and quarantine guidance…and statistical analysis [indicates] that as many as one third of the people who were
identified of to a positive at some point themselves became positive…if you are someone who is identified as a close contact, meaning that you’re less than 6 feet away for more than 15 minutes with someone who is positive, the possibility of you coming down with COVID actually increases significantly. And that is our own North Dakota data.”
He said that is the reasoning behind the decision to expand the quar
antine order to include all close contacts.
“The health department has always recommended this,” Burgum continued, “but this amended order brings [the state] in line with CDC guidelines.”
One day after the amendment was announced, news broke that it had been rescinded. Governor Burgum joined Rob Port on Plain Talk to explain the reasons behind this quick decision on Friday morn
ing.
“There was an order on the books from last April about household contacts,” Burgum said. “Dr. Mariani noticed when he was coming up to speed that we weren’t in line with the CDC guidelines.”
To remedy that, the ND health team managing the state’s response to the COVID-19 pandemic cultivated an amendment order, ultimately issued by the State Health Officer.
“It didn’t flag for me personally that by extending it to match CDC guidelines that we were going to have the firestorm of reaction that we did, and so that was a miscalculation on my part,” Burgum said. “Then we talked to Dr. Mariani the next day [after amending the order] and we said ‘look, our goal here is compliance. We want to get as much compliance as possible and to get compliance,
we have to have public support.’ And the public was really focused on the penalty as opposed to focusing on either our rising numbers or just the common sense understanding that the virus moves from people to people…[and that] one of the ways that you slow down the spread or flatten the curve…is that people that are positive must stay away from other people and people that have been in close contact with positives are sometimes the likely ones to be next infected, so THEY should stay away from other people. It’s just a common sense, practical thing that everybody understands
that that’s the way you slow the spread.”
Burgum said that because the public was focusing on the potential penalty of breaking quarantine orders—a class B misdemeanor—the state wanted to redirect that focus to increasing cases and seeking public compliance to slow the spread of the virus.
“A) we’ve got increasing cases and B) we’ve got to work with communities to find ways that people will seek compliance, and get people to stop focusing on the potential penalty,” Burgum said. “I’ve said all along, we’re for things that increase compliance and compliance is going to come when individuals and communities step up and make decisions
about how they want to slow the spread in their communities.”
He emphasized that the state is still strongly recommending that close contacts follow the CDC’s guidelines by isolating.
“We know that the government telling people to do stuff in ND doesn’t work, we just know that, so then that’s never been the plan,” Burgum said on Friday. “We’ve taken this path [of light government], and it’s been effective for North Dakota. We would like to just get people focused on the path that we’ve been on again and not get off of [on] the theoretical debates about enforcement and get back to doing what we need to do to help protect the vulnera
ble people in our state.”
After his conversation with Port on Friday, Burgum found himself commenting on yet another State Health Officer’s resignation on Saturday. Dr. Mariani explained in a statement that “While the governor and I agreed on the urgent need to isolate positives and quarantine close contacts in accordance with CDC guidelines, and that the amended order’s penalty provision was overly punitive, the circumstances around the handling of the order made my position untenable.”’
The newest person in the role of State Health Officer is NDDoH Chief of Staff Dirk. D. Wilke, who Burgum says will hold the position until a replacement is found.
Mariani’s resignation comes as health care workers at Sanford Health and CHI St. Alexius Health in Bismarck-Mandan report
that their facilities are at or near capacity due to COVID-19.
The state also posted a 7.4% 7-day positivity rate last week.