FARGO, N.D. (AP) — The mayor of North Dakota’s largest city said Monday he’d like to see a statewide mask mandate as the coronavirus spins out of control and in the meantime invoked emergency powers to require face coverings in most settings that don’t involve family members.

Tim Mahoney, who in addition to being Fargo’s mayor is also a general surgeon, has been largely supportive of Republican Gov. Doug Burgum’s approach to managing the pandemic. But he said up to one in four people being tested for the virus in his city in recent weeks has tested positive, and Mahoney said it “would be great” if Burgum issued an order for the entire state.

“Statistics have shown you get better compliance if it’s the whole state as opposed to one (city or county) at a time,” the mayor said.

Cass County, which includes Fargo, had over 200 new cases Monday and has had nearly 8,000 since the pandemic began. It’s been one of the hardest-hit spots in a state that has ranked worst in the nation for daily new cases per capita the past two weeks.

“We’re not doing well. I’m very concerned,” Mahoney told The Associated Press. “Our counts are not going down so we’re going to have to do something dramatic to get them down.”

North Dakota leads the nation in the number of new cases per capita in the last two weeks, a distinction it has held many times in the last couple of months, according to Johns Hopkins University researchers.

Burgum has in many respects left management of the virus up to local leaders and Mahoney himself cast the deciding vote against a mask mandate at the last city commission meeting. Mahoney explained that stance by saying enforcement is an issue and is made more complicated by whether next-door neighbors like West Fargo and Horace follow suit.

During Monday evening’s city commission meeting, however, Mahoney reversed course and announced the mask mandate, which has no penalty for non-compliance. Commissioners John Strand and Arlette Preston, who have pushed for the requirement, said they believe an enforcement component might be needed but called it a good start.

“I know the pressure has been immense,” Strand said, talking to Mahoney.

Burgum’s spokesman did not respond to an email message seeking comment.

Burgum in May formed a task force to address rising virus rates in eastern North Dakota and the move seemed to pay off in Fargo as positivity rates fell to about 2%. Midway through the summer, state officials turned their attention to a spike in the Bismarck-Mandan area, which had the most active cases at the time. It appears that Fargo has once again become the hot spot.

“We’re looking at sites reporting positivity rates of 18% to 25%,” Mahoney said. “We never thought we would get that high.”

Statewide positivity rates have been running over 10% for most of the last week, although the figure dropped to 8.17% in the last day. Hospitalizations rose by six to a record 153. The state went over 400 deaths over the weekend.

There were 271 available staffed inpatient beds plus 26 intensive care unit beds in North Dakota, according to state data reported Monday. In Fargo, there were 10 ICU beds and 26 regular beds at Essentia Health, up from three and 10 the day before. There were four ICU beds and nine regular beds at Sanford Health, up from zero and five, and no ICU beds and eight regular beds at the VA Hospital.

“Hospitals are getting full the death counts are too high,” Mahoney said. “If you have a heart attack and the hospital is full, we have to figure out what we’re going to do. How are you going to manage that?”

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