Dakotas COVID, North Dakota and South Dakota lead the country in new cases per capita over the last two weeks.

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.

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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?

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.

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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.

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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.

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