Cook County, Minnesota, has kept COVID at bay

GRAND MARAIS, Minn. – Rewind to August weekends here, when visitors queued up for entry to downtown shops, it was nearly impossible to find a hotel room and one restaurant was selling enough tacos on a given night to feed half of this small town's population.

Throughout this hectic summer tourism season, when businesses were at times overwhelmed by traffic, many of Cook County's 5,400 permanent residents worried: Would this be the week the out-of-towners caused a massive COVID-19 outbreak?

"It was terrifying at first," said Jill Terrill, who owns Joy & Company, a boutique in the remote county along the North Shore of Lake Superior.

Visitors kept flooding in, but the wave of infections never came. Cook County reported its 100th COVID-19 case Friday, becoming the last Minnesota county to pass into triple-digit territory.

The county has by far the lowest number of cases per capita, having recorded just 18 infections for every 1,000 residents — half as many as Lake of the Woods County, which has the second-lowest rate in the state. No Cook County residents have died from the virus, nor has the local hospital seen any severely ill COVID-19 patients.

How did this small region manage to mostly keep the virus at bay while welcoming some of its largest-ever summer crowds? Dr. Kurt Farchmin, a family physician who became the de facto medical director of Cook County's pandemic response, said numerous tourists tested positive for COVID-19 during or after trips to the area.

"I think we had too much COVID here for it to be just luck that we didn't get it," Farchmin said.

Residents say collaboration across industry sectors and investments in public health — including the formation of a local contact tracing team — were key to success. The close-knit community recognizes the potentially devastating consequences a widespread outbreak could have on their fragile health care system and limited workforce.

"It wouldn't take much to overwhelm us," said Grace Grinager, Cook County's public health supervisor. "So our strategy has really been to make this pandemic response something that's owned by the broader community."

Six physicians and one nurse practitioner serve Cook County's 16-bed hospital and 37-bed nursing home, as well as a home care center and the Sawtooth Mountain Clinic. With the nearest intensive care unit more than 100 miles away in Duluth, Farchmin said he knew in March: "This was a public health issue, and our ability to make it at the hospital was going to be entirely dependent upon what people did out in the community."

Grinager, Cook County's sole public health employee at the time, quickly initiated conversations with the hospital, the clinic, the chamber of commerce, the tourism bureau, school officials and tribal leaders from the nearby Grand Portage Reservation.

Their goal? Get everyone on the same page — an easier undertaking for a county with the sixth-smallest population in the state.

With so little known about COVID-19, officials encouraged extra caution. Right away in late March, most hotels and lodging shut down and tourism promoters paused marketing as residents pleaded with visitors to stay away. Grand Marais' three grocery stores temporarily offered only curbside pickup; some had to take orders by phone or e-mail.

Health leaders like Grinager and Farchmin started appearing on local radio segments multiple times each week to give updates about the virus and the county's pandemic response. ("It's like having our own Dr. Fauci," said Stephanie Anderson, who runs three Grand Marais hotels.)

While the community was shut down — even more so than many other parts of the state — locals started to craft a plan for the summer. Visit Cook County prepared a social distancing campaign encouraging tourists to stand "one moose apart." CARES Act funding allowed the county to hire a few additional public health employees, who went over individualized safety plans with businesses.

As the county gradually started to reopen in mid-May, several Cook County residents still argued that welcoming visitors was akin to inviting in the virus. In early June, the county sheriff's office believes someone cut down a tree to block tourists from traveling up Hwy. 61. Two days later, Cook County's first COVID-19 case was recorded.

"We knew early on we weren't going to be able to shut down our main economic engine," Grinager said.

"In theory," Farchmin added, "we just needed to keep the tourists from infecting the locals."

Come end of September, it appeared Cook County managed to do just that, finishing the month with seven total COVID-19 cases among residents. Officials said there was no evidence that any tourist passed the virus to a local throughout the summer, when thousands made road trips to explore the region's woods, trails and lakes.

The low case numbers may be partly because of good timing. Minnesota's recent surge in COVID-19 cases occurred during the North Shore's offseason. Cook County also lacks large facilities like prisons or meatpacking plants that have seen outbreaks in other parts of the state, and its sole care facility has not produced a positive test.

But health officials also credit their local contact tracing efforts, recalling a handful of instances in which they significantly reduced the risk of exposure to the virus because of the speed at which they were able to identify connections. The local tracers, a team of trained part-time workers and volunteers staffed seven days a week, use their knowledge of the community to build trust and avoid delays that may occur in the statewide system.

"It's been a pretty big ontaking," said Grinager, who asked the state for special permission to start handling contact tracing in-house at the end of the summer. "I think there definitely is a strength in knowing who the other players are in the community."

Retailers, restaurants and hotels worked to help curb the virus' spread, too. Drury Lane Books installed a pickup window for customers who did not want to venture inside. Hungry Hippie Tacos served only takeout all summer. The Shoreline Inn often let rooms air out for a night between guests.

Several Cook County businesses had banner years in 2020, and others said they might have if they weren't missing the international summer workers who could not enter the country because of pandemic restrictions.

Now they have high hopes for a boom in winter business. Some outfitters have sold out of snowshoes and cross-country skis. Abby Tofte, who owns the Big Lake gift shop, said she is buying inventory for January and February for the first time.

After the chaotic summer, Tofte feels comfortable that her COVID-19 protocols — which include large red and green light bulbs her electrician husband rigged near the entry to reflect the small store's capacity — will hold up in the colder months.

"Whatever we've been doing, it works," she said.

But Farchmin is leery winter tourism has the potential to be "a powder keg" for a COVID-19 outbreak. Cook County's North Shore Health Hospital has for weeks been unable to transfer patients to Duluth for special care, such as treatment for a broken bone or heart attack.

"My biggest job right now is to be a wet blanket. If people are wanting to come up here this winter, I say bring a lot of warm clothes," Farchmin said. "Because we don't want you inside."