South Dakota welcomed hundreds of thousands of visitors to a massive motorcycle rally this summer, declined to cancel the state fair and still doesn't require masks. Now its hospitals are filling up and the state's COVID-19 death rate is among the worst in the world.
The situation is similarly dire in North Dakota: The state's governor recently even moved to allow health care workers who have tested positive for COVID-19 to continue working if they don't show symptoms. It's a controversial policy recommended by the U.S. Centers for Disease Control and Prevention in a crisis situation where hospitals are short-staffed.
And now, after months of resisting a statewide mask mandate, North Dakota Gov. Doug Burgum changed course late Friday, ordering that masks be worn statewide and imposing several business restrictions.
“Our situation has changed, and we must change with it,” Burgum said in a video message posted late Friday. Doctors and nurses “need our help, and they need it now.”
North and South Dakota now face a predictably tragic reality that health experts tell USA TODAY could have been largely prevented with earlier public health actions.
Pandemics require people to give up some of their freedoms for the greater good, University of British Columbia psychiatry professor Steven Taylor told USA TODAY. In conservative regions like the Dakotas and elsewhere in the world, it's common to see pushback like an “allergic reaction to being told what to do,” said Taylor, author of "The Psychology of Pandemics". 
But months of lax regulations have contributed to a growing public health crisis in the Dakotas.