On June 8, 2020, someone blocked the main road leading into remote Cook County, Minnesota, with a large downed tree. In fraught pandemic times when so much was new, unfamiliar, and yet to-be-determined, the guidance from this hidden messenger rang simple and clear: Stay out.
Scan the news from any corner of America, and you likely won’t have too much trouble finding stories about rural communities’ struggles concerning the coronavirus. Lately, you’ll see reports about rural counties where vaccination rates lag metropolitan or statewide levels and demand for shots is low. Earlier, you may have seen stories about rural businesses protesting orders to close and packing their dining rooms. Animus about masks has been a flashpoint from the start and remains one today. Whether it’s vaccine hesitancy or calls to reopen, an underlying theme of stories like this is almost as clear as the message sent by the tree: Rural places aren’t taking this whole Covid thing as seriously as everyone else and we ought to do something about it.
Yet, dropping a tree on the main thoroughfare, that is nothing if not serious. And turns out, it’s just one small moment in a remarkable rural story.
What if I could show you a rural county where vaccination rates are leading the way, surpassing statewide trends and even beating out core metro counties? A rural county where transmission rates have remained low and local businesses helped lead the way on masking and social distancing? A rural county where, more than a year later, no local residents have lost their lives to Covid-19?
You know where this is going. To show you all of these things, I would show you Cook County, Minnesota. And suffice to say, it took much more than a downed tree on a scenic highway to achieve those milestones.
Setting the Scene — Highway 61 Revisited
Follow the north shore of Lake Superior a couple hours northeast of Duluth and you’ll find yourself in Cook County. Flanked to the south by the great lake and to the north by Canada, Cook County is Minnesota’s pointy northeast terminus, populated by about 5,300 people. Running alongside the lakeshore is Minnesota Highway 61, once part of the nationwide route of the same number that runs south all the way to New Orleans — and which inspired a beloved Bob Dylan album.
As 61 arrives in Cook County, it takes drivers through small lakeside townships like Schroeder, Tofte and Lutsen, before ultimately arriving in the county seat of Grand Marais, at one point designated “America’s coolest small town.”
Past Grand Marais, just before the border to Canada is the indigenous community of Grand Portage. Along this whole stretch of road, nestled between Lake Superior and the Sawtooth Mountains, you’ll find a state park at almost every turn off, each one complemented by cabins, resorts, hiking trails, ski hills and much more. And a short drive away from the lakeshore, up the Gunflint Trail, sits the Superior National Forest and points of entry into the vast and beloved Boundary Waters Canoe Area Wilderness.
Given this bounty of natural resources and attendant outdoor recreation opportunities, it’s no surprise then, that Cook County’s stock and trade is tourism.
And therein lies the likely motive of the downed tree on Highway 61.
“Is this really going to come to Cook County?!”
Before there was a chance for any defiant acts of resistance in Cook County, there was mere disbelief.
“When Governor Walz declared a state of emergency, and that was I think two days after the World Health Organization called Covid ‘the pandemic,’ I just remember this sinking feeling in the pit of my stomach, like ‘Oh man, I can’t even imagine what this is going to mean for us here,’” said Grace Grinager, the county public health coordinator. “Is Covid really going to … is this really going to come to Cook County?”
Whether east, west, or here in the northwoods, outdoor recreation and tourism-oriented communities got an answer to that question much sooner than many of their rural peers. “I knew at a logical level that yes, pandemic means everywhere,” Grinager recalls.
As communities around the state of Minnesota adjusted to what they could and couldn’t do under new pandemic-era rules and rituals, there was little doubt that people would keep coming to Cook County. The appeal of its outdoor offerings and open spaces only increased in this moment. And so the challenge immediately shifted to making sure those people who did come to Cook County didn’t bring Covid outbreaks with them.
“There was some real resistance to having the level of tourism we’re used to here, but our economy really depends on it,” Grinager admits. “So rather than making it this public health versus business thing, we just tried … to support the businesses coming up with good plans and giving them an opportunity to troubleshoot with us and brainstorm with us over the course of the past year.”
Beyond working with local business leaders, the public health department partnered with the area’s tourism office, “Visit Cook County,” to put together a promotional campaign and a visitor’s pledge. The pledge challenged everyone visiting to wear masks and protect the community by following social distancing recommendations. Minnesota’s governor was relatively quick to announce a statewide mask mandate, which headed off controversial conversations locally, but all in all, Grinager said area businesses were some of the first stakeholders she heard from wanting government leaders to step in and set those rules.
Small Teams, Big Undertaking
As Cook County put its plans into action, the stakes were immediately understood, and the consequences of failing to get it right were not hard to understand. For starters, like many rural areas, the population in Cook County is older than average. In fact, it has one of the largest senior populations by percentage in the state, with about a third of its residents being 65 years of age or older. And while the county was fortunate to have healthcare infrastructure that many other rural areas lack, it was also particularly vulnerable in some important ways that rural places know all too well.
In describing the healthcare system in Cook County, Grinager says they have “one of everything,” one hospital, one clinic — a federally-qualified health center — and one long-term care facility. She also mentions Grand Portage Health Services located in the tribal nation as a vital partner.
“There [are] a lot of really talented people, very passionate, skilled individuals working within [that system]. But we don’t have an ICU. We don’t have any ventilators or staff to staff a ventilator in our county … it would all be in Duluth. That’s two to three hours from us,” Grinager explained. “So I think we all entered this pandemic very well aware of that, not just on the medical, public health side of things, but the community at large. Everyone knew that if they were to need that level of care, they would be transported down to Duluth, essentially. And so I think that awareness was motivating for us to put a lot of work in on the prevention side of things and to try to be really clear about what we were doing and why.”
The medical resources Cook County didn’t have may have been a good motivator, but what the county did have was enough to accomplish quite a bit. According to Grinager, in most parts of Minnesota, state government officials in Saint Paul have helped lead testing and contact tracing, but her team opted to put in the effort to keep those activities close to home, working in partnership with Grand Portage Health Services.
“We’ve just kept that very localized, figuring that because we’re so small, we have relationships with the community. They’re probably more likely to pick up the phone if they see a local number versus an out-of-town number and that’s gone very well,” Grinager said of testing and tracing. “We have a relationship with the local lab too, so we’re able to do the work very quickly. If someone [tests] positive through the lab, we’re calling them usually within the day, sometimes within a couple of hours. So that’s been a huge undertaking, but a huge asset.”
Throughout our conversation, Grinager noted that it took a lot of work to get each of these systems into place. Small teams taking on big jobs is a consistent theme; at the onset of the pandemic, Grinager was the only full-time member of the area’s public health department, so collaboration was essential to make it all work. Public health meetings with the local business community, area schools, and other stakeholders take place every two weeks, Grinager says, and the county’s Emergency Operations Center includes representation from hospital and healthcare system staff, business leaders, and school officials.
“I’ve been really proud that we’ve stuck together,” Grinager said. “I didn’t think of it as a particularly siloed community, but the fact that we’ve been able to work together across organizations, with our tribal partners in Grand Portage Health Services, that’s something I hope really continues on. We’ve just developed such rich, collaborative relationships here and that’s been so hugely beneficial.”
In recounting it all, Grinager is also quick to address another issue that must be confronted in any rural story like this: “Broadband hasn’t been an issue. We actually have really good broadband access here,” she said.
Stepping Up to Help the Vaccine Effort
As the pandemic has entered its next phase, from prevention to vaccination, the heart of the public health effort in Cook County has moved to a locale entirely befitting northern Minnesota mythology: a curling rink. One of the largest pieces of property owned by the county, the rink was well suited to be repurposed into the area’s main mass vaccination site. In its very first clinic, the county vaccinated 40 people, primarily EMTs. As they worked through additional eligible groups, they eventually ramped up capacity to provide 400 shots each day. This was in addition to shots being administered at the federally-qualified health center and by Grand Portage Health Services.
Like the prevention efforts that preceded this, the vaccination rollout has been designed locally and managed collaboratively. The county used CARES Act funding to hire temporary public health staffers to help set up the registration system, commiting to keep it as simple as possible. They held a series of “Train the Trainer” sessions on how to sign up for appointments online. And as the tribal nation in Grand Portage was authorized to set their own eligibility criteria, they could offer surplus vaccine doses and general support across the county as well.
All told, this has resulted in Cook County being the statewide leader for vaccinations in Minnesota. According to Minnesota Department of Health data, nearly 80% of adults in Cook County had received at least one dose of the Covid-19 vaccine by May 13. That was about 10 percentage points higher than the core counties containing the Twin Cities, and 5 points higher than Olmsted County, home to the internationally-renowned Mayo Clinic.
Grinager said the mass vaccination effort has been an especially gratifying experience, even more so than she expected.
“People come in and you can just tell they’re smiling under their mask, that they’ve just been waiting for this vaccine all year,” she said. “It feels a little strange actually, to have so many people coming through a space when we’ve all been separate for the year, but just looking out at the curling rink and seeing people sitting there and looking just grateful and happy to be there … there’s a joyful element to the mass vaccination efforts I didn’t quite anticipate.”
That gratitude has carried forward into action. With each new shot that goes in someone’s arm, the vaccination effort is becoming more community-driven, thanks to an outpouring of volunteer support. Grinager noted that there are about 70 active volunteers who are helping support various elements of the vaccination clinics, many of them retired individuals in the 65 and up age group. The demographics that once illustrated Cook County’s vulnerability were now emerging as a point of strength — about 97% of Cook County seniors are vaccinated or on their way.
The volunteer spirit has been key, given the small number of full-time staff available in both the health care system and the public health department.
“To have people in the community, stepping up and giving their time and energy and expertise has been really crucial for vaccinating,” Grinager said. “Seeing all those volunteers too, I’m like, ‘Wow, there’s so many people here who just want to help.’ And I think that’s been something that’s very unique to the Cook County response because we’ve really tried to find ways to help people plug in.”
The volunteerism doesn’t stop at the curling rink. Grinager mentions another volunteer-run effort dating back to earlier in the pandemic, a “community support line” residents can call if they are feeling stressed, isolated, or in need of mental health support.
“We’re Not Done Yet”
For the astute observer looking to replicate Cook County’s success and adapt it elsewhere, there are plenty of possible takeaways here. When a baseline level of rural healthcare infrastructure still stands somewhere, you have tools and options for advancing public health. When leadership comes from within and resources are deployed locally, it fosters greater cohesion and trust. When strong, collaborative relationships exist between government, business, and community groups, you can get a lot done. And when high-quality broadband access is not in doubt, it’s possible to focus attention where it belongs, on the challenge or crisis at hand.
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For media junkies, the local news environment may be worth a quick look; Grinager mentioned the Grand Marais-based community radio station, whose airwaves she appeared on weekly to provide important public health updates. And for the armchair political scientist, the voting behavior of this place is not to be ignored, this being a rare rural county colored blue on the electoral map.
But beyond any specific criteria, any wonky wish lists, or theories, there’s a more foundational sense of camaraderie and community that may underlie it all.
“We’re not done yet,” Grinager admitted, “But I think there’s a lot of power in small communities working across agencies and coming together in the face of a public health emergency. I mean, I think that can be hugely powerful in smaller places and more rural places. And that’s something we’ve seen really shine through here.”
It’s a clarion call, or a fitting grace note at least, for a nation in desperate need to come together over something — anything — as the pandemic winds into its latest chapter.
That old downed tree on Highway 61 may have garnered attention and consternation from the outside, but it was never a suitable response nor a relevant part of this narrative. Solidarity, effective coexistence, and a commitment to caring for one another, those things are the story here in Cook County and the source of its success. And from where Grinager is standing, that’s not an especially complicated or controversial concept.
“It’s like we know everyone and we have to keep seeing everyone and living with everyone in this community,” she said. “So working together is really the best option rather than alienating one another.”