As Montana rounds into its eighth month battling a pandemic experts say is likely to rage on well into 2021, the question of how to enforce state and local public health orders designed to curb the spread of COVID-19 is one that remains largely unanswered, though some counties have been more successful than others.

The order that has been met with perhaps the most pushback from Montanans is Gov. Steve Bullock’s mask mandate, which went into effect in July.

Among other measures, it requires businesses, government offices and other indoor spaces to ensure employees, volunteers, customers and others wear a face covering over their mouth and nose while indoors.

And although the order has been politicized by many in the state who primarily view it as a violation of their constitutional rights, it’s Flathead County that state officials recently pinpointed as an area where noncompliance is most rampant and a likely contributor to local cases.

Bullock recently spotlighted the county when he announced the state health department would be lodging complaints against five local businesses, the owners of which are now scheduled to appear in Flathead County District Court in early November.

The lawsuits, which Bullock recently said he would ultimately like to see settle, raise the question, why has Flathead County become a focal point over other areas in the state?

And are there lessons that Flathead County can glean from how others have handled the pandemic?

After speaking with public health officials at the helm of COVID-19 education and enforcement efforts in other similarly- sized counties, the overwhelming message is this: if residents, local boards, elected officials and law enforcement don’t cooperate with and support public health leaders, there is very little hope for controlling COVID-19 cases.

“It is critical that every individual accepts the responsibility of making sure protocols are followed,” said Trisha Gardner, public health officer for the Cascade City County Health Department. “There’s a large enough voice refuting the science that backs up the things that we do.

And people are unfortunately listening to that.”

IN CASCADE County — an area somewhat similar to Flathead County politically as it leans more conservative — law enforcement came out at the start of the pandemic stating they would only take COVID-19-related calls if someone refused to leave a business that required patrons to wear face masks. The Flathead County Sheriff’s Department offered a similar statement in July, making it clear they would also not be the ones tasked with enforcing Bullock’s mask mandate.

In an interview late last week, Flathead County Attorney Travis Ahner said he and local law enforcement leaders currently have no plans to revisit the topic of enforcing the mask directive. And on Thursday, Flathead City-County Interim Public Health Officer Tamalee St. James Robinson said she is unsure how orders will be enforced, including one that goes before the Board of Health Monday that would limit indoor gatherings to 500 people.

She diverted further enforcement questions to Ahner, who could not be reached for comment on the matter.

According to Gardner, in Cascade County, the responsibility of enforcement has ultimately fallen to the maxed-out shoulders of public health.

She added their health department is struggling to hire additional staff to tackle growing the area’s caseload.

Hiring has also been an issue at the Flathead City-County Health Department in recent months, as new cases have swamped contact tracers and case investigators. Deputy Public Health Officer Kerry Knuckles said in late September that other health-care entities can usually offer higher pay or more benefits, hence hiring has been a challenge. Gardner said the same is true for Cascade County, but added that constant pushback from residents, county officials and others is a contributing factor as well.

“The reaction to public health is causing burnout,” Gardner explained.

“This is a really difficult time for people to contemplate coming into this arena.”

WHILE FLATHEAD

and Cascade counties have experienced similar challenges on the enforcement front, other large counties have pursued complaint-driven systems that involve local health departments, county attorneys and law enforcement.

In Gallatin County, complaints regarding businesses not following the mask directive fall first to the Gallatin County Health Department. Each complaint is reviewed by sanitarians, who then contact the facility to educate owners on ways their business can come back into compliance.

According to Matt Kelly, public health officer for the Gallatin County Health Department, if there are repeat offenders in the community, they issue warning letters, which are written in collaboration with the local county attorney. Kelly said since late summer, less than 12 letters have been sent out to businesses. “Very often we get a response and we see immediate change. For the most part, businesses want to stay open and be good community partners,” said Kelly, who added that the health department has worked closely with local businesses since the start of the pandemic in order to “build relationships and understanding when it comes to mandates.”

Kelly did say their local complaint-driven system is time-consuming and requires an all-handson- deck approach. The health department has about 50 staff members, all of whom perform tasks related to COVID19. Even with that many employees — a figure that is nearly double what Flathead County has for its COVID-19 tasks despite the two counties having similar caseloads — Kelly said “some days it feels like I could use 50 more people and it still wouldn’t be enough.”

AT THE Lewis and Clark Public Health Department, Licensed Establishment Program Supervisor Laurel Riek said officials are in the process of revising their compliance enforcement process to include risk assessments for businesses.

She said their system will soon be able to pinpoint which businesses are more likely to be a source of COVID-19 than others. Riek said this will be determined through a number of factors, including whether businesses have a compliance plan in place, or if they are repeat offenders. Riek said in Lewis and Clark County, if violations lead to written corrective action from the health department, those letters are delivered by law enforcement officers, who will inspect the facility to validate the complaint prior to issuing the warning letter.

If there are further complaints, a county attorney is brought in, though she said this is rare.

“What we have found is the majority of businesses want to be compliant,” Riek said. “I think probably the hardest part about enforcement and everything is it’s usually an individual’s behavior that is causing the problem, but it’s attached to a business. That’s challenging.”

ALTHOUGH RIEK and Kelly both said they also encounter locals and businesses that have no desire to follow Bullock’s directive, they said for the most part, county attorneys, law enforcement, elected officials and others have all been on board with assisting their local health departments with enforcement and education efforts.

Riek pointed to one example in July when the Lewis and Clark Commission, Helena Mayor Wilmot Collins and public health officials issued an ultimatum of sorts. According to reporting by the Independent Record, at the time, County Commission Chairwoman Susan Good Deise told the public “this event today is a request in the strongest possible terms for people to do what is right voluntarily. No one wants to go to a mandate...this is your last chance.”

Riek emphasized elected officials have not wavered on their outward support for mask-wearing, social distancing and other COVID-19 safety protocols — a level of outspoken support that has not yet occurred in Flathead County, namely from the county commissioners. And during a press call in early October, Bullock put pressure on local leaders to change this.

He spoke about the county’s then-uncontrolled surge of cases and said “if leaders of Flathead County aren’t discussing additional steps that they should be considering, they’re not serving their communities as well as they could.”

In response, Flathead County commissioners released a statement separating themselves from the issue.

“The Governor’s directive was to health officials and the county attorneys, not the commissioners,” they wrote.

“The commissioners do not have legal grounds to mandate masks or health mandates. Instead, we support the Constitutional rights of Montanans to make choices about personal protection for themselves and their families.” They then recommended individuals and businesses follow guidelines from the health department, which earlier that day implored individuals to wear masks, social distance and take extra precautions as cases were climbing.