What started as a Midwestern surge has grown into coast-to-coast disaster.
Over the past two months, rural counties and midsize cities in the Great Plains and Upper Midwest have been the main drivers of the dizzying growth in U.S. coronavirus cases.
But the virus appears to have entered a new phase in recent days: The reason the country is continuing to break case records has less to do with North Dakota and Wisconsin than it does with swift resurgences of the virus in cities like Baltimore, Los Angeles, Miami and Phoenix and with first-time spikes in smaller cities away from the nation’s middle, like Cumberland, Maryland.
“Our people are tired,” said Maggie Hansen, chief nursing executive at Memorial Healthcare System in south Florida. “They’re tired, and they don’t see an end in sight.”
Coronavirus cases are emerging in their highest numbers of the pandemic, with more than 175,000 a day, on average, in a country that has seen more cases and more deaths than anywhere else in the world. More than 1.2 million cases have been identified in the United States in the past week alone, and the country is on pace to reach 13 million known cases in the coming days. Deaths are also rising fast, with more than 2,200 announced nationwide Tuesday, the most on a single day since early May.
The spread of the virus rages on in the Great Plains and the Upper Midwest. Iowa and South Dakota continue to report new cases at some of the highest rates in the country, and deaths there have reached their highest levels on record. But the pace of the spread has slowed in those regions while rapidly increasing in other, more populous parts of the country, including in California, where more than 17,000 cases were announced Monday, and in Texas, where more than 20,000 cases were announced Tuesday, the two highest daily totals of any state during the pandemic.
All of this has been unfolding on the eve of what infectious-disease experts see as a likely turning point for the outbreak in this country. Dr. Eli Perencevich, an infectious-disease physician and epidemiologist at the University of Iowa, said he feared the worst was still yet to come in his state, especially with Thanksgiving gatherings and cold weather looming.
“Human behavior is very different indoors versus outdoors when it gets cold, so I’m worried that’s going to make things worse,” said Perencevich, who has treated coronavirus patients. “And then we know Thanksgiving, where we’re all just bracing, given that the hospitals are completely full.”
Unlike in the spring, when the Northeast faced the worst, and the summer, when the Sun Belt saw explosive growth, this latest surge has begun to move beyond a single region. In fact, it is elbowing back into places like New York City that had brought earlier outbreaks under control and tearing through cities that had not seen many cases all along.
“People just wanted some normalcy and got loose, and here you are,” said Cyndi Kirkhart, who runs a food bank in Huntington, West Virginia, an area that is averaging a record 250 cases daily, more than triple the number from a month ago. “With the pandemic fatigue and all the politics stuff getting close to Election Day, there were so many things that contributed.”
The small city of Cumberland, in Maryland’s Appalachian panhandle, also avoided the worst of the pandemic’s first months.
By midsummer, Emmanuel Episcopal Church, a Gothic Revival landmark overlooking the city’s downtown, was inviting people back inside for services, though with disinfectant and temperature checks. The church rector and a part-time priest and their spouses dined together regularly but took precautions, usually staying outdoors.
And even as cases started rising this fall on the northern Plains, infections remained relatively scarce around Cumberland and many other cities in the mid-Atlantic and Northeast.
“Then, right before Halloween,” said the rector, the Rev. Martha Macgill, “it just exploded.”
In the first days of November, the priest and her husband were both admitted to the hospital with COVID-19. Per capita, Allegany County, where Cumberland is the county seat, now has the worst outbreak in Maryland, and the Cumberland region has the 14th-highest number of recent cases per capita of any U.S. metro area.
“It kind of happened silently then all of a sudden it was bad,” Macgill said.
About 1,100 miles to the west, in Sioux Falls, South Dakota, the fall surge came early. Mayor Paul TenHaken said some people in his city wrongly thought they had made it through the worst after a spring wave, mostly confined to a meatpacking plant, came and passed.
But the virus returned and hit the city hard: Two of TenHaken’s five staff members tested positive, as have dozens of others the mayor knows. The Sioux Falls area has had the sixth-most known cases per capita of any U.S. metro area. Hospitalizations and infections remain high statewide but have slightly declined in recent days. TenHaken’s unease remains.
“This week makes me a little nervous, just with all the travel and Thanksgiving and gatherings,” the mayor said. “I think this will be the real test, how diligent people are once you get into the holidays.”
Elsewhere, in the Midwest, there are localized signs of progress, or at least stabilization, though officials say that it could all prove fleeting.
The marginal progress in the Midwest comes after governors in some states, including Illinois, Iowa and North Dakota, imposed additional restrictions, and after hospital leaders across the region issued public warnings that they were running out of capacity to treat the sick.
In Wisconsin, which for weeks reported explosive growth, reports of new cases continued rising, but by 4% over the past two weeks. In Nebraska, which also saw runaway growth, the curve has flattened, with 1% growth. And in Illinois, which has averaged more than 10,000 cases per day, infection numbers have also leveled off, especially around Chicago.
“This is going to take weeks, not days,” Gov. J.B. Pritzker of Illinois said this week. “But is there a glimmer of hope? There is.”
Any incremental improvements in the Midwest has been more than offset by growing outbreaks elsewhere. In Los Angeles County, California, where cases have soared past the levels seen this summer, to an average of more than 4,000 a day, restaurants can no longer offer indoor or outdoor dining starting Wednesday evening. Around Miami, reports of new cases have more than quadrupled since the start of October, although they remain below the peak levels seen in July.
“We fully anticipate it’s going to increase, but we just want to do whatever we can to not get into the same position we were over the summer,” said Dr. Peter Paige, who was recently appointed the chief medical officer of Miami-Dade County. “It’s a real threat.”
Epidemiologists and public health officials around the country said the reason for resurging outbreaks could be explained by a simple variable: what people choose to do.
Dr. Debra Bogen, health director in Pittsburgh’s Allegheny County, told reporters last week that the fast-paced increase in local cases was fueled by people letting down their guard.
“The virus itself hasn’t changed — what has is our behavior,” Bogen said, recounting the story of an informal homecoming dance, organized by parents in a local school district, that turned out to be an event that led to multiple confirmed cases.
In Kansas, Anil Gharmalkar, 41, who owns a trucking company and lives in the town of Oswego, believed that the virus was a “big city problem,” unlikely to affect him.
Then he got infected.
“COVID didn’t care what I believed,” Gharmalkar said in a video posted by the University of Kansas Health System, where he has been treated and received a breathing device that has been implanted in his throat. “I gave lip service to being careful, and I could have been more careful, and I wish I would have been.”
All the while, deaths are rising, the virus is raging and, for most Americans, a vaccine is still months away.
What comes next? It depends in part, experts said, on how Thursday plays out around the country.
“Thanksgiving hasn’t happened yet,” Dr. Ngozi Ezike, director of the Illinois Department of Public Health, said this week. “People can still change their plans and change the outcomes. We don’t have to have superspreader events at homes.”