The coronavirus is tearing across the United States at an alarming pace. Hospitals are filled to perilous levels. More than 120,000 new cases are being identified every day. And ever higher and more miserable records — of states’ cases, of positive testing rates, of hospitalizations — are being set, day after day.

A pandemic that was once raging in New York and later across the Sun Belt is now spread so widely across the country that any number of cities and states might now be considered the worst off, depending on the measurement used.

The Minot, North Dakota, area has seen more cases per capita in this upsurge than anywhere in the country. Wisconsin’s outbreak has escalated more rapidly than those in other states. The county that includes Los Angeles has reported more COVID-19 cases since the pandemic’s start than anywhere else. Texas has the most cases of any state, and the most cases reported on college campuses.

The list of deeply troubled locations — each with its own, different gauge of the problem — goes on and on. If anything, the sheer number of hot spots comes as a reminder of how widespread this outbreak has grown.

“The entire country is out of control,” said Dr. Dara Kass, an associate professor of emergency medicine at Columbia University Irving Medical Center in New York who treated numerous COVID-19 patients this spring and had the virus herself. “When you see the Dakotas and Montana and Oklahoma and Utah and Iowa and Texas — all these states — overrun with cases, it’s jarring to know that no matter what we do here, it’s going to depend on the action or inaction of leadership and people everywhere else.”

Here is a snapshot at some of the places in the country that might be considered the most trouble-prone when it comes to COVID-19.


Minot, North Dakota

The metro area with the most recent cases per capita.

It is not immediately obvious in Minot, a city of 47,000 that is known for its Air Force base, that a spike of virus cases is unfolding. Schools are proceeding in person and indoor dining, though limited, is still allowed.

But inside Trinity Hospital, a crisis is clear. Doctors and nurses are working overtime to care for the rapidly increasing number of coronavirus patients. An entire hospital floor — 35 beds — is dedicated to COVID-19 patients, but hospital officials say it is not enough and an expansion is being considered, as other large hospitals in the state are full and unable to help.

“It’s very scary,” said Lisa Clute, a public health official in Minot. “One day my mom called and she said, ‘I lost three friends last night to COVID.’ It’s heartbreaking. I just don’t know how else to say it.”

Sioux City, Iowa

The metro area that may have faced the most prolonged suffering.

Other places have had bigger outbreaks, worse days and faster surges. But few have seen the sustained pain of the Sioux City metro area.

It has had more known cases per capita than any metro area except Bismarck, North Dakota, according to a New York Times analysis. Nearly 9% of people in the area, known to locals as Siouxland, have tested positive.


The troubles started this spring, when outbreaks at meatpacking plants sickened hundreds of people.

After a relatively quiet summer, infections have started rising again, with daily case levels across the Sioux City metro area exceeding 180 a day, almost as many as at the May peak.

School officials have said they could soon ask the state for permission to close some buildings. Mayor Bob Scott said pretty much everyone at an outdoor Veterans Day event was wearing a mask, a level of compliance he would not have expected even a few weeks ago.

But the struggle has been so prolonged, and so relentless, that Scott said he did not think most people in Sioux City realized their area had one of the country’s highest case rates.

“It’s been so gradual,” he said, “that we’ve just sort of learned how to live with it.”

More on the COVID-19 pandemic


New York City

The big city with the highest death toll.

In New York City, the U.S. center of the pandemic in its first dark months this spring, there is a distinct feeling of post-traumatic stress disorder as the number of new infections rise to a level — more than 1,000 cases a day — that last occurred in May.

“A second wave is knocking at the door,” Bill Neidhardt, the press secretary for Mayor Bill de Blasio, tweeted on Wednesday morning.

More than 24,000 deaths in New York City have been linked to the virus, more than in any other American city. And even as hospitalizations and death rates remain at a small fraction of what they were at their height, the sound of ambulance sirens can touch off a sense of dread.

“It’s a scary time,” said David Lat, a 45-year-old lawyer who chronicled his hospitalization in March on Twitter. “Everyone is worried about another spike.”

Los Angeles County

The county with the most known cases since the start of the pandemic.

Phones lit up across Los Angeles this week with an emergency alert: Coronavirus infections were on the rise after months of remaining steady.


Los Angeles County is seeing daily case counts at levels not seen since the late summer.

“This isn’t a blip,” Barbara Ferrer, the county public health director, said. “This is now a surge.”

Los Angeles County, with 10 million people, is more populous than most states and has seen more known cases than any other county: 326,000. Factoring for population, its numbers look far different. On a per-capita basis, nine California counties have more cases.

Avenal State Prison, California

The biggest known cluster.

Avenal State Prison, in California’s San Joaquin Valley, is the nation’s largest known coronavirus cluster of any kind, with at least 3,314 infected inmates and correctional officers over the course of the pandemic, according to the Times database. Eight inmates have died.

As of Wednesday, more than 85% of the prison’s inmates had tested positive, according to state prison data. Twenty inmates remained ill. A spokeswoman for the California prison system did not immediately respond to requests for comment.

Michelle Tran said her husband, who is incarcerated in Avenal, had so far tested negative for the virus. But she is worried.


“I don’t want to bring him out in a bag,” she said. “I don’t want to bring him home like that.”

Norton County, Kansas

Among the most cases per capita of any county.

Before the outbreak at the Andbe Home, a nursing home in Norton, Kansas, the county had gone months with almost no known cases. Then all at once, the virus spread through the nursing home, infecting all 62 residents and killing at least 10. More than 500 inmates in the nearby Norton Correctional Facility have also been infected.

“I think it’s opened everybody’s eyes up,” said Tammy Steinmetz, whose 89-year-old father tested positive for the virus in the Andbe Home. “I don’t know if we thought we were immune to it, but you just didn’t think it would be as bad as it was here.”

Steinmetz has not seen her father, who has dementia, since mid-September. He has a flip phone, and no way to make a video call. She is anxiously waiting for him to be moved to a room with a window so she can at least get a look.

“I’ll be right up there looking at him through the window and talking to him on his phone,” she said.

Navajo Nation

The Native American reservation with the most known cases.

Cases are rising again on the sprawling Navajo Nation, which already had far more known cases and deaths than any other Native American reservation, and more than most places in the country. More than 12,000 people have been infected and at least 595 people have died.


Tribal officials have reimposed nightly curfews, announced weekend lockdowns and installed highway checkpoints aimed at keeping outsiders from bringing the virus in. President Jonathan Nez said there had been little organized pushback to the restrictions.

“People are not saying you’re taking away my freedoms by forcing me to wear a mask,” Nez said. “It’s because we got hit hard.”


The state that has unraveled the fastest.

The pandemic has worsened across the country over the last two months, but perhaps nowhere as quickly as in Wisconsin.

At the beginning of September, Wisconsin was averaging about 700 cases a day. By this week, it was averaging more than 6,000. Hospitals are packed and more than 300 deaths were reported in the state over the last week, a record. Last week, Wisconsin’s chief health officer quit, noting the enormous pressure on public health officials during the pandemic.

“It took us 7 1/2 months to get to 100,000 cases,” Gov. Tony Evers said at a news conference on Tuesday evening, after issuing an executive order advising residents to stay home. “But it only took 36 days to add another 100,000. The way things are going, it will take us only 20 days to reach another 100,000.”

Testing centers are overwhelmed, raising the risk of further spread as people who might otherwise learn they are infected delay isolating themselves.


“They told us, ‘Yeah, you should get tested, but we’re out of tests,’” said Tim Cigelske, 39, of Whitefish Bay, of a local testing site he called when his family grew sick. It required multiple phone calls, virtual doctor visits and four trips to testing sites over three days to get himself, his wife and their two children tested, Cigelske said.

All were positive for the virus.

South Dakota

The state with the highest hospitalization rate.

South Dakota has the highest hospitalization rate in the country, with about 42 of every 100,000 South Dakotans hospitalized with COVID-19, according to the COVID Tracking Project.

Still, the state has no mask mandate, and on Tuesday night, Mayor Paul TenHaken of Sioux Falls cast the tiebreaking vote to strike down a citywide mask mandate, which he has called “simply unenforceable.”

On Wednesday afternoon, Kate Dossett, 39, arrived home from a Sioux Falls hospital, still hooked up to a portable oxygen machine. She had spent eight days on a floor that was usually meant for stroke patients but was, she said, overrun with people sick from the virus.

“I don’t know how the nurses can keep going,” she said. “It’s just day after day after day.”

With so many patients, staff members from other departments were stepping in to care for COVID-19 patients, Dossett said. A physical therapy assistant had helped care for her at one point, she said.


“It’s clearly all hands on deck,” she said.


The state with the most total cases, and the most cases linked to colleges.

More than 1 million cases have been reported in Texas, more than any other state. And more than 20,000 of those cases have been linked to colleges and universities, also the highest in the country.

While those records are partly a function of the state’s large population, major outbreaks have emerged this fall in cities like El Paso and Amarillo, as well as on several university campuses.

More than 2,200 cases have been reported at Texas Tech, more than 2,000 at Texas A&M and more than 1,500 on the Austin campus of the University of Texas. Hunter Heck, the student body president at Texas Tech, says there has been a disconnect between life on campus, where students for the most part are socially distanced and wear masks, and raucous off-campus parties.

She said the toll of the pandemic has been broader than just infections, especially among students who are following the rules on social distancing.

“People just feel alone,” Heck said. “I’m a firm believer that humans are created for one another. We crave community.”