Case numbers surged in the Northeast this spring. They spiked early this summer in the South and the West. And now, even as parts of the country experience rapid improvement, reports of new infections have soared in the Midwest.
Nationally, new coronavirus cases reported daily dropped to fewer than 40,000 in mid-September from a peak of more than 66,000 cases in late July. But that trend overlooks the pandemic’s complicated geography. Improvement in one region can come amid increased suffering in another.
Through Friday, North Dakota, South Dakota, Missouri and Iowa had added more recent cases per capita than all other states. As restrictions were loosened around the country, some local governments in the Midwest urged people to take the virus more seriously, and considered possible new limits on bars and face mask requirements in public.
“When things opened up, it was like, ‘We’re ready to party,’” said Dr. Steve Stites, the chief medical officer for the University of Kansas Health System. Kansas has seen some of its highest daily case averages in recent weeks. “We didn’t get the initial surge that New York did, so people weren’t as shellshocked.” But, he added, “all of the sudden, that caught up with us.”
The upticks have prompted alarm and fear in places that had until now avoided the worst of the pandemic.
“Our community is experiencing its first sustained, significant surge of illness since this terrible pandemic began,” said Joe Parisi, the county executive in Dane County, Wis., which includes Madison. “We will have some incredibly difficult and sad weeks ahead if we don’t rally together now and stop this deeply disturbing trend.”
The rise of infection in the Midwest is different from what happened in Brooklyn in March or in South Texas in July. So far, hospitalizations have not spiked. Morgues have not been overrun. Lockdowns have not been ordered.
Young adults, who often have milder cases of the virus, are helping to drive this surge in cases. Thousands of infections have been linked to Midwestern universities, some of which have struggled to enforce social distancing rules. Though college outbreaks are not unique to the region, the scale of those outbreaks, given the relatively small populations of states like South Dakota and North Dakota, has had an outsize effect.
“We knew this was coming,” said Mayor Brandon Bochenski of Grand Forks, N.D., where more than 600 infections — or roughly one of every 24 cases in the state — have been linked to the University of North Dakota. “If we could control college students,” Mr. Bochenski added, “we would have figured that out about 200 years ago. We did the best we could.”
College campuses don’t explain all of the Midwest’s challenges. Many cases across several states have been linked to a motorcycle rally in Sturgis, S.D., which attracted thousands of people from around the country. Hundreds of people were infected at a jail in Wichita, Kan. And in parts of rural Iowa and North Dakota, case numbers have risen with no obvious link to a college.
New daily cases and hospitalizations in the Midwest
7-day rolling average of new cases is shown.
As summer ends in the Midwest, difficult questions linger. Is the worst still ahead? Will college outbreaks spread beyond campuses? Will places like Michigan and Ohio, which have so far avoided the worst of this surge, start to backslide? And can public health officials persuade more people to wear masks?
“It’s just been a challenge for us to have to go out there and upset half the citizens who don’t believe or are still not sold that face coverings are critical to the spread of Covid-19,” said Greg McDanel, the city manager of Maryville, Mo., where local officials required masks and where hundreds of cases have been reported at Northwest Missouri State University. “Face coverings are unfortunately a political issue for many.”
Case numbers are not the only sign of trouble in the Midwest. Testing positivity rates, which measure the percent of positive findings among all people tested, are concerningly high across much of the Great Plains, a sign of uncontrolled spread and insufficient monitoring.
“If the positivity rate is more than 10 percent, especially more than 15 percent, that’s kind of worrisome that people are just simply not doing enough testing,” said Dr. Bill Miller, a professor of epidemiology at Ohio State University. “If you’re getting that high of a positivity rate, it implies that you’re really targeting your testing to people that are symptomatic.”
Though the national outlook has improved since July, the Midwest is not the only region facing problems. Several Southern states have also seen caseloads increase in recent weeks. And thousands of new cases continue to emerge each week in the West and the Northeast.
But the regional trendline in the Midwest, where case numbers remain high, has left many residents uneasy. In Lee County, Iowa, along the Mississippi River, new case reports have begun to fall in recent days after a spike in August. But the mood remains grim, said Rita Cashman-Becker, who has operated a salon in Fort Madison for more than 30 years.
“I find that people are just sad and depressed, and saying, ‘How do we know when the end will be?’” Ms. Cashman-Becker said.