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.
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 U.S. 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 to come in his state, especially with Thanksgiving gatherings looming.
"Human behavior is very different indoors vs. outdoors when it gets cold, so I'm worried that's going to make things worse," he said.
Unlike in the spring, 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.
Any incremental improvements in the Midwest has been offset by growing outbreaks elsewhere in the country. In Los Angeles County, Calif., 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. Around Miami, reports of new cases have more than quadrupled since the start of October, although they remain below 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, chief medical officer of Miami-Dade County. "It's a real threat."
Public health officials said resurging outbreaks could be explained by a simple variable: what people choose to do. Dr. Debra Bogen, health director in Pittsburgh's Allegheny County, said the increase in cases was fueled by people letting down their guard. "The virus itself hasn't changed — what has is our behavior," Bogen said.
