Covid-19 cases are increasing across the United States and surging in the upper midwest, in what appears to be a third pandemic peak. In North Dakota, cases are increasing at a higher and faster rate per capita than in any other state throughout the pandemic so far.
Experts have long predicted cooler weather and pandemic fatigue would increase the spread of Covid-19 this fall. That now appears to be coming to pass, coupled with the longer and higher levels of death and disease the US has seen throughout the pandemic compared to peer countries.
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“Everyone who knew anything about infectious disease and epidemiology predicted this six to eight months ago,” said Dr Ezekiel Emanuel, vice-provost for global initiatives at the Perelman School of Medicine at the University of Pennsylvania.
“Yes, it will surge in the fall, and the reason it will surge is because we are moving indoors,” said Emanuel. “Our surge is much higher than the surges in general,” he said, because the US has started, “from a higher baseline”.
Surges are especially pronounced in Montana, North Dakota and South Dakota, according to the Covid Tracking Project, but states from Wisconsin to Kentucky to Massachusetts are also seeing the curve bend upwards.
Last week, the Democratic governor of Wisconsin, Tony Evers, activated a field hospital on state fairgrounds to expand treatment capacity. Kentucky’s Democratic governor, Andy Beshear, called increasing cases “grim” and said officials were now revisiting surge plans made last spring.
“We are now going back to our plans about capacity in hospitals, looking if we have to at hotel options and the use of state parks,” Beshear said during a press briefing. “Ensuring that we have the operational plans to stand up the field hospital, if necessary.”
In Massachusetts, Boston’s mayor, Marty Walsh, said children would return to virtual learning until the city’s positivity rate – the percentage of all Covid tests that come back positive – decreased for two weeks in a row.
But far and away North Dakota leads in increasing Covid-19. The state has the highest per-capita rate of Covid-19 infections anywhere in the nation, at 1,350 cases per 1 million residents. That is nearly double the rate of the second hardest-hit state, Wisconsin, where there are 805 new cases per 1 million residents.
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Nearly three weeks ago, the state loosened public health guidance, telling residents they no longer needed to quarantine for 14 days if they came into close contact with a person positive with Covid-19, as long as both were wearing masks.
“There’s just no science to support that,” said Dr Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm said that with “runaway” transmission in the upper midwest, “why would you be loosening up your recommendations, as opposed to [tightening]? Then it made no public health sense at all.”
The decision was driven in part by spread inside schools, North Dakota’s governor, Doug Burgum, said at the time, because quarantining students was difficult for caregivers. The change would result in, “a more positive school experience”, Burgum said, according to the Grand Forks Herald.
This week, Burgum called in the national guard to notify people who have tested positive, and abandoned contact-tracing, advising people to self-notify contacts. Burgum has resisted a statewide mask mandate.
But even with increasing transmission across Europe, the United States has done worse on the whole than even “high-mortality” peer nations, studies have found.
Emanuel recently co-authored a research letter published in the Journal of the American Medical Association, in which researchers examined how the United States had fared during the pandemic compared with 18 other high-income countries.
“We’ve done worse,” said Emanuel. “I think it’s that simple.”
Even compared to “high-mortality” countries such as Italy, the US has performed badly. If Americans had died at the same rate as Italians, for example, between 44,000 and 100,000 fewer Americans would have died.
“We’ve had bad leadership that has resulted in inconsistent, haphazard implementation of public health measures,” Emanuel said. “That has led to migratory outbreaks you might say – first in the north-east, then in the south, then in the south-west, and now in the midwest.”
European countries have also taken stricter measures to contain recent outbreaks.
Like North Dakota, France has also experienced more than 1,000 new cases per million residents in the last seven days, according to the World Health Organization. But France imposed masks at all workplaces and recently imposed a curfew. Germany, also hard-hit, is tightening mask rules and closing some schools. Some regions of Italy are also closing schools.
“It’s clear from the data that countries like Germany, France and others that have put into place clear health communication,” have been able to “manage the growth of the disease and the spread over time,” said Reginald D Williams II, vice-president of international health policy at the Commonwealth Fund. “Unfortunately, we have not put those policies into place in a uniform fashion across the country.”
At the same time, official case tallies probably underrepresent the problem. This week, experts at the US Centers for Disease Control and Prevention published research that aligned with independent analyses, finding the true death toll is probably far higher than official estimates. By October, researchers said, the death toll was closer to 300,000 rather than the widely cited 215,000.
Osterholm compared the situation to a “coronavirus forest fire”.
“I’ve been saying it for some time – I think the darkest weeks in this pandemic are just ahead of us,” he said. “Between pandemic fatigue, pandemic anger and indoor air, everything is going to get much worse.”
Further, wide distribution of an approved vaccine is unlikely to take place before the middle or third quarter of 2021.
“We have to figure out how we’re going to live with this virus, or not live with it, meaning some people will, obviously many people will, get seriously ill and some will die.”