Experts say that cases are surging in the region as the weather has turned colder and more people are forced inside — into more poorly ventilated indoor spaces where transmission thrives — with the virus arriving even in remote areas in largely conservative states where Republican leaders have resisted mask mandates or business closures, asking their residents to rely instead on personal responsibility.
The region’s surge is a preview of what the rest of the United States can expect in the coming weeks as winter approaches, experts say.
The situation has become so acute that even some leaders who previously resisted restrictions have moved toward new strictures. Republican Gov. Kim Reynolds in Iowa, long an opponent of closures and mask-wearing as “feel-good” options, this week moved to prohibit maskless indoor gatherings of 25 or more and require those attending larger outdoor events to wear a mask.
In Minnesota, Gov. Tim Walz (D) has warned of more “nightmare” numbers to come, even as the state has instituted new restrictions on bars, restaurants and social gatherings in an attempt to stop the spread. On Friday, Minnesota will begin limiting social gatherings to 10 people or less and tightening restrictions on larger social receptions as the country heads into a holiday season when doctors fear multigenerational family gatherings could become superspreader events.
In North Dakota, where cases have increased 60 percent in the past month, Republican Gov. Doug Burgum said this week that the state’s hospitals are at capacity and are so strained that the state will allow its doctors and nurses to continue working after they test positive for the coronavirus. His spokesman later qualified this is a potential short-term tool.
Even though he has continued to resist a statewide mask mandate, Burgum urged his fellow residents to take precautions as hospitals brimmed with patients.
“You don’t have to believe in covid, you don’t have to believe in a certain political party or not, you don’t have to believe whether masks work or not. You can just do it because you know that one thing is very real. And that’s that 100 percent of our capacity is now being used,” Burgum said.
Doctors and health-care providers across the Upper Midwest grappling with rising caseloads and staff shortages continue to urge leaders in their states to do more to stem the tide of the virus, as many in these hardy, wind-swept states where independence is prized still refuse to wear masks.
“We had months to prepare for this, we saw it happen in other states that were hit earlier. Why weren’t we prepared for what was coming?” said Sarah Newton, chief medical officer of the hospital in tiny Linton, N.D., population 997.
She said she saw coronavirus cases begin surging in late September and October, and on some days ill patients filled the hospital, a low-slung brick critical-access facility with 14 beds.
“I felt so emotionally overwhelmed by what I was seeing. I felt like I was screaming into a void. I was drowning in my own hospital,” Newton said.
The disconnect with what was going on inside the hospital and her community was extreme, Newton said. She would go outside and see no one wearing a mask or social distancing, “having giant weddings and going about their lives.”
This week, the unthinkable happened. She called several hospitals in the region and was unable to find an intensive-care bed in a bigger hospital to transfer a rapidly declining coronavirus patient who needed more help than her small facility could provide.
“We have people we are not able to get to a higher level of care, and honestly, it’s a horrible feeling,” Newton said. “We have failed to do the things that prevented us from being here.”
Andrew T. Pavia, chief of pediatric infectious diseases at the University of Utah School of Medicine, said on a press call organized by the Infectious Diseases Society of America on Wednesday that the “enormous surge” in the Upper Midwest and mountain states is concerning because health-care access in some rural areas is already limited and staff and facilities taxed.
“The situation really has to be described as dire,” Pavia said, saying that the “political climate” and “general distrust of the government” in these areas resulted in a reluctance of public officials to take more stringent measures to stop the spread of the novel coronavirus, which causes the disease covid-19. Mass gatherings such as the motorcycle rally in Sturgis, S.D., also contributed, Pavia said, as well as university students attending classes that were largely in person.
More than 330 coronavirus cases and one death were directly linked to the Sturgis bike rally as of mid-September, according to a Washington Post survey of health departments in 23 states.
“There’s an awful lot of preventable deaths happening right now,” Pavia said.
Doctors at one of the region’s largest health-care systems, Avera Health in Sioux Falls, S.D., with facilities in South Dakota, Minnesota, Iowa, Nebraska and North Dakota, said that its modeling showed the virus surge was only going to get worse in the coming weeks. Already, some of its facilities are nearing capacity and between 200 and 400 of its staffers are either out sick or in quarantine, officials said.
In Minnesota, state officials presented grim new infection numbers Thursday — with 7,228 people testing positive — and warned that the state is on pace to see at least 100,000 new cases by Thanksgiving.
The state reported 39 deaths Thursday. It set a record the day before, reporting that 59 people had died of covid.
In stressing the urgency of the situation, state health officials have pointed to a dramatic uptick in the positivity rate in diagnostic testing in recent weeks — rising from just 5 percent a month ago to 15 percent on Thursday.
Overall, nearly 202,000 people have tested positive in the state since the pandemic began, and nearly 2,800 people have died.
“This is going to be a long dark winter,” Walz told reporters Tuesday. “[You] can’t wish it away, can’t hope it, can’t think it’s not real. This is killing large numbers of people.”
What has worried state officials is that there is no hotspot in Minnesota — the entire state is described as a “red zone.” Cases and hospitalizations have risen dramatically in all regions, including rural areas that had been largely spared by the disease until recent weeks.
In Itasca County, a rural area of 45,000 residents northwest of Duluth, county health officials said there were 200 coronavirus cases and 13 deaths through September. Numbers have skyrocketed in the past few weeks — averaging about 200 to 300 new cases a week — with a positivity rate so high that the beleaguered county health department announced it would no longer do contact tracing and focus its efforts on protecting “high-risk settings” including schools and long-term-care facilities.
An underlying concern for state officials is the pressure on Minnesota hospitals.
State health officials have warned of dire capacity levels statewide in terms of the number of available intensive-care beds, saying this week that they were at 90 to 95 percent capacity. In the Twin Cities, just 22 ICU beds were available — statistics that Walz described as “catastrophic.” Hospitals and the state are trading information hour by hour on capacity restraints and how to move patients. Officials are beginning to enlist retired health-care workers to help in what could be a nightmarish scenario in coming weeks.
Case counts are skyrocketing throughout the Midwest, with Illinois reporting 12,702 cases Thursday, a record, and Kansas reporting two record-high case counts this week.
“Now even in rural America people are thinking maybe I should pay attention to this,” said Liz Stedry, 44, a property manager and mother of a blended family of eight in Prairie Village, Kan., including 16-year-old twins with cystic fibrosis.
Stedry’s mother is a county commissioner in Jefferson County, Kan., which approved a mask ordinance Monday; the county commissioner pushed for one for weeks.
Stedry and her family have been in quarantine since Wednesday, after her husband and two of the children came down with mild cases of covid-19.
“The numbers are crazy scary. You want them to be kids but you worry about it. I’m actually happy it’s a forced quarantine,” she said. “Now the others have to be at home, too, until the time is up.”
Last week, South Dakota’s new daily reported cases rose by roughly 9 percent; the state also reported an 18.2 percent increase in daily deaths and a 26.5 percent uptick in hospitalizations, according to Washington Post data. The South Dakota Department of Health reported 2,020 new coronavirus infections Thursday, a record for positive results in a 24-hour period.
Despite this, its largest city, Sioux Falls, rejected a mask mandate Tuesday, and many in the state just don’t seem to think masks are necessary. Gov. Kristi L. Noem (R) has taken a laissez-faire attitude toward the virus and has refused to issue a statewide mask mandate or other controls.
Erin Blake, 42, a mother of five in Sioux Falls, said she believes masks negatively affect children and that adults should be free to choose whether to wear them.
Masks, she said, “impact socialization and education of children.”
Masks are one of the most effective tools at fighting the coronavirus, public health officials say, and help protect the wearer and others.
Noem’s spokesman, Ian Fury, said that Noem had no intention of changing her approach, noting that although the hospitalization rate has increased, 34 percent of the state’s hospital and ICU beds remain open.
But doctors have countered that just because a bed is open doesn’t mean there will be enough staff. Monument Health, a hospital system in South Dakota, issued a statement this week that it is experiencing “stressed capacity” across the state.
“Our limiting factor isn’t beds, it’s staff,” said John Pierce, president of Rapid City Hospital, noting that the facility has a “record high” number of coronavirus patients and is having to shift non-coronavirus patients to other hospitals and hiring contract caregivers.
Chris Bjorkman, of De Smet, S.D., lost her husband, John, 66, a retired schools superintendent, after both were sickened by the coronavirus in September. Bjorkman had to be flown to a hospital in Marshall, Minn., when his condition worsened and there was no room for him in South Dakota, she said.
He eventually ended up back in a hospital and died Oct. 20. The last time she was able to speak to him, she said, he told her the hospital food was awful, so she had a meat-lovers pizza delivered to his room.
Bjorkman said that since her husband’s death she has been disheartened that so few of her neighbors have been wearing masks. Even the clerks in her local supermarket didn’t wear them until one of her family members called them out on it last week.
“People are not taking it serious,” she said. “Some just don’t care.”
Jacqueline Dupree and Emily Wax-Thibodeaux contributed to this report.