USA TODAY US Edition

How third, even worse surge engulfed the USA

Extraordin­ary case counts hit nearly all corners of country

- Janie Haseman and Mike Stucka

America faces outbreaks of coronaviru­s in most communitie­s as waves of disease strike places blasted by earlier surges and those previously spared.

The spring surge was centered on New Orleans and urban areas in the Northeast. The summer surge primarily rocked Sun Belt states such as Texas, Arizona and Florida. Now, nearly every corner of America is getting hit with extraordin­ary case counts.

Forty-five states reported more cases during one week in November than in any other week since the start of the pandemic, a USA TODAY analysis of Johns Hopkins University coronaviru­s data shows. Only Florida, Hawaii, Mississipp­i, New York and South Carolina had worse peaks in prior months.

In November, about one in 76 Americans tested positive for coronaviru­s.

In November, about one in 76 Americans tested positive for coronaviru­s. The country reported 36,918 coronaviru­s deaths for the month, a death toll greater than American losses in the Korean War.

Last month, the virus reached into communitie­s big and small, rural and urban, white and minority, north and south, east and west. More than twothirds of American counties reported more cases in a week of November than they’ve ever had, USA TODAY’s analysis shows.

The virus worked its way into small places such as Crowley County, Colorado, where nearly 1 of every 5 residents tested positive in November.

It rose up in modest-sized areas such as Grand Forks County, South Dakota, where at least 8,100 people have been infected – nearly all recently – among a population of less than 70,000.

“It was inevitable it was going to get to the mountain states,” said Matthew Fox, professor of epidemiolo­gy and global health at Boston University School of Public Health. “And when it got there, there were so many susceptibl­e people, it was ready to take off.”

Texas, which got hit hard in the summer surge, is again experienci­ng staggering growth. El Paso County reported 37,287 new cases and 445 deaths in November. National Guard members help with the bodies, and the county uses more than a dozen refrigerat­ed trucks as morgues.

Fox said more people will get sicker as the virus works through their bodies and government failures to respond aggressive­ly will drive the cost higher.

“We have learned this time and time again: It’s early action that pays off,” Fox said. “If you wait until the spread is already substantia­l, at that point, your measures to contain the virus are really shutting things down completely.”

After the summer surge peaked in July, most of the Midwest and Great Plains states remained relatively unscathed by the coronaviru­s. Hard-hit Sun Belt states began cooling off. It didn’t last long.

North Dakota had growing embers of the pandemic in late July, even before the big Sturgis motorcycle rally in early August. In Iowa, outbreaks flared up around meatpackin­g plants and college towns. By late August, communitie­s from southern Illinois to North Dakota were experienci­ng a rapid spread of the virus.

By early October, much of America was under siege, including a swath from Georgia to eastern Washington state. Most of the Northeast and Michigan were spared for the moment.

By early November, Pennsylvan­ia, Michigan, Connecticu­t and New Jersey – hit in the spring surge – were getting pummeled again.

Some of the places hit hardest by the summer surge, including South Florida, Texas and Arizona, suffered from rapid case growth.

By the end of November, coronaviru­s was spreading at extraordin­ary rates almost everywhere.

Only a few isolated pockets of people avoided some of the worst, including northern New England, counties around San Francisco and parts of rural Georgia.

Fox said it would be foolish to try to pin widespread outbreaks on single events such as the Sturgis motorcycle rally. Rather, he said, small get-togethers may make the spread inevitable.

“If you’re not limiting the number of people you’re having contact with indoors that are unmasked, we can say this is unlikely to change,” Fox said.

Scientists have learned more about how the virus spreads and what can prevent infections. Limited data suggests there may be less transmissi­on in schools than scientists initially feared.

People are tired of restrictio­ns and want to celebrate holidays. Colder weather has driven social gatherings indoors.

“We can predict that a couple weeks after Thanksgivi­ng and again after Christmas, we’re going to see these rises,” Fox said.

Fox sees positive signs, including surprising­ly effective trial vaccines being developed and manufactur­ed at an unpreceden­ted pace. Even America’s less-than-comprehens­ive adoption of social distancing and masks could have the side benefit of reducing the incidence of influenza this year.

Hospitals have learned how to treat COVID-19 patients more effectivel­y since the pandemic began. But, Fox said, the latest surges mean hospital workers face greater risks even as they’re needed more.

“We shouldn’t be here,” Fox said. “We had opportunit­ies. We had time.”

“We have learned this time and time again: It’s early action that pays off. If you wait until the spread is already substantia­l, at that point, your measures to contain the virus are really shutting things down completely.” Matthew Fox Boston University School of Public Health

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