Across the US, COVID-19 slams rural towns, suburbs, and cities alike

Hospital beds are filling up quickly in some regions.
National guard members assist with point-of-care testing in Tempe, Arizona wearing face shields and plastic suits

National guard members assist with point-of-care testing in Tempe, Arizona. Tech Sgt. Michael Matkin/U.S. Air National Guard

Follow all of PopSci’s COVID-19 coverage here, including ways to tell if your symptoms are just allergies, advice on sanitizing masks, and tips on how to prepare for winter.

Several states saw fresh waves of COVID-19 cases and deaths in the past week, bringing the US total of coronavirus cases to 10.2 million, according to the Johns Hopkins University tracker. Of those people, nearly 240,000 have died.

One of the main concerns now is the rate of hospitalization, which is skyrocketing in many areas and stretching resources in cities like Topeka, Kansas, and El Paso, Texas. Urban centers on the East Coast, including Boston and New York City, have also been preparing for another wave of cases.

In the first week of November, the US logged 500,000 COVID-19 cases, marking its highest seven-day total since the virus first reached the states 10 months ago. The country also broke a record with 120,000 new cases in a single day last week. Many of the new positive cases came from the Upper Midwest: Five percent of North Dakotans, for example, have contracted the pathogen. Rural counties in lesser-affected states like Maine and Vermont also saw a rise in cases.

This comes just a month after the US pushed past 200,000 deaths, which was the upper limit of the Centers for Disease Control and Prevention (CDC)’s estimate back in March. Fatalities have dropped sharply since the summer, however, and experts note that the high caseload is also likely a result of increased testing across the nation. Here’s the breakdown of the latest numbers.

How bad is COVID-19 in the US right now?

Current hotspots for infection include Wisconsin, New Mexico, Missouri, Rhode Island, and even Alaska. Puerto Rico continues to log a steady stream of cases, and much of the Southeast states are still high risk.

After successfully flattening the curve this summer, Northeast cities and states seem to be entering a second wave of the pandemic. New York City, Boston, Massachusetts, and Newark, New Jersey, are all seeing an uptick in new hospitalizations and deaths.

Cases continue to increase in almost every US state, as well as territories like Guam and the Virgin Islands. At least 29 states have also seen a recent rise in deaths. Some governors and mayors are instituting shutdowns, curfews, mandatory quarantines, and more. Tribal nations in Montana and South Dakota are also locking down their reservations to curb the spread of the virus. Prisons and elder-care facilities are also reporting spates of new positives.

In an interview with CNN in August, White House coronavirus task force coordinator Deborah Birx stressed that no part of the country is immune to the pandemic. “What we are seeing today is different from March and April. It is extraordinarily widespread. It’s into the rural as equal urban areas,” she said. “To everybody who lives in a rural area, you are not immune or protected from this virus,” Birx said. “If you’re in multi-generational households, and there’s an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you’re positive, if you have individuals in your households with comorbidities.”

The onset of winter and flu season have experts worried as well, as the symptoms for both diseases overlap heavily. What’s more, some infected patients who thought they’d recovered from the disease may now be struggling with long-term comorbidities. It still remains to be seen how that will affect the COVID-19 mortality rate.

Why is COVID-19 still spreading?

Kids seem to be contracting the virus more now and are possibly infecting the rest of their households and communities. Many schools and workplaces have also reopened, and folks are gathering and traveling in larger numbers, now that the pandemic has passed the six-month point.

While several vaccines have seen positive results in clinical trials, publicly available treatment isn’t expected until the spring of 2021 at the earliest. Until then, it’s up to each person to limit their risk of catching and passing on the virus in the day today.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, pointed out to Five Thirty Eight that the behavior of individuals, even asymptomatic ones, also matters. While some states truly opened too quickly, he said. Others tried to slowly and responsibly reopen a few businesses only for citizens to throw caution, along with their social distancing practices and masks, to the wind.

“Many of the citizenry said, ‘You know, well, I’m either going to be locked down or I’m going to let it all rip,’ ” Fauci said.

Parties and other “super-spreader events” are particularly dangerous when it comes to COVID-19 transmission. Earlier this fall, the White House faced its own mini outbreak, after mask-less officials flocked to the Rose Garden for a Supreme Court nomination ceremony. Private gatherings—as well as bars and clubs in reopened states—have been traced to new COVID-19 clusters, particularly among young people.

There have also been reports of patients getting infected by the coronavirus a second time. Epidemiologists are still trying to learn how long COVID-19 antibodies last. At the same time, several pharmaceutical giants are pushing forward with clinical trials for vaccines, though it may be a few more months before one is safe enough to be distributed to the public.

How bad is COVID-19 globally right now?

There have been 51.2 million reported cases of COVID-19 and nearly 1.3 million deaths across the world since the virus first emerged in Wuhan, China, last December. While some governments—New Zealand in particular—have managed to crush COVID-19 for now, many countries are still in the thick of the pandemic. India and Brazil follow the US with the largest case counts, and Europe is bracing for a new resurgence. Life in East Asia has largely returned to normal, though international travel bans and quarantines are still in place.

Meanwhile, Africa, which was one of the last continents to be hit hard, has posted 1.9 million cases, with South Africa claiming the majority of deaths. International health groups are still concerned about the fragile health care systems around the continent and are hoping the flat curve continues.

“No single country can fight this virus alone. Its existence anywhere puts lives and livelihoods at risk everywhere,” World Health Organization Director-General Tedros Adhanom said this summer in a press briefing. “It’s never too late to turn outbreaks around and many countries have done just that. It’s never too late to turn the situation around. Our best way forward is to stick with science, solutions, and solidarity, and together we can overcome this pandemic.”

What can I do to keep from getting or spreading COVID-19?

At the beginning of the pandemic, evidence was spotty on how best to prevent its spread. Now it’s become clear that wearing masks is key to lowering transmission and perhaps preventing deadly cases. (Recent evidence shows that the risk of infection depends on the size of the air-borne droplets.) Public health experts resoundingly recommend wearing face coverings whenever you leave the house or interact with people from outside your household. Here’s our latest guide to understanding how masks keep you and other people safe, and instructions for making your own mask at home—with or without a sewing machine.

Social distancing is also crucial, especially as teachers and kids return to schools and some workers head back to their offices. Maintaining a distance of six feet or more from people outside your household drastically reduces your risk of transmitting COVID-19. Even if you stay far away from people, it’s best to wear a mask and play it safe since neither method is a complete guarantee against spreading the virus.

The third tool in the anti-coronavirus trifecta is proper hand washing. If you wash your hands thoroughly and frequently, wear a mask whenever going out, and keep your distance from other people, your risk of catching or spreading COVID-19 drops dramatically. But any sloppiness makes the risk go up: Sitting in a bar or restaurant full of strangers is dangerous, even if you keep a mask on when you’re not sipping or snacking. Going for a walk without your mask is still risky, even if you try to avoid all passersby. Coming back inside and forgetting to wash your hands leaves you more vulnerable than if you immediately gave them a good scrub.

Lastly, if you’re expanding your social circles ahead of the holidays, be sure to set rules for the people in your “pod.” Many people affected by the virus are still presenting as asymptomatic, so regular testing and restricted interaction are key to protecting your most vulnerable family members and friends. We even mapped out a calendar of to-do’s for you to prepare for Thanksgiving.

How do I know if I have COVID-19?

Many people with COVID-19 have few, if any, symptoms. So it’s important to wear a mask and practice social distancing even if you feel fine, and to continue looking out for symptoms. According to the Centers for Disease Control and Prevention (CDC), known COVID-19 symptoms now include fever or chills, coughing, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, a sudden loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. If you have an existing condition that causes some of these symptoms, such as seasonal allergies or a gastrointestinal disorder, take note of what is normal for you. If you suddenly begin to experience worse than average symptoms, they may be due to the virus. The context of you and your household’s behavior is also important: a bit of a cough after weeks of careful social distancing is less worrisome than one developed just days after going out to a restaurant.

If you find out that someone you’ve recently been in close contact with has been diagnosed with COVID-19, you should operate under the assumption that you have it. Don’t rely solely on temperature checks, as they’re often inaccurate and swayed by a multitude of external factors. And while tests are more widely available now, and free under certain health care plans, they do run the risk of false negatives and positives.

What should I do if I think I’ve been exposed to COVID-19?

If you have symptoms of COVID-19, have recently been exposed to someone with the disease, or have attended a large outdoor gathering like a protest, you should get tested. Most municipalities have drive-through centers and walk-in clinics that offer free nose swabs or saliva tubes, with results delivered in two to five days. Check your state’s health department website for specific instructions and locations. Confirming your infection will allow those who’ve come into close contact with you to take necessary precautions. It will also help doctors keep tabs on your symptoms in case your illness starts to take a turn for the worse.

If you experience trouble breathing, persistent chest pain or pressure, bluish lips or face, an unusual level of confusion, or an inability to wake or stay awake, the CDC says to seek immediate medical attention.