The Coronavirus Surge That Will Define the Next 4 Years

The third surge has belied some of Trump’s predictions about the pandemic. The president has repeatedly said that only states led by Democrats have struggled with the virus. “If you take the blue states out, we’re at a level that I don’t think anybody in the world would be at,” he said at a press conference last month.

Since then, coronavirus infections have skyrocketed in rural America. The number of people hospitalized with COVID-19 has more than tripled in North Dakota, Montana, and Wisconsin. It has roughly doubled in South Dakota, Utah, Indiana, and Ohio.

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But describing what’s happening now as simply a red-state surge would be too pat. Cases are now rising in all but nine states—meaning this surge is more widespread, and harder to explain, than either of the earlier waves.

It may end up being less deadly, however: The United States now runs many more tests than it could in March and April, and people who are hospitalized with the virus are less likely to die. At the same time, the virus’s long-term complications, which might range from respiratory disability to cognitive decline, now seem more ominous.

What’s happening now might be best understood as three smaller types of outbreaks. You could call them the rural explosion, the swing-state surge, and the fatigue creep.

The rural explosion

The first phenomenon: After months when viral transmission seemed to dominate cities, the coronavirus has now wheedled its way into rural America. That’s a large part of what’s happening in North and South Dakota, which stand out even in a country of hot spots. Earlier in this article, I mentioned that one in 1,000 Americans has tested positive for COVID-19 in the past week.  But on Tuesday alone, one in every 1,000 residents of North and South Dakota was diagnosed with COVID-19. That’s a per-capita rate of infection nearly double New York State’s during the spring.

In North Dakota, the harder hit of the two, the number of people hospitalized with COVID-19 has tripled in the past month. The state is so deluged that it has asked residents to do their own contact tracing.

The state’s cases are not limited to its largest cities, such as Fargo and Bismarck. Look at Ward County, for instance, which is home to about 68,000 people and, according to the state health department, reports nearly 646 active cases—one case for every 105 residents. Or Williams County, with a population of about 38,000, which reports 203 active cases—one case for every 187 residents. The state of Maine has 43 times more residents than tiny Stark County, North Dakota, but they reported the same number of new COVID-19 cases on Tuesday.

To some degree, the rural explosion is playing out across the conservative Mountain West. The western U.S. now reports as many cases per capita as it did in late June—but spread over the country in a very different way. In the early summer, California and the Pacific Northwest dominated the region’s numbers; today, the interior states lead. Wyoming, Idaho, and Montana, where Democratic Governor Steve Bullock has fought incumbent Senator Steve Daines in a close congressional race, now each report at least 400 cases each day per 1 million residents. Utah is reporting more than 1,200 new cases a day, its worst-ever outbreak, but most cases remain concentrated in Salt Lake City and the surrounding area, according to state data.