States in and near the Great Plains may soon be the next coronavirus hot spot in the United States.
Iowa, Kansas, Minnesota, Montana, Nebraska, North Dakota, and South Dakota have all experienced increases in their daily average number of new COVID-19 cases over the last two weeks. Nebraska has seen the smallest rise at 3%, followed by Montana at 9%.
The other states have seen increases in the double-digits, with South Dakota topping the list at 142%. The Sturgis Motorcycle Rally that ended just over two weeks ago may be partially to blame. Many participants did not wear masks or practice social distancing. In Meade County, which is part of Sturgis, the number of cases have risen by nearly 250%.
Professor David Jacobs, Mayo professor of public health at the division of epidemiology and community health at the University of Minnesota, says the rise in cases is caused by both a reaction to state government restrictions and careless behavior.
“People are going stir-crazy and having difficulties managing their lives … this is even worse for people who have lost their jobs or are otherwise suffering from economic damage,” Jacobs said. “Therefore, they are coming together, so belligerently refusing to wear masks, others inadvertently breathing exhaled air.”
Dr. Paul Carson, a professor at North Dakota State University Department of Public Health, suggested that part of the increase in his state is due to testing.
“First, we have a governor who has been from the beginning very proactive about bolstering our testing capability, including such things as mass testing events for college students before starting up at their university,” Carson said. “We are one of the most tested states in the country, and as such, we find more cases.”
He acknowledged, though, that testing is far from the only culprit, as the positivity rate in North Dakota has risen from 2.5% two weeks ago to 4.7% Wednesday. “We then saw a lot of relaxing of distancing with Fourth of July parties, barbecues, and weddings and infrequent use of masks in many parts of the state,” Carson said.
Hospitalizations and deaths have, thus far, not followed the same pattern. While the daily average of COVID-19-related hospitalizations has increased in North Dakota and South Dakota, they have remained flat in Minnesota and declined by almost half in Nebraska when compared to two weeks ago. Deaths have increased in Iowa, Kansas, and Minnesota, but declined or stayed the same in the other four states.
It’s not clear yet whether deaths will rise to match the increase in cases. Usually, deaths lag cases by weeks because patients often ail for a long time before dying, and then it takes time for their passing to be recorded.
“Our second wave has been driven by a different dynamic, with most of our cases in the 20-29-year-old age group,” said Carson. “These are often asymptomatic or mildly symptomatic, again leading to a false sense of security.”
Daily average hospitalizations have increased 19% in the last two weeks over in North Dakota. Carson stated that “thankfully, this has not yet really translated into a lot more deaths. This is, in part, due to better treatments that are now available, and a skewing of the cases more towards the younger population.”
Of the seven states, Minnesota has the most restrictions on businesses, with retail stores being the only non-essential businesses permitted to open.
Carson doubts that it will be necessary for states to put more restrictions on businesses.
“As Dr. Birx noted at her recent visit here, many of the southern states that had marked increases in their cases earlier this summer, were able to accomplish a downturn without having to go back to lockdowns or business closures,” he said. “Things such as localized mask mandates, restricting size of events or gatherings, limiting restaurant and bar capacity with preference for outdoor only seating, and earlier bar closures were some of the strategies that worked in those states.”
One state that will not be imposing any new restrictions is South Dakota, whose governor, Republican Kristi Noem, has taken the approach of providing residents with information on the pandemic and letting them decide for themselves.
“She will not be changing that approach,” said Ian Fury, Noem’s communication director.
Hospitals in these states appear to be in good shape. No state has yet approached 70% occupancy of intensive care unit beds, an important measure of hospital capacity. The state with the highest ICU occupancy is South Dakota, at 68%. However, only 6% of those are COVID-19 patients, according to the state’s COVID-19 dashboard.
