Story at a glance

  • North and South Dakota, Wisconsin and Utah are among the states experiencing record-high new coronavirus cases and hospitalizations.
  • Community spread among less dense populations and colleges are two likely culprits.

As the Midwest becomes the next COVID-19 hotspot, North Dakota is seeing some of the most pronounced spikes, with 21,846 confirmed positive cases and a current testing positivity rate of 9.05 percent. 

Based on data from the state department of health, the daily new positive cases have been on a steady incline since the end of June, hitting a record high in September. 

Active hospitalizations have also increased over the same time period, with 89 COVID-19 patients currently hospitalized — a record high.


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Central Burleigh county leads the state in cases, and data aggregated by The New York Times places three counties in North Dakota, including Logan, Emmons and Renville, in its top 10 hotspot list. The Times also reports a 32 percent increase in new cases over the past two weeks for the state, as well as a 187 percent increase in deaths over the same timespan. 

Neighboring South Dakota is facing a similar problem, with health department data reporting 259 new cases as of Tuesday. South Dakota currently has 3,684 active cases, and 211 COVID-19 patients currently hospitalized. Larger trends reveal that South Dakota hit a record-high new case count on Sept. 24, with 488 coronavirus infections confirmed. 

Over the last 14 days, South Dakota’s testing positivity rate stood at 12.3 percent, bringing the cumulative positivity rate to 9.1 percent. 

The U.S. Centers for Disease Control and Prevention (CDC) guidelines advise that any jurisdiction must see a 14-day downward trajectory in percent positive infections to advance into Phases 2 and 3 of reopening. 

Per New York Times data, South Dakota is witnessing a 91 percent increase in new cases over the last 14 days, with at least 197 new cases reported on Sept. 28. 

Other states in the Midwestern and Western U.S. showing similar jumps in new infection and hospitalizations include Montana, Wisconsin and Iowa. 

The reasons behind the surge for the central U.S. can be attributed to the virus moving inland from its previous coastal hotspots. 

“It was only a matter of time,” Leana Wen, a public health professor at George Washington University, told TIME. “Essentially, we’re playing Whac-A-Mole. One part of the country is a hotspot. We’re able to suppress that. But that wave then moves to a different part of the country.”

Community spread is a major reason for the increased transmission into more rural areas, namely among smaller populations and within college campuses. 

Wen says a key to controlling the surge will be an increase in testing surveillance, as well as strict adherence to public health mandates, such as face masks and social distancing. 

“We’re not at the beginning of this outbreak. We’ve now seen what is effective in other places,” she reportedly said. “We know what works. Now is the time to implement it.”


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Published on Sep 29, 2020