Midwest Outbreaks Pause, Hospitalizations and Deaths Keep Rising: This Week in COVID-19 Data, Nov 25

In the week before Thanksgiving brings thousands of Americans through airports and travel stations and into multi-generational indoor gatherings, US states have reported more than 1.2 million cases of COVID-19. The seven-day average for new cases has more than doubled since the beginning of November. The number of people currently hospitalized with the virus in the United States hit nearly 90,000 on Wednesday, breaking the national record for the 16th day in a row. As hospitals fill up across the country, deaths are also spiking. For the first time since May 7, daily reported deaths exceed 2,000 this week, first on Tuesday and again on Wednesday.

In better news, growth in the number of new tests this week outpaced the number of new cases for the first time in two months. The increase in the number of reported tests may have been driven in part by people getting a COVID-19 test before traveling for the holiday. (In related news, Quest Diagnostics this week said turnaround time for lab results was rising because of the latest surge. The company also said that because so many tests are coming back positive, it is relying less on pooled testing, the practice of combining several test specimens into a batch and testing the resulting sample.)

A warning to data-watchers: Over the past eight months, we have observed that the data coming from states and territories during and after weekends and holidays tends to be erratic. We expect to see this trend in full force over the holiday weekend and for several days afterward. As our managing editor Erin Kissane explained on Tuesday, “Holidays, like weekends, cause testing and reporting to go down and then, a few days later, to ‘catch up.’ So the data we see early next week will reflect not only actual increases in cases, tests, and deaths, but also the potentially very large backlog from the holiday.”

Where cases are rising—and falling 

On Wednesday, California reported 18,350 new cases, the highest single-day count for any US state during the pandemic. The western state’s single-day case record is followed by Texas’—15,609—set on the same day. California and Texas are the country’s most populous states; on a per-capita basis, California and Texas’s case rates are unremarkable compared with the midwestern states we discuss below. Nevertheless, these are large numbers. As of Wednesday afternoon, 45 of California’s 58 counties were in the state’s “purple tier,” which indicates that infections are widespread, many non-essential activities are restricted, and non-essential businesses may be closed.

Los Angeles County’s director of public health this week called the region’s current case and death numbers “the most alarming metrics we’ve ever seen,” according to the Los Angeles Times. City health officials on Wednesday released a report estimating that one in 145 people in Los Angeles County—population 10 million—is infected with the coronavirus. A week ago, the report says, that metric was 1 in 250 people. 

In California, our COVID Racial Data Tracker shows that the Latinx and Native Hawaiian/Pacific Islander communities have more than three times the cases per capita as the white population. To date, nearly 60 percent of all cases reported by California are for Latinx people, who make up slightly less than 40 percent of the state’s population. More than 100,000 new cases for Latinx people have been reported in the last month, and 1 in 32 Latinx people in California have tested positive for COVID-19 since the pandemic began. Native Hawaiian and Pacific Islanders make up less than 1 percent of California’s population, and are similarly affected, with 1 in 33 having tested positive for COVID-19. For comparison, 1 in 99 white people have tested positive for COVID-19. (All these figures are based on California’s confirmed case count and therefore exclude antigen testing.)

In the national picture, many of the Midwest and Mountain West states we’ve been tracking closely posted very high per-capita case numbers this week, with Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming all exceeding 1,000 new cases per day on the seven-day average this week, along with Southwest outlier New Mexico. North Dakota has had the highest per-capita number of cases of any state for 10 of the past 12 weeks.

What the case map doesn’t show is a small but important change in US COVID-19 data patterns this week: After three months of seeing a consistent rise in the seven-day average of new daily cases, North Dakota's cases began to fall. The state's current hospitalizations, too, are declining, which means that more COVID-19 patients are leaving North Dakota's hospitals than are entering them. We’re also seeing convincing case drops, backed by clear decreases in hospitalized patients, in Iowa, Montana, South Dakota, and Wisconsin.

This change in state numbers is reflected in the regional view of new cases per capita, which shows that across the Midwest, daily new cases are declining. In the other three major regions, however, daily cases are still rising—a sign that we should expect to see hospitalizations continue to rise in much of the country for the immediate future.

Hospitalizations are now 50 percent higher than they were during both the spring and summer case surges. Nearly 90,000 Americans are in the hospital with COVID-19 today. 

Hospitals across the country continue to experience extraordinary levels of strain. Cases have been rising in Alaska, and in Anchorage, the state’s biggest city, hospitals are filling up, and one facility has opened an overflow unit, according to the Anchorage Daily News. Hospitals in Utah are approaching capacity, according to the Salt Lake Tribune; a Mayo Clinic facility in Wisconsin is placing hospital beds in an ambulance garage; and Arizona’s hospitals are running out of beds.

Dramatic and terrible increases in long-term care facilities

As our long-term care team reported in its weekly update, cases in US congregate care facilities grew enormously: States reported a 50 percent increase in new long-term care cases—46,153 new COVID-19 cases this week alone. Long-term care facilities recorded about 3,000 new deaths in one week. The Midwest remains the epicenter of long-term care facility outbreaks, accounting for 39 percent of new cases reported in the US. But the crisis stretches beyond the Midwest, too. This week each region of the US reported its largest increase of long-term care cases in the past four months. So far this month, long-term care residents represent 39 percent of all US COVID-19 deaths.

This week, 20 percent of long-term care facility cases and deaths in the Midwest were reported in Illinois—the highest increase in cases in the past six months.

A deep dive on COVID-19 test sensitivity

This weekly update covers the number of tests reported, but it’s worth reminding readers that the US health system administers multiple kinds of COVID-19 tests—PCR and antigen are the most commonly used test types—and our testing data does not, as a whole, distinguish among these tests. We have previously written about which states break out antigen tests from PCR tests; this week, we published a deep dive in which contributor Whet Moser explains how the two test types play different roles in an effective public-health response to the pandemic. 

Be safe and well

Although we expect the holiday weekend to bring data disruptions to much of the country, we’ll be here doing our regular daily updates throughout. We wish you all a healthy and happy holiday.