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One week before Thanksgiving—the same week we got the welcome news that a second, likely highly effective vaccine is on the way—US states reported more than a million new cases of COVID-19. This wave of cases arrives in a moment when many hospital systems across the country are already inundated with COVID-19 patients and are warning of staff shortages. Averaged across the whole of the past week, current hospitalizations have passed 72,000, and if we look at the data states reported on Wednesday, November 18, we see nearly 80,000 people in the United States hospitalized with COVID-19 right now—more than there have been at any time since the pandemic began. Our previous weekly record for hospitalizations, 59,924, was reported seven months ago, on April 15. The record levels of hospitalizations we’re already seeing will almost certainly be followed by a spike in the reported fatalities, even before this week’s million-plus new cases are taken into consideration, and even if Americans follow new state lockdown measures and skip big Thanksgiving gatherings. This week, states reported 8,461 deaths, the highest weekly death count we’ve seen since May.

Fifteen states hit all-time records for new cases this week, down from 20 last week. Five of those record-setting states are in the Northeast; the last time a northeastern state hit a record for new cases was May 31. 

Cases grow exponentially

We know that outbreaks have been worsening rapidly in more densely populated midwestern states like Illinois and Michigan. And we know that at the same time, cases have been steadily rising in every region of the country. Nationally, the seven-day average for daily reported cases has almost doubled since November 1. But what does it mean to see states report a million cases in a single week? Leaving aside the staggering scale of detected cases—true infections are almost certainly higher—we know this wave of newly diagnosed cases will crash into hospital systems that are, in many areas, already over capacity. And we know that three or four weeks behind each jump in cases, we expect to see a spike in reported deaths. Ominously, cases in the South have grown closer to that region’s summer peak while the Midwest continues to post enormous increases and the West and Northeast creep upward.

Scale matters, too. Our national testing expansion has been linear, but our outbreaks are growing exponentially. News organizations are once again reporting long lines at drive-through COVID-19 testing sites, and Quest Diagnostics, which makes both PCR and antigen tests, this week said high demand and limited supplies are delaying the delivery of some results. Data reporting, too, is increasingly difficult as case numbers soar, case investigations and contact tracing even moreso. And at the moment, we don’t see any indications that we’ve reached a peak.

Nationally, cases have already been rising for 10 weeks. Based on what we’re seeing in the data, the outbreaks in many states, even in the hard-hit Midwest, may have plenty of room to grow. In North Dakota, the canary in our third-surge coal mine, case growth took off on August 18. It took 67 days beyond that point for every state in the Midwest to break 200 daily cases per million on the seven-day average. North Dakota has now reported the highest number of new cases per capita of all US states and territories for nine of the past 11 weeks, and it’s not yet clear that the state’s outbreak has peaked. Some states in the region have taken more aggressive public health measures than North Dakota, but those that have adopted a similar approach to the virus could be looking at many more weeks of rising cases.

A similar story is unfolding across the country. Only three US states are still reporting fewer than 200 daily new cases per million residents on the seven-day average, but many states just crossed that threshold. If they follow the same path as the Midwest, these states could more than triple their case counts in the coming weeks.

Where race and ethnicity data is available, we are seeing cases rise most quickly for Indigenous and white populations in many states. Not all states report data for Indigenous people; of those that do, 18 now report more than 1.5 times the number of cases reported a month ago. In eight states, the number of reported cases for white people has more than doubled over the same time, while cases have grown more slowly in other racial and ethnic groups.

Hospitalizations break records

As we have written many times before, it’s clear that increases in COVID-19 cases mean more reported hospitalizations about 12 days later, and more reported deaths within a few weeks. In human terms, some of the people being diagnosed now will end up sick enough to be admitted to a hospital. Some of those people—though far fewer than in the spring—will die. 

The gains we’ve made since the spring in keeping people alive with severe cases of COVID-19 are at risk if our hospital systems are overtaxed. And our hospital systems are already overtaxed, even before the huge case spikes we saw this week and last week have converted into rising hospitalizations. This week states reported a 21 percent increase in the number of patients hospitalized with COVID-19; that figure has risen 67 percent since November 1. The number of people hospitalized per capita in the Midwest has hit a level not seen since the spring surge in the Northeast.

COVID Tracking Project cofounder Alexis Madrigal wrote at The Atlantic this week about the dire straits facing American hospitals; 22 percent of facilities told the US Department of Health and Human Services they expect staffing shortages. The examples are everywhere: More than 900 staff at the Mayo Clinic in Minnesota and Wisconsin have been diagnosed with COVID-19 in the past two weeks; El Paso’s convention center has been converted to a field hospital, and some hospital patients are being sent as far as Austin, nearly 600 miles away, for treatment.

Using the data we compile from state and territorial health departments, we have been able to track total current COVID-19 hospitalizations, but not newly admitted COVID-19 patients—a more precise measure of where outbreaks are worsening. A newly released dataset from the Department of Health and Human Services allows us to look at daily COVID-19 admissions of new patients, and they are rising sharply in every US region.

A per-capita view of hospital admissions data also allows us to pinpoint states both inside and outside the Midwest that are seeing spikes in new hospitalizations. It’s clear that Wisconsin is still in serious trouble and that Montana’s new admissions are rising sharply, while South Dakota’s may have peaked. Iowa, Kentucky, and Oklahoma are all showing the signs of dangerous increases in new patient admissions as well.

Deaths turn upwards

States reported more deaths from COVID-19 this week than we’ve seen since May. Yesterday, The New York Times reported that the COVID-19 pandemic has claimed 250,000 lives. As we wrote the last time a similar record loomed, our current figures run behind those of several other sources because we compile data at the state level, rather than from counties or cities. As of November 18, The COVID Tracking Project recorded 241,704 fatalities from COVID-19. 

Our understanding of who is dying is hampered by states not reporting demographic categories consistently. Reported deaths for white people are still proportionately lower than for most other demographic groups, but the trend is shifting. In many states, deaths are rising most quickly among white residents. Six states are reporting more than 1.5 times the deaths among white residents as in mid-October, while deaths have generally risen more slowly in other racial and ethnic groups.

The virus continues to ravage long-term care facilities

As our long-term care update detailed earlier this week, nursing homes and other congregate care facilities reported their largest increase in cases in the last six months—29,606 cases. New COVID-19 cases in nursing homes, assisted living facilities, and other long-term care facilities rose 20 percent across the nation.

From the 38 states that report residents and staff separately, we know that residents account for twice as many cases as staff. Yet, from the same batch of states, we know that less than 1 percent of deaths in long-term-care facilities occur among staff. There are still 13 states that don’t split resident and staff cases and deaths, obscuring any additional analysis. 

After three weeks without releasing cumulative long-term-care case data, North Dakota’s health department sent CTP a spreadsheet on November 17 that shows substantial increases in cases. Resident cases increased by 70 percent and staff cases by 61 percent since October 29, 2020. With a three week gap in the data, we are unable to determine at what rate cases are increasing. 

Scattered public health responses

Facing rising cases and hospitalizations, many states and metropolitan areas recently mandated new or more stringent measures in an effort to contain the virus. California Governor Gavin Newsom said he was pulling an “emergency brake” for the state, eliminating indoor dining, closing indoor gyms, and banning indoor worship services in 41 counties, among other efforts. Iowa, a state whose governor had long resisted a mask mandate, announced it would require residents to wear masks. Minnesota’s governor banned indoor dining and in-person get-togethers until mid-December. New York City this week said it would shut down schools as cases have risen. Governor Mike DeWine of Ohio, who was one of seven Democratic and Republican governors to co-author an opinion piece in The Washington Post this week urging Americans to cancel Thanksgiving, advised residents to wear masks and instituted a curfew. Costco, one of the nation’s largest retailers, said customers would be required to wear a mask while inside its stores, regardless of local and state regulations. 

This week, West Virginia Governor Jim Justice tightened the state’s mask mandate and held a 80-minute press conference in which he implored West Virginians to get on board. “I love all of our kids, and I want them to be able to play ball and go to school, but more than anything I want us to get more control over this terrible virus that’s just eating us alive,” said Justice, a Republican. “I want us to absolutely wear a mask. I will not allow people to just decide they’re not going to wear a mask, I mean, what right do they have to infect others or possibly infect others? What right do they have because that’s just what they want to do? 96 percent of the people in West Virginia believe we ought to be wearing masks. I strongly urge — strongly urge — us all to wear a mask. That’s all we’ve got to go on right now.”

Please stay home

It has not been the practice of the COVID Tracking Project to offer public health advice. The US Centers for Disease Control and Prevention, however, is now strongly urging Americans not to travel for Thanksgiving. As we face down the prospect of indoor holiday gatherings during a record-breaking case surge and with many hospital systems already dangerously overextended, we have collected a few of the many recent news reports and advisories quoting experts and officials who can offer this kind of advice. Be safe.

Correction: We have removed our report on West Virginia’s deaths and cases related to long-term care facilities. COVID Tracking Project researchers misinterpreted the state’s newly reformatted long-term care data and reported that cases had more than doubled, with deaths increasing at nearly the same rate. Resident cases actually increased by 9%, staff cases increased by 18%, and deaths increased 16% in the state this week.

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Artis Curiskis is outreach & reporting co-lead at the COVID Tracking Project and collaboratively runs the CTP special projects Long-Term Care COVID Tracker and City Data.

@Artis_Curiskis
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Alice Goldfarb leads The COVID Tracking Project’s part in The COVID Racial Data Tracker.

@afgoldfarb
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Erin Kissane is a co-founder of the COVID Tracking Project, and the project’s managing editor.

@kissane
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Jessica Malaty Rivera has an MS in Emerging Infectious Diseases and is the Science Communication Lead at The COVID Tracking Project.

@jessicamalaty
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Kara Oehler is outreach & reporting co-lead at the COVID Tracking Project and collaboratively runs the CTP special projects Long-Term Care COVID Tracker and City Data.

@karaoehler
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Joanna Pearlstein is an editorial lead at the Covid Tracking Project and a former editor at WIRED and Protocol.

@jopearl
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Peter Walker is Head of Marketing & Growth at PublicRelay and Data Viz Co-Lead at The COVID Tracking Project.

@PeterJ_Walker

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