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This week’s update is brought to you by Alice Goldfarb, Erin Kissane, Jessica Malaty Rivera, Joanna Pearlstein, Sara Simon, and Peter Walker.

This week, the COVID-19 pandemic in the United States accelerated again, driving record numbers of cases and hospitalizations as healthcare systems around the country warned that they are approaching a breaking point. Cases are up 41 percent, hospitalizations up 20 percent, and deaths up 23 percent. States reported 875,401 new cases this week; 1 in 378 Americans tested positive for COVID-19 this week.

The seven-day average of deaths now exceeds 1,000 per day, a level not seen since the summer surge. States reported another 7,382 lives lost to COVID-19 in the past week.

The number of people who are hospitalized with COVID-19 in the United States has nearly doubled in the past two weeks, and hospitalizations increased in 47 states. As project co-leaders Erin Kissane and Alexis Madrigal wrote on our site and in The Atlantic earlier this week, the dangerous spike in hospitalizations suggests that further increases in the number of fatalities are imminent. Twenty-seven states this week hit a record for the number of new cases reported.

Once again, our metrics reveal a pattern: Cases lead to hospitalizations lead to deaths. The current national case surge has been underway for nine weeks, hospitalizations have risen for seven weeks, and deaths have risen for five. Testing is up 13 percent this week, but as we have written many times, this testing increase, while important, cannot account for a 41 percent increase in cases. Because of substantial inconsistencies in the way states and territories report their COVID-19 tests, we do not calculate test positivity from the public data we can compile. But according to the White House Task Force—which has access to federal reporting pipelines20 states now have a test positivity rate of more than 10 percent, with many counties at more than 20 percent test positivity.

Although we have seen cases (and hospitalizations and deaths) spike twice before in the United States, several things about this moment in the pandemic are new: Daily new cases are now nearly twice as high as they were in the Sunbelt surge this summer.

Hospitalizations have broken the previous national record and are rising very quickly in every US region—something we’ve never seen before.

In fact, hospitalizations are now rising more quickly than we’ve ever seen outside of a brief period in late March. The past three days have seen increases larger than any single day since mid-April.

Where the virus is hitting hardest 

For weeks, the states of the upper Midwest have been the most hard-hit, per capita, by COVID-19; now major increases in deaths are following. Kansas now leads the nation in per-capita cases, with North Dakota, South Dakota, Wisconsin, and Iowa close behind. And the death toll—a metric known to lag cases by about three weeks—is already worsening in every one of the region’s 12 states.

In South Dakota, one in 1,629 residents is hospitalized with COVID-19, and in North Dakota, one in 1,854 is hospitalized. For weeks hospitals in the upper Midwest have warned that their capacity to treat patients was declining rapidly; on Wednesday the Mayo Clinic’s health system said its facilities in northern Wisconsin are now full. According to the Chicago Tribune, fully half of the ICU patients in Mayo Clinic hospitals in that region have COVID-19, and hundreds of staff have been exposed to the virus. Meanwhile, hospitals in North Dakota are so short-staffed that the state has invoked recent guidelines from the US Centers for Disease Control and Prevention that permit workers who are COVID-19-positive but asymptomatic to continue to treat patients. On Wednesday, the North Dakota Nurses Association said its members oppose this practice as a solution to mitigating staffing shortages, arguing that nurses should make their own decisions about whether to work under these circumstances.

Although the Midwest’s numbers remain the worst of any US region, the building hospital capacity crisis is already hitting cities in other parts of the country. The Texas Tribune reports that in El Paso, Texas, hospitals are full and are sending patients to other parts of the state, the US Department of Defense has sent medical teams to support local healthcare workers, and the county has ordered 10 “mobile morgues” to hold the bodies of dead patients. 

In Utah, hospitals are nearing capacity and—unusually—the state itself has stepped forward to explain in lucid detail how the case surges there have affected local healthcare systems and what will happen if the current fragile balance is lost:

When hospital resources are maxed out, doctors must make tough choices about who gets scarce attention, drugs and supplies. Years ago, the State of Utah with the Utah Hospital Association drafted Crisis Standards of Care, which guides doctors in deciding who gets care and who doesn’t, based on who is most likely to survive. The Standards have been updated to reflect the unique issues of the pandemic.

Although no one wants to make such choices, our escalating case counts put us on a trajectory that might require it.

For months, cases in the Northeast have been quiet compared with the wretchedness of this spring. But that trend is changing: In the past month new cases per capita in the region have tripled, and states have implemented new lockdown measures to control the virus’ spread. Both New York and New Jersey this week introduced new restrictions on bars and restaurants; New Jersey banned indoor sporting events, and New York Governor Andrew Cuomo said in-person gatherings must be limited to 10 people. The mayor of New Jersey’s most populous city, Newark, issued an executive order instituting a 9 pm curfew for some zip codes, banning the playing of all sports, and prohibiting visitors at long-term care facilities for a two-week period, among other measures. 

Trends in race and ethnicity data

For states in the Midwest, the surge in cases has resulted in a rise in cases and deaths for all reported demographic groups, but some groups are seeing larger rises than others. Over the past month, cases among white people in Iowa have risen 63 percent in the past month. In Kansas, cases and deaths in the white and Indigenous populations are seeing the largest increases, both rising 50 percent in the past month. North Dakota does not report any information for deaths by race or ethnicity, but it does report such data for cases. The rise in cases is most pronounced for residents in the state's very broadly defined “Asian” demographic category, with nearly 2.5 times as many cases now as a month ago.

Even with the rise in cases, we are seeing a decrease in case fatality rates, with two notable exceptions: In South Dakota, the case fatality rate for Black and Asian people is increasing. South Dakota is also showing a much steeper increase in Indigenous cases per capita than for other groups reporting. Wisconsin is showing a steep rise in the Indigenous cases per capita compared to the overall cases. Most states are showing a slight rise in this metric for white people, with declines for other demographic groups.

The third surge has also arrived in long-term care facilities

Forty percent of the nation’s deaths from COVID-19 are tied to long-term care facilities, and as our team reported yesterday in our new weekly LTC update, the pandemic is surging in those facilities once more. There were more than 24,000 new cases identified in long-term care facilities in the last week alone, and 2,554 deaths. More than 91,000 deaths have been tied to long-term care facilities since the pandemic began. While fewer people who catch COVID-19 in long-term care facilities now die from it compared with fatality rates in the early days of the pandemic, the case fatality rate remains alarmingly high.

Recommendations for a national pandemic data dashboard

The COVID Tracking Project team has spent months immersed in often-clunky state and regional health department data dashboards. Since President-elect Joseph Biden’s new pandemic mitigation plan calls for a national data dashboard, on Wednesday we published some recommendations for how such a dashboard might work

A window into case fatality rate, through through the new COVID Tracking Project City Dataset

For months, a special team within The COVID Tracking Project collected data from 65 cities and counties within the US. Our goal was to identify and analyze local trends that can be obscured by state-wide data. We learned that the case fatality rate—the percent of people with COVID-19 who pass away from the disease—varies widely by city and county, and in some locations it has worsened over time. This week, we released the data and reported on what we’ve learned about case fatality rates by geography and race over time. 

To keep up to date on our work, follow us on Twitter and join our low-frequency email list.


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The COVID Tracking Project is a volunteer organization launched from The Atlantic and dedicated to collecting and publishing the data required to understand the COVID-19 outbreak in the United States.

@COVID19Tracking

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