Rural areas have been hardest hit this fall, but cities are now seeing dramatic increases in cases
By Brittany Shammas, Mark Guarino and Jacqueline Dupree
November 26, 2020 at 6:00 a.m. CST
For a few months, coronavirus-weary Chicago residents got a reprieve from the strict regulations that shuttered the nation’s third-largest city during the spring.
After infections plummeted in early June, restaurants welcomed diners back inside. Movie theaters, fitness centers and bowling alleys reopened their doors. And the barriers came down on the bike pathway along the city’s cherished lakefront.
But with new coronavirus cases surging beyond the springtime peak, Chicago is now hunkering down. Statewide measures have closed some businesses and limited the capacity at others, while officials are urging residents to stay home. Again.
“We’ve been through a heck of a lot this year,” Lori Lightfoot, the city’s Democratic mayor, said during a recent news conference. “And it’s not over.”
Across much of the United States, the picture is similar. Major metropolitan areas were the face of the pandemic before being overtaken by spikes in less-populated parts of the country in September. Since then, the nation’s worst outbreaks have been concentrated in rural parts of the Upper Midwest.
Yet dramatic increases have been reported in many major U.S. cities in recent weeks, with some being hit harder than they were during their previous peaks. Testing has greatly ramped up since the start of the pandemic, but that alone does not explain the growing caseloads.
“The dreaded fall wave, in many places, is upon us,” said Josh Michaud, an epidemiologist and associate director for global health policy at the nonprofit Kaiser Family Foundation. “And that includes in metropolitan areas.”
In Cook County, where Chicago is located, the seven-day average of new cases hit a record high of 4,654 on Nov. 17 — far outpacing the peak of 1,690 during the spring surge. Deaths are lower than the numbers seen in the spring but have climbed in recent weeks.
With winter approaching, business owners who stayed afloat by turning to outdoor service have been investing in heating lamps, hoping to keep customers coming even in temperatures that can drop below freezing.
Michelle Foik, co-owner of Eris Brewery & Cider House, said she saw the shutdown of indoor dining as inevitable. The facility’s patio has been “our saving grace,” she said, but she worries about what will happen this winter. She’s torn between relief that the rise in cases was met with more restrictions and concern over the effect on her business.
“Believe me, we need the money,” Foik said. “We’re a start-up. We are investing in our future, but if this becomes a longtime shutdown, it just hurts everything.”
At NorthShore University HealthSystem, infectious-disease specialist Kamaljit Sandhu Singh said he and other health-care workers were “exhausted physically and mentally” as hospitalizations and intensive care unit admissions increased.
He said the pandemic reminded him of growing up during the Vietnam War: “I could never wrap my brain around the number of soldiers’ lives lost, but the pictures were compelling.”
Cases are surging on Chicago’s West and Southwest sides, where the virus spread at a disproportionate rate in the spring and the majority of residents are Black or Latino. Kiran Joshi, senior medical officer at the Cook County Department of Public Health, said “a myriad of factors” play into why those areas are surging highest, but that a common attribute is that people there “experienced structural racism over decades.”
The second peak in Chicago mirrors those in metropolitan areas across the country. In recent weeks, counties home to cities including Philadelphia, Los Angeles, Detroit, Las Vegas and Minneapolis have seen new cases surpass their past highs. Miami-Dade County has been trending up again, while Salt Lake County is experiencing its first major peak of the pandemic, with cases and hospitalizations rising since early October.
In Maricopa County, which includes Phoenix, Valleywise Health “had a little breather” after the summer’s surge in Sun Belt states, said Michael White, the health system’s chief clinical officer. But the seven-day average of new cases, which hovered around 500 a day in late October, exceeded 2,000 on Monday.
“We’re hanging in there is how I would describe it,” White said. “Our biggest concern always is, as we continue to see this case count rise, that that certainly can lead to more folks needing hospitalization down the road, on top of a time where we usually see a higher rate of hospitalizations for non-covid-related illnesses.”
Phoenix-based Banner Health is projecting that 125 percent of the system’s licensed hospital beds will be full by the first week of December. Hospital administrators believe they have stocked up on enough personal protective equipment, ventilators and beds to weather the surge, Chief Clinical Officer Marjorie Bessel said during a news conference Tuesday. They worry most about staffing; they’ve hired nearly 1,000 health-care workers from out of state and are recruiting 900 more.
The health system always beefs up its staff for the winter months, Bessel said, but the coming weeks are expected to be markedly different from previous years and even the Sun Belt’s summer surge.
“The entire country is surging at the same time,” she said.
Health officials attribute the virus’s resurgence in cities to several factors, including eased restrictions, increased gatherings and what’s being called “covid fatigue.” Eight months into the pandemic, “there is no longer that sense of urgency,” said Mouhanad Hammami, chief health strategist in Wayne County, home to Detroit. “When you live with something, it is no longer urgent, and you tend to get desensitized to it.”
Some authorities in Chicago blamed rock-bottom hotel prices and the state-imposed indoor dining ban, suggesting it may have caused parties to relocate to hotel rooms or other spaces, such as Airbnb rentals. On Nov. 12, Lightfoot told reporters that current restrictions apply to both.
“I know the hotel industry was hit hard and is in many instances is on life support, but that cannot include parties,” she said. “I urge the hotel industry to be much more diligent about who is coming in. … People think it’s party time. It’s not.”
Officials in many hard-hit cities also point to increasingly widespread transmission across the United States, which has been reporting record-setting numbers of infections. Over the past week, the country had well over 150,000 new cases each day. Ahead of Thanksgiving, traditionally a time of significant travel and extended family get-togethers, health experts feared the number would only continue to climb.
“We would love to be that shining city on the hill where we’re avoiding all this,” said Philadelphia Department of Public Health spokesman James Garrow. “But I don’t know that anybody’s going to be able to avoid this.”
Mortality rates have improved from earlier in the pandemic — a change attributed to improved therapeutics and knowledge of how to handle covid-19, the disease caused by the virus. Still, authorities in areas that are seeing spiking infections have reacted with alarm, noting that the explosion in cases will inevitably drive up the death toll.
In Los Angeles County, where hospitalizations are up and deaths increased slightly last week, Public Health Director Barbara Ferrer on Friday described the data as looking “really bad right now” and added that the county had experienced “three terrible days in terms of case rates and increases in hospitalizations.” She said health officials were hoping deaths “don’t go up … as much as earlier in the pandemic.”
With rapidly rising case numbers has come a return to some of the restrictions of the spring. In Los Angeles, health officials suspended outdoor dining for the first time since May. They warned that a stay-at-home order could follow if the situation worsens.
Wayne County’s health department on Friday strongly recommended that schools shift to virtual instruction through mid-January, noting that the current wave “is at a level higher than the first peak in April 2020.”
Philadelphia on Nov. 20 imposed new “Safer at Home” restrictions, which required schools to shift to online learning, restaurants to suspend indoor dining, and gyms and indoor fitness classes to close. Movie theaters, casinos and bowling alleys were also shuttered and indoor gatherings of more than one household prohibited.
“The hope is that by implementing these restrictions as soon as we could — and we’re doing it ahead of at least a lot of surrounding counties and states — that we’ll be able to head off getting to a point where we outstrip our capacity and get to a point worse than we were in April,” Garrow said.
Months after the first shutdowns in the United States, a better understanding of how the coronavirus spreads means that this latest wave of restrictions can be more targeted, Michaud said. Authorities can focus on what is believed to carry the greatest risk of transmission: venues where people are crowded together indoors for extended periods of time.
“In the spring, we didn’t know a whole lot about the virus and exactly what were the activities that were the riskiest,” he said. “We know a whole lot more now. And that means that we don’t have to put in a Chinese-style lockdown to have an effect on transmission. You can be much more surgical in your approach.”
But among some already battered by earlier shutdowns, the new restrictions drew frustration.
The Illinois Restaurant Association released a statement objecting to the state’s ban on indoor dining, arguing that it “will force people into less controlled, private gatherings with no safety precautions — resulting in the exact opposite of slowing the spread” of the virus. The organization said that without being allowed to serve indoors in some capacity, “our state’s largest private sector employer will be pushed to the brink of permanent devastation.”
Mark Domitrovich, co-owner of Chicago restaurants Ina Mae Tavern and Frontier, said he was trying to “string together as much as an outdoor dining situation as we can get” because takeout and delivery alone weren’t enough to get by.
“At this point, we’re trying to grind it out. To try to drive as much business as possible,” he said. “It’ll run out at some point, and it doesn’t seem like the cavalry is on the way, either, so we’re just praying right now.”