COVID Cases Climbing in 36 States | Health News

By Robin Foster and E.J. Mundell
HealthDay Reporters

(HealthDay)

WEDNESDAY, Oct. 14, 2020 (HealthDay News) — Coronavirus outbreaks in the Midwest and Western United States have driven the national case count to its highest level since August, fueling fears of what the coming winter will mean for the country.

COVID-19 cases are starting to climb in 36 states, including parts of the Northeast, which is starting to backslide after months of progress, The New York Times reported. More than 820 new deaths and more than 54,500 new cases were announced across the country on Tuesday, the newspaper said. Idaho and Wisconsin set single-day records for new cases.

About 50,000 new cases are being reported each day in the United States for the week ending Monday, the Times reported. That is still less than in late July, when the country was seeing more than 66,000 cases each day.

But the trajectory is worsening, and experts fear what could happen as cold weather drives people indoors, where the virus can spread more easily, the newspaper said. The latest spike in cases shows up just before the increased mingling of people that comes with Halloween, Thanksgiving and Christmas.

Sixteen states each added more new cases in the seven-day period ending Monday than they had in any other weeklong stretch of the pandemic. North Dakota and South Dakota are reporting more new cases per person than any state has previously, the Times reported.

“A lot of the places being hit are Midwest states that were spared in the beginning,” William Hanage, a Harvard University infectious diseases researcher, told the Washington Post. “That’s of particular concern because a lot of these smaller regions don’t have the ICU beds and capacity that the urban centers had.”

COVID-19 hospitalizations have already begun rising in almost a dozen states, including Ohio and Pennsylvania, raising the probability that increasing death counts will soon follow, the Post reported.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told CNN that he hopes the numbers “jolt the American public into a realization that we really can’t let this happen, because it’s on a trajectory of getting worse and worse.” He called the rising numbers “the worst possible thing that could happen as we get into the cooler months.”

It is unclear what is driving the climbing case count, but it could be the long-feared winter effect already taking place, or the reopening of businesses and schools, or just people letting down their guard on social distancing efforts, the Post reported.

Second COVID vaccine trial paused

A second coronavirus vaccine trial was paused this week after an unexplained illness surfaced in one of the trial’s volunteers.

Johnson & Johnson, which only began a phase 3 trial of its vaccine last month, did not offer any more details on the illness and did not say whether the sick participant had received the vaccine or a placebo. The trial pause was first reported by the health news website STAT

Which states had the best pandemic response?

For this story, reporters interviewed a wide range of health researchers, public officials and academic experts to ask them which states were standouts in their management of the pandemic. What we heard repeatedly were lessons culled from a handful of states that others could follow.

We’ve distilled their insights into three categories that represent the greatest challenges states are facing: fighting the virus, managing the economic fallout and reopening schools.

FIGHTING THE VIRUS

Leading the way in the rural Northeast

Few states have a record as unblemished as Vermont.

The odds could have been stacked against the state. The virus arrived in Vermont during the first wave sweeping the country. It shares borders with some of the hardest-hit states and has the third-oldest population in the country.

But Vermont swiftly flattened its initial wave and has since gone weeks at a time without any new confirmed infections. Fewer than 60 people have died, giving the state the second-fewest deaths per capita behind Alaska, which has seen surging caseloads in recent weeks. If the country as a whole had the same per capita death rate as Vermont, the nationwide death toll would be 30,000 instead of more than 215,000.

“This should be the model for the country, how you’ve done it,” Anthony Fauci, the nation’s top infectious disease expert, said during a briefing with state leaders in September. “Notwithstanding that this is a small state, it should be the model of how you get to such a low test positivity that you can actually start opening up the economy in a safe and prudent way.”

While health experts say the state has likely benefited from its rural geography, other sparsely populated areas of the country that let their guard down were overwhelmed by the virus this spring and summer. That sense of complacency never took hold in Vermont, where a moderate Republican governor and a Democratic-led Legislature helped defuse partisan tensions that hampered the response elsewhere.

“Any state that’s going to succeed against Covid has got to have the compliance of the population, because every single thing you do is telling people to alter their personal behavior,” Mark Levine, Vermont’s health commissioner, said in an interview.

What works:

— Vermont reopened slowly. The lockdown it put in place in late March is still gradually being lifted, restaurants and bars are still limited to 50 percent indoor capacity and even outdoor gatherings are still subject to a 150-person limit.

— Local governments have authority to set their own stricter rules. Burlington, the state’s most populous city, reduced its outdoor gathering limit to 25 in late August when college students began returning to nearby campuses.

— The state is also strict about visitors, requiring a two-week quarantine for people arriving from places with higher infection rates. And it invested early in testing and contact tracing and implemented a state-wide mask mandate early on.

“They took action early, they let science lead, and they were consistent

LA Could Soon Escape State’s Most Restrictive Shutdown Tier

LOS ANGELES, CA — In a sign of the light at the end of the tunnel, Los Angeles County health officials said the region is on track to emerge from the most restrictive tier of the state’s coronavirus economic-reopening roadmap within the next few weeks.

Angelenos just have a little more work to do to help get the number of new coronavirus cases a little lower, Los Angeles County’s public health director said.

“My hope is that in the next few weeks we get to Tier 2” of the state’s reopening matrix, Barbara Ferrer told the county Board of Supervisors.

It will depend on whether the county can reduce its average rate of new cases per 100,000 residents from 7.6 to below 7. If the county can get there, it can advance out of the restrictive “purple” Tier 1 and into the slightly more liberal “red” Tier 2. As always seems to be the case, there are events and holidays on the horizon that could prove to be hurdles. On Tuesday, the state followed the county’s lead in advising against trick or treating on Halloween this year. Ongoing protests, demonstrations and postseason NBA and MLB gatherings could lead to an uptick in new cases.

Ferrer told the board that reducing the number of new cases will take continued action from residents, some of whom have contributed to recent upticks thanks to large gatherings held in spite of public health orders barring them. She reiterated earlier guidance from health officials suggesting that residents balance their daily risk of exposure by limiting their activities outside the home. She suggested, as an example, that if a person goes to a grocery store during the day, that person should consider staying home for dinner instead of visiting a restaurant that same day.

Large gatherings, however, have continued to vex efforts to control the spread of the virus. Health officials on Monday said the tens of thousands of people who attended a pro-Armenian march in the Mid City area on Sunday may have been exposed to the virus, and should now be avoiding others for the next 14 days and get tested for COVID-19. The same applies to the hundreds of people who flocked to downtown Los Angeles Sunday night to celebrate the Lakers’ NBA championship.

Ferrer also told the board that businesses must continue to adhere to health protocols as they welcome back customers, noting that the county has generally seen good compliance.

On Tuesday, the county reported another 18 coronavirus deaths, while health officials in Long Beach announced three additional fatalities. The new deaths increased the countywide total since the start of the pandemic to 6,793.

The county also announced 790 newly confirmed cases of the virus, while Long Beach added 40 and Pasadena reported three. Those cases lifted the overall cumulative total since the pandemic began to 283,793.

The county Department of Public Health noted that Tuesday’s number of new cases was likely artificially low due to reporting lags from

CDC says teen gave COVID-19 to 11 relatives across 4 states during a family vacation. Experts see a cautionary tale for holidays

A COVID-19 outbreak that infected 11 people across four states began with a 13-year-old girl who transmitted the virus during a three-week family vacation over the summer, according to a Centers for Disease Control report.

In Illinois — one of the states involved — a Cook County Department of Public Health spokeswoman said that the community where some of the family members live is not currently at risk from this particular outbreak, which occurred months ago.

But the case shows that kids and teens can contract and spread the virus, public health experts say. It also serves as a cautionary tale before the holiday season, a traditional time for many large family get-togethers.

“(The) outbreak highlights several important issues that are good to review before the holidays., a Cook County Department of Public Health spokeswoman said in an email.

The CDC noted that the case underscores the risk of exposure during gatherings, as well as the benefits of social distancing.

“SARS-CoV-2 (the virus that causes COVID-19) can spread efficiently during gathering, especially with prolonged, close contact,” the CDC report said. “Physical distancing, face mask use and hand hygiene reduce transmission; gatherings should be avoided when physical distancing and face mask use are not possible.”

The three-week family gathering involved five households from four states, according to the CDC report, which was released earlier this month. The report in a footnote mentioned public health departments in Rhode Island, Massachusetts, Illinois and Georgia; it did not give any other information about where the family gathering took place or the states where various relatives lived.

The report said the initial patient, a 13-year-old girl, was exposed to COVID-19 during a large outbreak in June. A rapid antigen test four days after her exposure came back negative, before her symptoms began. Two days later she had some nasal congestion, her only symptom. That day she traveled with her parents and two brothers to attend a large family gathering, which began the following day, according to the CDC report.

She was one of 14 relatives ranging in age from 9 to 72 who shared a five-bedroom, two-bathroom home for eight to 25 days, the report said. The relatives did not wear face masks or practice physical distancing, according to the report.

Eleven other family members contracted the virus; one was hospitalized and another went to the emergency room for treatment of respiratory symptoms, but both recovered, according to the report.

“This outbreak highlights several important issues,” the report said. “First, children and adolescents can serve as the source for COVID-19 outbreaks within families, even when their symptoms are mild. Better understanding of transmission by children and adolescents in different settings is needed to refine public health guidance.”

Six additional family members did not stay at the home but did visit on different occasions, maintaining physical distance from relatives from other households. None of those individuals developed symptoms, and four tested negative for the virus, the CDC found.

“None of the six family members

31 states have growing rates of new Covid-19 cases, and ‘we know what’s coming next’

Once again, most of the country is in trouble.



a person standing in front of a car: A man performs a self-swab at a drive-through COVID-19 testing site at Eastern Florida State College on October 9, 2020 in Palm Bay, Florida. The Florida Department of Health reports that COVID-19 cases, deaths, and hospitalizations are on the rise while U.S President Donald Trump plans to hold a rally in Sanford, Florida after contracting the disease. (Photo by Paul Hennessy/NurPhoto via Getty Images)


© Paul Hennessy/NurPhoto/Getty Images
A man performs a self-swab at a drive-through COVID-19 testing site at Eastern Florida State College on October 9, 2020 in Palm Bay, Florida. The Florida Department of Health reports that COVID-19 cases, deaths, and hospitalizations are on the rise while U.S President Donald Trump plans to hold a rally in Sanford, Florida after contracting the disease. (Photo by Paul Hennessy/NurPhoto via Getty Images)

As of Monday, 31 states have reported more new Covid-19 cases this past week compared to the previous week, according to data from Johns Hopkins University.

And nine states reported record-high Covid-19 hospitalizations on Sunday, according to the Covid Tracking Project: Arkansas, Kansas, Missouri, Montana, Nebraska, North Dakota, Oklahoma, Wisconsin and Wyoming.

“These are extremely alarming trends, and there should be warning bells going off around the country,” emergency medicine physician Dr. Leana Wen said.

“Some will say, ‘Well look, we are having increasing numbers of cases because we’re testing more.’ But we also know that in more than 15 states, the test positivity rate is over 10% — which means that we’re not doing nearly enough testing.”

On top of that, many people have no idea where they caught the virus.

“Many parts of the country are reporting that 50% or more of their cases cannot be traced back to any single infectious source — which also means that there is a high level of community spread,” Wen said.

“We know what’s coming next … we’re going to get increasing numbers of hospitalizations,” she said.

“Hospitals could again become overwhelmed. And then we’re not just talking about patients with coronavirus who might be in trouble. It’s also about other patients who might be coming in for heart attacks and strokes and car accidents who may find a situation that’s really untenable.”

The states headed in the wrong direction

Five states are grappling with a 50% increase in new cases this past week compared to the previous week: Montana, New Mexico, Tennessee, North Carolina and Vermont.

Video: Arkansas Gov.: spike in hospitalizations ‘concerns me’ (CNN)

Arkansas Gov.: spike in hospitalizations ‘concerns me’

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Another 26 states had increases between 10% and 50%: Arkansas, Oregon, Idaho, Utah, Arizona, Colorado, Wyoming, North Dakota, South Dakota, Nebraska, Oklahoma, Minnesota, Iowa, Missouri, Illinois, Indiana, Michigan, Ohio, Kentucky, Mississippi, Florida, Virginia, West Virginia, Pennsylvania, New Jersey and Rhode Island.

Only three states — Maine, Texas and Washington — had fewer new cases compared to the previous week. The remaining 16 states are relatively steady.

No one is off the hook — not even states that have improved

Several states, especially in the Northeast, have enjoyed much better success at fighting coronavirus after implementing strict and innovative ways to limit the virus’ spread.

But those residents can’t let their guard down, White House coronavirus task force coordinator Dr. Deborah Birx said.

“We’re seeing those early suggestions here in the Northeast and what we wanted

As COVID-19 cases rise again, how will the US respond? Here’s what states have learned so far

<span class="caption">States have tried shutting down bars and limiting restaurants to outdoor seating to slow the coronavirus's spread.</span> <span class="attribution"><a class="link rapid-noclick-resp" href="http://gettyimages.com/detail/news-photo/patrons-dine-at-an-outdoor-restaurant-along-5th-avenue-in-news-photo/1227674724" rel="nofollow noopener" target="_blank" data-ylk="slk:Sandy Huffaker/Getty Images">Sandy Huffaker/Getty Images</a></span>
States have tried shutting down bars and limiting restaurants to outdoor seating to slow the coronavirus’s spread. Sandy Huffaker/Getty Images

When COVID-19 began spreading in the U.S. in early spring, governors in hard-hit states took drastic steps to reduce the threat and avoid overloading their health care systems. By shutting down nonessential businesses and schools and ordering people to stay home, they slowed the virus’s spread, but several million people lost jobs.

Since then, we’ve witnessed a series of ad hoc experiments with more targeted approaches. As states started to reopen, they tested different levels of restrictions, such as face mask mandates and capacity constraints on restaurants. Some closed bars when cases rose again but left other businesses open. Others set restrictions that would be triggered only for hot spots when a county’s positive case numbers passed a certain threshold.

Now, as cooler weather moves more people indoors and daily case numbers rise, states and communities are looking to those successes and failures as they consider what future strategies should look like. Could more targeted closures and restrictions be effective, or will a return to statewide stay-at-home orders be needed again?

As public health researchers, we’ve been following the strategies as they evolve, and we see lessons those experiments hold for the country.

Better testing and treatment, but a long way to go

The nation’s ability to respond to the virus has improved since COVID-19 first reached U.S. cities.

Testing capacity has expanded and results are available faster. That means people who become infected can be isolated faster. Treatment methods have also improved. For the most severe cases, innovative use of low-cost steroids and repositioning patients to support breathing have helped seriously ill patients recover faster.

However, there is still no vaccine, a lot of questions remain about new therapies, and shortages are predicted for personal protective equipment as a new flu season approaches.

People stand in line at a clinic offering quick coronavirus testing near Long Beach, California.
Rapid tests and more testing supplies at clinics have helped pinpoint coronavirus hotspots. Brittany Murray/MediaNews Group/Long Beach Press-Telegram via Getty Images

With colder weather now arriving, the nation faces a greater potential for virus outbreaks to spread. More person-to-person contact will be inevitable with more indoor activities and in-person classes in schools and colleges.

The upcoming holidays will also mean more inside gatherings and travel. Throughout the pandemic, data have revealed a pattern of increased cases within two weeks of holidays and other events that increase contact and related exposures. For example, an uptick in cases in the Midwest was linked to late summer gatherings around Labor Day and the reopening of colleges. State and local leaders need to be prepared.

So what works?

From the nationally reported and global case data, it seems clear that requirements for social distancing and mask-wearing combined with stay-at-home orders and business closures can effectively reduce virus transmission.

New Jersey and New York initially implemented strict, prolonged measures and were able to keep case rates lower through the summer, while several states that quickly lifted restrictions saw their

New cases are up by at least 50% in 5 states

More than half of US states are seeing an increase in new Covid-19 cases, with five states — Montana, New Mexico, North Carolina, Tennessee and Vermont — reporting a jump of more than 50% in one week.



a person standing in front of a car: A man performs a self-swab at a drive-through COVID-19 testing site at Eastern Florida State College on October 9, 2020 in Palm Bay, Florida. The Florida Department of Health reports that COVID-19 cases, deaths, and hospitalizations are on the rise while U.S President Donald Trump plans to hold a rally in Sanford, Florida after contracting the disease. (Photo by Paul Hennessy/NurPhoto via Getty Images)


© Paul Hennessy/NurPhoto/Getty Images
A man performs a self-swab at a drive-through COVID-19 testing site at Eastern Florida State College on October 9, 2020 in Palm Bay, Florida. The Florida Department of Health reports that COVID-19 cases, deaths, and hospitalizations are on the rise while U.S President Donald Trump plans to hold a rally in Sanford, Florida after contracting the disease. (Photo by Paul Hennessy/NurPhoto via Getty Images)

Health experts warned over the weekend that the US could have a surge in coronavirus cases and deaths in the coming months, adding to the more than 7.7 million cases and 214,764 deaths on record.

Only Maine, Texas and Washington are reporting fewer new daily cases on average from last week. The number of new cases is holding steady in 16 states: Alabama, Arkansas, California, Connecticut, Delaware, Georgia, Hawaii, Kansas, Louisiana, Maryland, Massachusetts, Nevada, New Hampshire, New York, South Carolina and Wisconsin.

Everywhere else, 31 states in all, new cases have climbed compared with the week before.

Montana, one of the states reporting a steep uptick over the week, has reported 5,000 coronavirus cases in the last 11 days. That’s a stark contract to the beginning of the pandemic when it took the state almost five months to chart its first 5,000 cases.

The state recorded its first coronavirus case on March 13 and on August 10 reported having 5,017 cases across the state. Then from September 30 through October 10, Montana reported 5,046 coronavirus cases, according to data from Johns Hopkins University.

Public health experts have warned that the fall and winter could bring an explosion of new Covid-19 cases as Americans exercise less caution and spend more time indoors, where there is a greater likelihood of transmission.

20,000 deaths ‘inevitable’ this month

An additional 20,000 Covid-19 deaths by the end of the month are “inevitable,” according to a former director of the US Centers for Disease Control and Prevention.

The estimate is based on the number of infections “that have already occurred,” Dr. Tom Frieden said Saturday, during CNN’s “Coronavirus: Facts and Fears” town hall.

The United States reported 57,420 new coronavirus cases on Friday, the highest number of new daily cases since August. That number fell to 44,614 on Sunday.

“Anytime we ignore, minimize or underestimate this virus, we do so at our peril and the peril of people whose lives depend on us,” Frieden said.

By February, the coronavirus death toll in the US could double to about 400,000, a model from the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine projected. Daily deaths will peak at about 2,300 in mid-January, the model predicted.

New Covid-19 cases continue to grow across the country. Florida health officials reported 5,570 new case on Sunday after there

10 states with the rudest drivers

For many, the experience of driving creates a feeling of anonymity. Protected inside the pod-like confines of our car, we may begin viewing the world outside as an observer, rather than as a participant. This detachment can embolden drivers to behave more aggressively or impolitely towards other drivers than they would in another social situation. 

Unfortunately, rude driving behavior and aggression towards other drivers are ubiquitous in America. In fact, more than half of all drivers in the United States reported at least one incident of significant aggression, anger, or road rage towards another driver over a one-year period. 

While drivers may not feel particularly accountable for behaving impolitely towards others, some forms of rude driving behavior can be extremely dangerous. Honking to express annoyance may be one thing, but it’s quite another to angrily tailgate a car, truck, or motorcycle, or to run a red light in utter disregard of oncoming traffic. 

The data scientists at Insurify, an insurance quotes comparison website, were eager to investigate patterns in rude driving behavior that are on the more dangerous (and illegal) end of the spectrum. Curious to find whether there are regional differences in these extreme behaviors, Insurify’s data scientists turned to their database and ranked each state based on its share of ill-behaved drivers. 

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Only two US states report a decline of new cases and nationwide hospitalizations are increasing

Covid-19 cases are trending upwards across the US, with only two states reporting a decline of cases compared to last week. And hospitalizations across the country have also begun to rise, according to data from the COVID Tracking Project.



a man in a police car parked in a parking lot: People line up in their vehicles to undergo the coronavirus disease (COVID-19) tests, distributed by the Wisconsin National Guard at the United Migrant Opportunity Services center, as cases spread in the Midwest, in Milwaukee, Wisconsin, U.S., October 2, 2020. REUTERS/Alex Wroblewski


© Alex Wroblewski/Reuters
People line up in their vehicles to undergo the coronavirus disease (COVID-19) tests, distributed by the Wisconsin National Guard at the United Migrant Opportunity Services center, as cases spread in the Midwest, in Milwaukee, Wisconsin, U.S., October 2, 2020. REUTERS/Alex Wroblewski

Wisconsin health officials reported a record-high number of 141 new patients Wednesday, days after the state saw records in new Covid-19 cases and deaths. Gov. Tony Evers announced Wednesday the state will open a field hospital in response to the surge in hospitalizations.

“We obviously hoped this day wouldn’t come, but unfortunately, Wisconsin is in a much different and more dire place today, and our healthcare systems are being overwhelmed,” Evers said.

Other state leaders say they’re not trailing far behind.

“Our hospitalization rates are surging and beginning to place a strain on our healthcare system (especially staffing),” Utah Lt. Gov Spencer Cox wrote on Twitter Wednesday. “Sadly, we are now seeing increased fatalities. The Wisconsin announcement should be a sobering reminder as Utah isn’t far behind in infection rates.”

Other states, including Montana, Nebraska, North Dakota, Oklahoma, South Dakota and Wyoming have all seen record-high hospitalization numbers in the past days.

The uptick in Covid-19 patients comes as the US approaches winter with a daily Covid-19 base line that experts say is far too high. For the first time since August, the nation is averaging more than 44,000 new Covid-19 cases daily, according to data from Johns Hopkins University — an average that won’t help as the country enters what health officials say will be a challenging season. More cases will mean more community spread, more hospitalizations and ultimately, more deaths, Dr. Anthony Fauci has said.

At least half of US states, scattered across the Midwest and Northeast, are reporting more new cases than the previous week, according to Johns Hopkins. Only two states — Alabama and Hawaii — report a decline of cases.

More than 211,000 Americans have lost their lives to the virus, according to Johns Hopkins. And another 150,000 could die in the next three months, according to projections from the University of Washington’s Institute for Health Metrics and Evaluation.

State leaders take new measures

Some US leaders have pushed new measures hoping to curb the spread of the virus. In Kentucky, Gov. Andy Beshear said the state is seeing the third major escalation of cases and his mask mandate would be renewed for another 30 days.

That announcement comes after Beshear said authorities had been instructed to step up mask enforcement.

Wisconsin also issued a new order earlier this week limiting public gatherings. And in New York, the governor announced restrictions for areas where Covid-19 clusters were occurring — including closing schools and limiting crowds at houses of worship.

Clusters of

Months Into the Pandemic, 16 States Don’t Mandate Mask Use. Why?

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Nils Hase, a retiree who lives in Tarpon Springs, Florida, is wearing a mask and loading his Home Depot haul into his car on a recent weekday afternoon. In the store, because Home Depot insists customers and staff across the country wear masks, most faces were covered. But out here in the parking lot, in a state with a serious infection rate but no mask mandate, plenty of those masks hang down around people’s chins.

“It bothers me. They are being defiant,” Hase said. “And most of the people I see that walk in without a mask are just looking for a fight. They are asking you to ‘Just ask me. Just give me a reason to yell at you.’ I just stay away from them and keep on with my own life.”

Six and a half months after President Donald Trump declared the coronavirus emergency, COVID-19 has killed more than 207,000 Americans and infected 7.3 million, now including Trump himself and the first lady.

Scientists are warning of a larger wave of infection this winter. They agree the simplest, easiest way to fight that surge is to get most people to wear masks most of the time.

Yet the political fight over face coverings rages. It plays out on city streets, in suburban grocery stores, in rural sheriff’s offices and at the highest echelons of government — all the way to the presidential debate stage this week in Cleveland. There, most of Trump’s contingent refused to wear required masks, and one of them tested positive soon afterward. Only time will tell if they spread the infection, but their behavior is mirrored across the nation.

Hefty Price in Iowa

In April, Iowa health officials cut an agreement with Iowa University to do modeling on the impact of coronavirus. Among the data are estimates of future death rates and the projection that more than a thousand Iowans could be saved by adopting a universal mask policy.

Later that month, the researchers warned Republican Gov. Kim Reynolds not to ease restrictions aimed at curtailing the virus, saying a spike would result later in the year. They also recommended a strong policy on facial coverings, producing a report that said face shields would dramatically lower the virus’s toll.

Reynolds took none of that advice. She started easing restrictions in late April. She argued it was more important to reopen the state’s economy while encouraging people to be responsible and wear masks than to throw down a mandate she called unenforceable.

“I think the goal is to strongly encourage and recommend that people wear them,” she said in late August. “I believe that people are.”

Yet at that moment, Iowa was proving the university’s predictions true, suffering the highest infection rate in the nation. In late September, the state was one of only seven that remained in the “red zone,” averaging more than 890 new infections a day.

The governor’s