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Nov. 5, 2020, 11:21 a.m. EST

Here are all the reasons COVID-19 cases are surging again

‘Pandemic fatigue’ is setting in among Americans tired of social distancing and wearing masks

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By Jaimy Lee

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Experts attribute the record-breaking number of coronavirus cases in the U.S. to growing weariness among Americans to keep up with pandemic practices like social distancing and wearing masks.

The U.S. on Wednesday reported more than 103,000 new coronavirus cases, marking the first time that case counts had crossed the 100,000 threshold, according to COVID Act Now, a nonprofit tracking the geographic spread of the virus in the U.S. That means the number of new cases has more than doubled since the end of the summer, when the U.S. had 40,123 cases on Sept. 1.

There is not a single state that is on track to contain the virus, according to COVID Act Now’s methodology .

These figures have set off alarms with public health experts who worry about surging case counts across the country, as much of the U.S. faces winter temperatures and the traditionally social-heavy holiday season.

“There is explosive spread occurring in many parts of the country, including in areas that have more limited health care infrastructure,” said Dr. Leana Wen, a visiting professor of health policy and management at the George Washington University School of Public Health and Baltimore’s former health commissioner. “We are already seeing hospitals becoming overwhelmed, and patients having to be diverted to other places for care. It’s extremely concerning. I cannot overemphasize how dire the situation is right now.”

The four experts interviewed for this story say multiple factors are to blame for the record-setting number of COVID-19 cases and hospitalizations right now in the U.S. However, what is different about this surge — compared, for example, with the spring — is that it’s happening in disparate parts of the country. During the last week of October, Chris Meekins, director of health-care policy at Raymond James, predicted the U.S. would hit 100,000 cases a day in the next few weeks.

El Paso, Texas, which has 128.7 cases per 100,000 people, implemented a 10 p.m. to 5 a.m. curfew during the week of Oct. 26. Some hospitals in Kansas City, Mo., have turned away ambulances because they are already overwhelmed, according to ABC News . Hospitals in northern Idaho are considering transferring COVID-19 patients across state lines to less crowded facilities in Portland and Seattle.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said that he sees the current surge in cases as “ an exacerbation of the original first wave ” in the U.S.

Many experts agree that the first wave hit the U.S. on a rolling basis, striking New York and parts of the Northwest in the spring, then Sun Belt states like Arizona and Texas in the summer, and now the virus is largely having the most impact in the Midwest, though infections are rising in nearly all states. “ ‘Phase 3’ is now really nationwide, from sea to shining sea,” Meekins said, “but, predominantly, the seeds were formed in the upper Midwest.”

What’s to blame for the recent surge in cases?

1. Falling temperatures mean more people are socializing indoors , as Americans shift their social lives from a summer of patios and backyards into living rooms and bars. A preprint , a category of preliminary scientific research, published in September found that indoor socializing carries a significantly higher risk of transmission than activities outdoors.

“As temperatures dropped, look where the areas with, let’s say, the highest positive test rates are,” Meekins said. “It’s the upper Midwest, where obviously the temperatures have dropped, and Montana [and] Idaho.” In Billings, Mont., the high the last week of October was 41 degrees Fahrenheit — cases in Montana are at an all-time high, with 67.9 cases per 100,000 people there, as of Oct. 26. (In comparison, New York has 8.4 cases per 100,000 people.)

2. People are dealing with “pandemic fatigue,” after nearly eight months of near-constant worry about the virus since the first U.S. lockdowns went into place in March. “People are tired of being cooped up, and they may not be using the best judgment at all times,” said Dr. Aaron Glatt, chairman of the department of medicine at Mount Sinai South Nassau in New York.

And because pandemic policies vary from state to state, the lack of a coordinated national response puts the onus on individuals to make their own choices, which can be stressful over long periods of time. “Some states are doing a lot to control the spread of COVID,” said Malia Jones, an epidemiologist and associate scientist in health geography at the University of Wisconsin–Madison. “Other states are doing very little. And without everybody working together towards the same goals, those things are often in conflict with one another.” In addition, Wen notes that “it’s hard to ask people to do their part, when the federal government isn’t doing theirs. ... For example, the White House is hosting social events when we’re asking people not to see their loved ones.”

3. This translates to more social gatherings with extended family and friends than the smaller “pods,” Zoom hangouts and Netflix parties that people relied on in the earlier days of the pandemic. “What’s driving it is individual behaviors, including, very importantly, letting down our guard with people that we know,” Wen said. “There is a magical thinking. We don’t want to believe that they could be asymptomatic carriers.”

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