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Examining COVID-19 Cases In Hard-Hit Wisconsin, Missouri, Tennessee

STEVE INSKEEP, HOST:

This Thanksgiving holiday arrives during an escalating calamity. More than 1 million people are testing positive for coronavirus every week now. That is a high enough number that there is a good chance that some of your family, friends or co-workers are among them. It's certainly been true for me these last several weeks. If you want to identify an especially hard-hit state, just throw a dart at a map because the odds are that any state you hit will qualify. This morning we visit three. Sebastian Martinez Valdivia is at KBIA in Missouri, Blake Farmer is with WPLN in Nashville, Tenn., and Bram Sable-Smith is with Wisconsin Public Radio. Welcome to all of you.

SEBASTIAN MARTINEZ VALDIVIA, BYLINE: Good morning.

BLAKE FARMER, BYLINE: Thank you.

BRAM SABLE-SMITH, BYLINE: Good morning.

INSKEEP: And, Bram, how widespread is the surge in Wisconsin where you are?

SABLE-SMITH: It's quite widespread. You know, by September, public health experts were really sounding the alarm about the rise in cases we're seeing in the state. Initially, we were seeing surges in cities where the universities are located, but very quickly, the virus was rampant in communities all over Wisconsin. And as you know, Steve, cases, they're just the beginning of a COVID surge, so our hospitals started filling up quickly. And maybe most concerning of all is our death rate. We reported a record 104 deaths yesterday. We're losing about 52 people every day on average, and over 3,000 people in Wisconsin have died of COVID-19 so far. And I should also note we are seeing a slight downturn. Our cases are dropping ever so slightly, but we're still very much at the top of a mountain.

FARMER: And, Steve, the death rate's very similar here in Tennessee, but cases are still climbing, often more than 4,000 a day. And as we found throughout this pandemic, deaths tend to lag those big spikes in new cases by a couple of weeks. So Tennessee's bracing for what could be to come because so far there just has no sign existing of cases letting up.

VALDIVIA: Blake, over here in neighboring Missouri, we're in a similar ballpark in terms of new cases and deaths. But the really troubling trend has been in hospitalizations, which are high and continuing to rise, and hospitals are really struggling with capacity in a lot of parts of the state.

INSKEEP: Well, let's talk a little bit more about how hospitals are doing in Missouri then.

VALDIVIA: Yeah. Well, one of the big problems is a lot of the smaller rural hospitals that traditionally transfer patients to urban and metro areas for intensive care are really struggling to find beds because those larger hospitals are already full. So for example, CoxHealth, which is in Springfield, the third-biggest city here in Missouri, has expanded its hospital capacity multiple times over the past nine months, but it's still had to turn people away. Steve Edwards is the CEO there.

STEVE EDWARDS: So we will have added 147 bed capacity, which is probably bigger than the average hospital in the state of Missouri.

VALDIVIA: He says the hospital keeps hitting what it would have considered a worst-case scenario every couple of weeks, but adding rooms isn't really the half of it. The biggest challenge, according to Edwards, is staffing, so training staff to care for COVID patients, and then the draining work of actually caring for them.

INSKEEP: So that's the crisis in Missouri. Bram Sable-Smith, let's go back to Wisconsin. How are doctors trying to keep up where you are?

SABLE-SMITH: Well, you know, in October, the state, we converted our state fairgrounds into what's called an alternative care facility to handle the excess capacity we have. So about 89% of the hospital beds available in the entire state are being occupied right now. In some regions, that's higher. At the alternative care facility, there's only nine patients right now, though. That's in part because it's voluntary to go there. It's also because it's where patients will go to recover kind of after they've cleared a hurdle in their COVID treatment. The idea behind that is to free up resources inside the hospitals to treat an influx of patients - resources like ICU beds that are in very short supply here.

FARMER: And, Bram, the Corps of Engineers built alternative care sites here in Tennessee as well, but increasingly, there's a concern about having the staff to open them. And a big reason for that is that so many nurses and doctors are out themselves with COVID-19 or because they have to quarantine.

INSKEEP: Well, Blake, what are hospitals in Tennessee saying about that?

FARMER: Well, they're really starting to sound the alarm in a way we haven't heard. For a long time, hospital administrators have wanted to make sure people knew that they would be able to handle their usual patients along with COVID, and that's just less so now. Dr. Katrina Green works in an HCA emergency room here in Nashville.

KATRINA GREEN: We are worried about what the delays in care will mean for our patients, and I am personally terrified that my hospital being full could result in someone dying in the waiting room.

FARMER: The situation has become particularly severe in parts of Texas as well, like El Paso and Lubbock. For now, they're able to transport COVID patients to other parts of the state, but there's going to be a time, likely, when those hospitals are at capacity, too.

SABLE-SMITH: You know, I spent some time last week in one of the five COVID units at the University Hospital here in Madison, Wis., where I live. I spoke to Mary Lowe. She's a nursing assistant in the unit. She's been there since the pandemic began.

MARY LOWE: This has been going on for a long time, and right now, it doesn't feel like there is an end in sight. Even though there will be a time, it doesn't necessarily feel like that right now.

SABLE-SMITH: You know, that unit has 28 beds, and they've been consistently full. And she says it's exhausting. And remember, the whole reason for shutdowns early on was to prevent hospitals from being overrun. Well, now in a lot of these states like ours, those restrictions are long gone, and hospitals are now nearing the edge of that cliff. But political leaders are really finding it hard to go backward after lifting restrictions months ago.

INSKEEP: OK. Granted, that's true. But, Sebastian, haven't some political leaders at least faced pressure to approve more safety measures?

VALDIVIA: Yeah. There's definitely been pressure. Here in Missouri, the State Hospital Association actually sent a letter last week to our Republican governor, Mike Parson, urging him to kind of issue one of those statewide mask mandates, saying the wolf is at the door. But like a lot of Republican governors, he's rejected that call. Just to the north of us, though, in Iowa, the story's a little different.

So Governor Kim Reynolds there, also a Republican, was initially against the mask mandate, and she even said that cities couldn't issue their own mandates back in the summer. But she recently reversed course. Iowa has seen one of the biggest surges in cases and hospitalizations in the country per capita. Iowa has roughly half the population of Missouri, but it's almost in the same ballpark in terms of new cases. So earlier this month, Reynolds did end up issuing a statewide mask mandate, as well as some restrictions on public and private gatherings, with exceptions for some businesses and religious services.

INSKEEP: Well, how political is the debate over public health in Wisconsin?

SABLE-SMITH: Very much. You know, our political leaders have been locked in a power struggle that really stems back to the election of Tony Evers, a Democrat, as our governor in 2018. Our Republican-controlled legislature has either filed or been supportive of a spate of legal challenges to the public health initiatives the governor's administration here has tried to take. So our stay-at-home order, it was overturned in May by the state Supreme Court. Capacity limits on places like bars, those were blocked in the courts as well. We're expecting a ruling soon on the mask mandate. And, you know, public health experts say, regardless of the outcome of these cases, the legal whiplash that they cause, that's doing damage to the public health messaging, where consistency is really critical.

INSKEEP: Well, I guess we can be consistent here and note that there's more and more evidence that masks work, that mask mandates work. There were questions about this six months ago - hardly any questions now. And if I'm not mistaken, Sebastian, there was even a study in a very red state, Kansas, that proved this.

VALDIVIA: Yeah. So Kansas actually has a mask mandate that counties can opt into and opt out of, and so the CDC looked at how cases have played out in the counties that opted out and opted in. And they found that in the two months after the mandate, new cases on average actually slightly decreased in counties with the mandate, but they doubled in those nonmandated counties. Now, there's some caveats there. Some of the mandated counties had other additional public health orders, so you can't chalk it all up to mask mandates. But the difference is pretty stark.

INSKEEP: Well, Blake Farmer, if we go back to Tennessee and we think about the trend lines here, the way that cases have been increasing in many places, what's the future look like?

FARMER: You know, it's hard to see how any state would hope to avoid the surges that several other states are seeing without taking other action. For instance, to the south of us, Georgia doesn't seem to be seeing the same dramatic surge Tennessee is, but the state hasn't done much differently than in Tennessee - no mask mandate, few restrictions. So our brief history with this pandemic tells us it's just a matter of time.

VALDIVIA: And here in Missouri, one of the things that people are looking at and across the country are just the holidays, Thanksgiving tomorrow. In Missouri, our governor said to be careful and that Thanksgiving will look different. He said his in-laws won't be coming because they're in their 80s, and they have health conditions. But he also really emphasized that that's a personal choice and went on Twitter to say that the government has no business, you know, telling people who they can have at their Thanksgiving.

SABLE-SMITH: You know, in Wisconsin, where we have a patchwork of local public health orders, Thanksgiving has been on leaders' minds as well. In Racine, Wis., they issued an order limiting gatherings, but that does not go into effect until the day after Thanksgiving. In Dane County, where I live, the health department did put in restrictions ahead of Thanksgiving, but a conservative legal group filed to challenge that order in court on Monday, and Monday also happened to be Public Health Thank You Day.

FARMER: And, Bram, Steve, the difficult thing about Thanksgiving is just how easy it is to give ourselves a pass. I mean, it's just really hard to draw a direct line between going to see my aunt in Kentucky and the fact that hospitals are about to be in desperate shape. But rather than focusing on kind of the voluntary sacrifices that are going to be required of everyone, hospital leaders are starting to point to renewed vaccine hopes. The COVID vaccine news is about as good as anybody could have hoped for at this point. Now, it's not going to help much this holiday season, but it does mean next year should be a bit more normal.

INSKEEP: We can hope so. But, Blake, tell me what it feels like in Tennessee just in day-to-day life in this moment where vaccines seem to be on the way, but somehow we have to - or as many of us as possible have to try to survive the next three, four, five, six, seven - who knows how many months?

FARMER: Well, those of us who have friends who work in hospitals are hearing some pretty dire stories just about what each shift is feeling like, and we're certainly hearing more from hospitals about having, you know, 50% more COVID patients over the next month. And of course, like you said, our own friends and family are turning out to be sick when they really didn't have any idea that they might have COVID-19. So we're all just sort of waiting and watching because we know these next few weeks it's hard to see how things really turn around.

INSKEEP: OK. An update from across the country from Blake Farmer of WPLN in Nashville, Bram Sable-Smith with Wisconsin Public Radio and Sebastian Martinez Valdivia at KBIA in Missouri. Thanks to all of you.

FARMER: Thank you.

SABLE-SMITH: You're welcome.

VALDIVIA: Thank you.

(SOUNDBITE OF WE CAME FROM THE NORTH'S "TALL CRUISE") Transcript provided by NPR, Copyright NPR.