Tanzina Vega: This is The Takeaway. I'm Tanzina Vega. COVID-19 has killed more than 1 million people worldwide since it was first detected 10 months ago. Here in the United States, that number is over 200,000 people who have died. The virus has stopped the world in its tracks and has devastated communities. In Wisconsin, more than 2,000 cases a day are being recorded and hospitalizations are at an all-time high. Here's Wisconsin governor, Tony Evers, at a press briefing yesterday.

Tony Evers: Right now, it's not slowing down. It's picking up speed. We have got to put the brakes on this pandemic. Skip the play dates, the dinner parties, the family get-togethers, and work conferences, or any other gatherings with people you don't live with for the time being. Wear a mask whenever you are around folks you do not want to live with.

Tanzina: Wisconsin is not alone. About half of the states in the United States are reporting increases in new cases. Even New York, where COVID was on the downturn, recently reported more than 1,000 new cases for the first time since June. Most of those are concentrated in a handful of neighborhoods. Here's Governor Andrew Cuomo addressing the cluster of cases of Brooklyn, Queens, and Rockland and Orange Counties.

Andrew Cuomo: These are embers that are starting to catch fire in dry grass. Send all the fire fighting equipment and personnel to those embers and stamp out the embers right away.

Tanzina: With me now is Rob Mentzer, rural communities reporter for Wisconsin Public Radio. Rob, welcome to the show.

Rob Mentzer: Hi. Thanks for having me.

Tanzina: Also joining me is Bill Hanage, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health. Bill, welcome back to The Takeaway.

Bill Hanage: Hi, Tanzina. It's good to be here.

Tanzina: Bill, we mentioned New York and Wisconsin. Are there specific trends that are spurring these outbreaks that we're seeing, these spikes?

Bill: Yes, indeed. After we had a pretty bad spring in New York and then the Sun Belt had a pretty bad summer, we're now seeing it shifting to the Midwest, and the Midwest is where we're seeing quite a lot right now. It's a sparsely populated area but still, taken altogether, a lot of people live there. I'm going to be really interested to hear about what's going on on the ground in Wisconsin.

Meanwhile, places like Massachusetts and New York are beginning to see upticks, although I should say upticks from very, very low levels of transmission. There's been a lot of really good and really hard work done here. It's been extremely helpful. However, we cannot let up just yet.

Tanzina: Rob, let's talk about Wisconsin specifically. What do we know is leading to this increase and this spike in cases in the state?

Rob: The spike in Wisconsin really started at the beginning of September. That coincided with the opening up of schools in a lot of communities and the opening up of college campuses across the state. In the early first two weeks of September, the numbers among especially young people, especially in college towns, shot up. There were these steep, steep increases among people 18 to 20. In the last two weeks, their numbers have come down. They have not had nearly as many new infections among those young adults, but every other age group has shot up. It's led to this very large, near exponential growth in Wisconsin.

Tanzina: Bill, one of the things that I think is most concerning here in addition, and I'd love to hear your thoughts, is that we're heading into the fall. We're here in the fall and we're heading into a winter season where most of us will be indoors. I wonder if that is something that's concerning to you as you see these spikes across the country.

Bill: Yes, it really certainly is. I just want to say, based on what we just heard there, that pattern of younger people getting infected and then it moving from those age groups into older age groups and that leading to hospitalizations-- Is there a word for deja vu over and over again? That's basically what we're seeing over and over again. That's something which we really, really need to be prepared for.

I would also say that if you think about what's been happening around New York City as well in those particular neighborhoods, some of what we're seeing, then, may be the result of gatherings, which have been taking place over the High Holy Days. That is something which should give us a little bit of insight into what we might expect when we start looking forward to things like Thanksgiving.

Tanzina: There have been suggestions to not celebrate holidays like Thanksgiving and Christmas in person, Bill. I'd love to dig into that in a little bit. Rob, wasn't there a mask mandate in Wisconsin? Do people support it or has it been politicized?

Rob: It certainly is politicized as things are these days. There has been polling on the mask mandate in Wisconsin and it has super majority support in the state. Significantly, it has majority support in all regions of the state, even in more red or Republican-voting areas of the state. Most people have been supportive of the mask mandate. On the other hand, as time goes on, I think that everyone can observe that compliance is not perfect. There's not a lot of enforcement.

Really, what has happened in Wisconsin is that people are, to a large extent, doing normal things. They talk about COVID fatigue or other factors, but people are going to youth sporting events, and they're having parties for the Packers games, and holding weddings that may have been postponed for the summer. It's a million little decisions that bring people together and create opportunities for the virus to spread.

Tanzina: Bill, when you hear that, what do you think has to stop, and not just in Wisconsin but across the country, as we're seeing these spikes? Is it people need to start wearing masks not as chin straps but as actual masks? Is it not gathering? What is happening here?

Bill: Like we just heard, it is a million little decisions. Now, when it comes to things like mask use, yes. If you wear a mask as a chin strap, it's not going to help. Remember your mask is not so much to protect you as to protect others in case you're infected. You can make sure it fits well over your nose and around your chin. You can find out about that elsewhere. The issue of what we need to do is we need to be confronting the fact that this is a dangerous virus and it is something that we are going to be living with for some time, at least. That means that we all have to make sacrifices. We all have to not do things that we would really like to do.

Tanzina: Bill, Americans don't like hearing that.

Bill: I know. I don't like it either. However, the thing which is worse is that we also have to remember that other people are just not going to listen. It's unfortunate that there are going to be some freeloaders who are going to be trying to benefit from all the sacrifices that others are making. Really, the best way to do this is to keep the virus under control by limiting the opportunities for transmission. Now, eradicating it or eliminating it is another thing entirely. What we can do is try and stop the sort of things that we're seeing in Wisconsin right now.

Tanzina: Rob, we heard from Governor Evers at the top of the show there reminding people to cancel play dates, not have dinner parties, not have work events. Wisconsin is also a critical state in the presidential election, as I'm sure you all are very aware of. How are you seeing this spike? Are people going to come out to the polls in just a couple of weeks if this spike continues?

Rob: Wisconsin, like other states, has had a huge surge in absentee ballot requests. As the presidential candidates like to say, the election is happening now because people are receiving and returning their absentee ballots. Wisconsin went through this in April, the presidential primary, and there was a statewide supreme court election that came right at the time when America was locking down. There was a lot of controversy about that spring election. The governor had proposed to postpone the election and that did not happen. The supreme court threw that out and the election moved forward.

It's been studied since then. There really is not a lot of evidence that a lot of new COVID-19 transmissions happened as a result of that election. The reason for that, as best the studies can tell, is that a whole bunch of people voted by absentee, which is happening again. The polling places themselves took a lot of precautions with shields and barriers and face masking, and were able to move people through in a way that--

I think that evidence should make people less nervous. It doesn't mean that you shouldn't take precautions. Vote absentee if you can. By all means, do that. I think that it's unlikely that this spike will cause people not to participate in the November election, which everyone is very focused on.

Tanzina: What about the local response? As I said, we heard from Governor Evers at the top reminding people not to gather, but what else have Wisconsin officials done? Are they out in force handing out masks? Are there public service announcements? What else are local and government officials, state officials, doing to prevent the spread?

Rob: Sure. We've certainly reached the phase where officials at all levels are sounding the alarm. The hospital system is strained. In parts of the state, it is overloaded and COVID-19 patients are being transferred. It's very bad. The thing that follows hospitalizations is deaths. We're going to see that increase as well.

Wisconsin is in a bit of a unique situation because in May, the state supreme court threw out the governor's stay at home order and overturned most of the governor's ability to order closures or other public health measures. Even the mask mandate is the subject of new litigation now in a legal challenge. The legislature here is controlled by Republicans. They have not wanted to meet or pass any new statewide measures. What officials say is what they're largely-- The tool that they have is persuasion. It's trying to get the word out but there isn't that much that the state government is doing in terms of actions that would slow the spread.

Tanzina: Bill, we're seeing that different states have approached this virus differently from New York to Wisconsin to Florida, where recently the governor there just decided to remove all COVID-19 restrictions. Bill, we're heading into the winter. What are tips for listeners so that they can deal with the transition into winter as the pandemic continues to go on? I mean, there really doesn't feel to be an end in sight, at least right now. How do we protect ourselves? We've got about a minute and a half to go.

Bill: I think that people need to recognize-- Remember this is a marathon, not a sprint. Come up with things they can do which are sustainable. We have to remember there's a difference between risks to ourselves and risks to our community. Is risks to young people-- For instance, the most severe consequences of infection are very uncommon in those who are quite young. However, they can, obviously, transmit to others. We want to limit that transmission. We want to limit surges building.

I have to say, when you're looking at somewhere like Florida, that's somewhere which I would expect to have problems because Florida is taking a very similar course to the one which Israel took a little while ago. Israel reopened. Not long after, it's now in its second lockdown. We want to avoid further lockdowns. Reopening thoroughly is not a way to avoid a second lockdown.

Tanzina: Well, we're going to see how this happens. A very serious issue as we move into colder weather. Bill Hanage is an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health and Rob Mentzer is a rural communities reporter for Wisconsin Public Radio. Thanks to you both.

Bill: Thank you.

Rob: Thank you.

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