NOEL KING, HOST:
The U.S. appears to be moving toward a higher peak in new coronavirus cases than we've seen to this point. And it's not just new cases - deaths from the coronavirus are also up in most states when compared to two weeks ago. And the Midwest is seeing the biggest surges. Here's Will Stone.
WILL STONE, BYLINE: Since the late summer, Dr. Misty Anderson has worried about the pandemic's grip on North Dakota's small cities and towns, places like where she lives, an hour west of Fargo.
MISTY ANDERSON: Never lost any patients until recently and lost a couple in just one week. And it has gotten into a nursing home in our area.
STONE: Anderson is an internist and president of the state medical association. North Dakota's hospitals are filling up, and cases are at record levels, but she says it seems like people are less willing to wear masks and follow social distancing recommendations than earlier in the year.
ANDERSON: We have gone 180 degrees away from that. It's like every man for themself.
STONE: And she's keenly aware of how even the most rural communities are at risk. She's actually from a small county with only about 1,300 people, just over the border in South Dakota.
ANDERSON: 'Cause it got into their school. It got into their bank. People my mom works with and knows, like, they had it. No one is immune from this, no matter how rural you are.
STONE: The U.S. is careening toward a devastating fall and winter. Cases are rising in most of the country, up more than 30% from just two weeks ago. But the Midwest has hurtled past those numbers. The Dakotas, Ohio, Indiana, Illinois, Michigan - in all of those states, average daily infections have jumped more than 60% since early October. This is straining hospitals, especially in rural communities like Wishek, N.D. Beverly Vilhauer is CEO of South Central Health there.
BEVERLY VILHAUER: I think our biggest challenge right now has been finding beds when we need it.
STONE: Her hospital has two dozen beds but can only staff about six to eight at a time. Vilhauer says they're transferring patients, sometimes even out of state, if the person is seriously ill.
VILHAUER: Sometimes it is kind of displacing those patients out of what we call our service area. The bigger hospitals are running out of ICU beds.
STONE: This is the situation for many small hospitals at the moment. In Carroll County, a hot spot in the west of Iowa, about 20% of tests are coming back positive.
ED SMITH: That's really high. We've actually expanded our COVID unit three times.
STONE: That's Ed Smith, who's CEO of St. Anthony Regional Hospital. Smith says the biggest challenge remains staffing, with their own health care workers getting exposed while out in the community.
SMITH: And we're seeing greater absenteeism at work due to employee illness or their kids or their husbands.
STONE: Iowa, like the Dakotas and Missouri, does not have a statewide mask mandate - neither does Oklahoma, but it does have some local mandates.
AARON WENDELBOE: It's clear that those communities with mask mandates have a more flat trajectory.
STONE: That's Aaron Wendelboe, a professor of public health at the University of Oklahoma. He says the state has been playing catch-up on the pandemic for months.
WENDELBOE: We really could have done better during the summer to prevent some cases and not be so full in our hospitals. I think that transmission really does reflect just the community's behavior.
STONE: And like so many public health experts, he's hoping that behavior changes heading into fall and winter, a time that many predict to be the darkest for the U.S. pandemic.
For NPR News, I'm Will Stone. Transcript provided by NPR, Copyright NPR.