One in 60 Wisconsinites had positive COVID-19 test results confirmed in October, making it not only the state's worst month of the pandemic, but one of the biggest surges yet seen in the U.S.
According to a USA TODAY NETWORK-Wisconsin analysis using Centers for Disease Control and Prevention data, only North and South Dakota have ever reported more cases per capita over a 30-day period.
That includes Florida and Arizona, which peaked this summer at 1,499 and 1,408 cases per 100,000 residents, respectively, compared to 1,685 in Wisconsin between Sept. 29 and Oct. 28 (the most recent comparable data).
It's also higher than New York's tragic spring surge (1,265, according to New York Times data), though antibody studies and death rates indicate that many cases there went unconfirmed because of a scarcity of tests.
The Dakotas have peaked at the same time as Wisconsin, with 2,623 cases per 100,000 recently in North Dakota and 2,344 in South Dakota. Montana is tied for third with Wisconsin at 1,685.
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Although Wisconsin and the Dakotas have seen fewer deaths than states with earlier surges, there can be a weekslong lag between a spike in cases — often driven at first by younger people who tend to have milder symptoms, if any — and a spike in deaths.
Ryan Westergaard, chief medical officer for the state's Department of Health Services, told reporters Tuesday that it's a "nightmare scenario, frankly, that this could get quite a bit worse in the next several weeks or months before it gets better."
"Worse" is a grim prospect. With a day left in the month, October has seen health officials report the deaths of 645 Wisconsin residents, more than twice as many as in April (300), the next-highest month. There were 339 deaths reported in the past 10 days alone.
Some hospitals are reporting that they're nearing ICU capacity. Contact tracers can't keep up. And state health officials — whose emergency powers have repeatedly been challenged in court — are urging residents to stay home and minimize risk.
For perspective, here's how dramatically Wisconsin's COVID-19 numbers have worsened in October:
Of 220,092 positive test results reported by DHS since the pandemic began, 97,818 have come since Oct. 1.
That's nearly the population of Green Bay (104,578) or Kenosha (99,944). It's almost as many people who have ever tested positive in Japan (100,450). It's one in 17 U.S. cases reported this month, though only one in 56 Americans are Wisconsin residents.
Green Bay Packers games will be played without fans until Brown County's COVID-19 rates improve, but for the sake of visualization: If Lambeau Field were at capacity for Sunday's game against the Minnesota Vikings, and fans were a representative sample of Wisconsin's population, 1,368 people there would have tested positive in the past month.
There were more cases confirmed in the past two weeks, 53,906, than in any other month, and more in the past seven days, 29, than in any other month besides September (46,671).
With cases still on the upswing at month's end, October had pushed Wisconsin to sixth among U.S. states in per capita infections since January (3,811 per 100,000).
About 33% of Wisconsin residents who have died with COVID-19 did so in October, even as climbing case numbers suggest the peak is yet to come.
According to The New York Times' COVID-19 tracker Thursday, Wisconsin's pandemic total of 34 COVID-19 deaths per 100,000 residents was a fraction of those in the hardest-hit states, like New Jersey (184) and New York (170), and well behind those most affected this summer, like Florida (78) and Arizona (81).
But over the past seven days, Wisconsin was fourth in per capita deaths, behind only the Dakotas and Montana.
More Wisconsin deaths involving COVID-19 had been reported since Sunday (202) than deaths from the flu during the entire 2019-20 season (183).
As the pace of new cases increased in July, August and September, some may have taken comfort in knowing a disproportionate share affected people in their late teens and 20s, who were far less likely to be hospitalized or die than older people.
Public health officials and epidemiologists warned residents, though: A surge that starts in healthy young people can spread to older and at-risk populations.
That's happened. As of Thursday, the age groups with the biggest percent increases in confirmed cases this month have been people in their 70s (97%), 60s (96%), 80s (95%) and 90s (94%). Of 621 deaths in October, 552 were in these age groups, while only four were under 40.
A note: Skeptics have wondered whether numbers like these mean that COVID-19 is killing people who are so vulnerable they would have died soon anyway. Evidence argues against that view: The Centers for Disease Control and Prevention released a report last week in which it estimated that nearly 300,000 more Americans had died from January to early October than has been typical in recent years.
Testing has increased in October, up to over 16,000 residents a day receiving a positive or negative result for the first time, up from just under 10,000 in September. Nearly half a million Wisconsin residents have been tested this month.
But even as average tests had increased 65% in October by Thursday, average new cases had increased by 106%, so it's not true that Wisconsin has more cases simply as a result of doing more tests.
Wisconsin's seven-day average of first-time COVID-19 results that were positive reached a record 27.1% Thursday — more than twice as high as it had ever been before Sept. 12. In early June, it was a shade over 3%.
Some critics, including the conservative MacIver Institute, have said it's misleading to measure test positivity this way, believing the rate should include repeated tests of the same people, like health care workers or nursing home residents.
Public health experts disagree, but in the interests of transparency: Factoring in the repeat tests of the same residents, Wisconsin's seven-day test positivity was at 14.2% — still a record, and 40% higher than it had been during that method's previous peak, when testing was limited to more severe and at-risk cases in April.
As of Thursday afternoon, there were 1,453 people hospitalized with COVID-19 in Wisconsin, with 330 of those patients in intensive care.
That's more than twice as many as were hospitalized Oct. 1 — 669, with 208 in the ICU — and five times as many as on July 1 — 237 and 77.
Before Sept. 22, the peak in COVID-19 inpatients had been 446 — less than one-third as high as Thursday's total — on April 9.
One in 4,000 Wisconsin residents are currently in hospitals with COVID-19, some of them fighting to breathe while isolated from loved ones, some requiring mechanical assistance.
Hospital leaders have said they're on track to run out of ICU beds and nurses to staff them, and the situation is so dire that Wisconsin last week became one of a few U.S. locations to admit patients to a purpose-built field hospital.
"That was our ultimate insurance policy, and we are utilizing it now," DHS Secretary Andrea Palm said Friday morning in a briefing with reporters.
Westergaard added that he was "surprised and disappointed" that Wisconsin has "failed as much as we have to slow it."
Antibody studies suggest that fewer than 10% of Wisconsinites have been infected, meaning 90% are still susceptible to COVID-19, despite the record-breaking month we just had.
Said Westergaard: "The worst-case scenario is that it's really just getting started."
Andrew Mollica contributed to this report.