Virus Surge, Once in the Nation’s Middle, Gains Steam All Around

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And even as cases started rising this fall on the Northern Plains, infections remained relatively scarce around Cumberland and many other cities in the Mid-Atlantic and Northeast.

“Then, right before Halloween,” said the rector, the Rev. Martha Macgill, “it just exploded.”

In the first days of November, the priest and her husband were both admitted to the hospital with Covid-19. Per capita, Allegany County, where Cumberland is the county seat, now has the worst outbreak in Maryland, and the Cumberland region has the 14th-highest number of recent cases per capita of any metro area in the country.

“It kind of happened silently then all of a sudden it was bad,” Ms. Macgill said.

About 1,100 miles to the west, in Sioux Falls, S.D., the fall surge came early. Mayor Paul TenHaken said some people in his city wrongly thought they had made it through the worst after a spring wave, mostly confined to a meatpacking plant, came and passed.

But the virus returned and hit the city hard: Two of Mr. TenHaken’s five staff members tested positive, as have dozens of others the mayor knows. The Sioux Falls area has had the sixth-most known cases per capita of any American metro area. Hospitalizations and infections remain high statewide but have slightly declined in recent days. Mr. TenHaken’s unease remains.

“This week makes me a little nervous, just with all the travel and Thanksgiving and gatherings,” the mayor said. “I think this will be the real test, how diligent people are once you get into the holidays.”

Elsewhere, in the Midwest, there are localized signs of progress, or at least stabilization, though officials say that it could all prove fleeting.

The marginal progress in the Midwest comes after governors in some states, including Illinois, Iowa and North Dakota, imposed additional restrictions, and after hospital leaders across the region issued public warnings that they were running out of capacity to treat the sick.

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