How Wisconsin’s Covid-19 epidemic became one of the worst in the US

The coronavirus epidemic in Wisconsin is so bad that, earlier this month, the state opened field hospitals to take on a wave of cases and deaths that officials feared would overwhelm the health care system.

The US has one of the worst Covid-19 outbreaks in the world, and Wisconsin has one of the worst outbreaks within the US. Only the Dakotas and Montana have higher rates of daily new cases. Wisconsin’s outbreak also shows no signs of abating: Since the beginning of October, the seven-day average of daily new coronavirus cases has risen by almost 40 percent. Covid-19 deaths have increased by more than 95 percent over the month.

Wisconsin is the most populous state ranked in the top five for Covid-19 cases. And it’s likely the most important politically — Donald Trump’s win in the state helped cement his Electoral College victory in 2016.

In some ways, the story of Wisconsin’s recent surge is similar to other surges across the country: Cases gradually rose after restrictions were loosened in May, then skyrocketed as the public eased up — gathering for Labor Day, going back to bars and indoor dining, and returning to college campuses.

“It’s a combination of a lot of things that have occurred at the same time,” Ajay Sethi, an epidemiologist at the University of Wisconsin Madison, told me. “It was a perfect storm.”

But what makes Wisconsin unique is the role political polarization has played. It’s not just that its voters are divided enough to make Wisconsin a swing state in presidential elections. The state government is also divided, and that’s had clear consequences: Gov. Tony Evers, a Democrat, has repeatedly tried to enact new restrictions and policies to combat Covid-19, only to have them threatened or overturned by Republican lawmakers.

It was a Republican-controlled Supreme Court that forced Wisconsin’s reopening in the first place by striking down Evers’s stay-at-home order. (Some local governments imposed new restrictions, but others didn’t.) It’s the Republican-controlled legislature that’s now threatening to repeal the state’s mask mandate. And President Donald Trump has held rallies in the state — even as its caseload grew — downplaying the pandemic by claiming it’s “rounding the corner” and calling for the state to “open it up.”

Experts argue that the state needs a united front to take down the coronavirus — and, in particular, the state’s Republican leaders have to accept what scientists have repeatedly said on Covid-19. But, for now, the public isn’t getting consistent leadership or messaging. Some GOP lawmakers, like Trump, continue to push for the opposite, calling into question the need for social distancing and masking even as the evidence supports both.

For Wisconsin, that’s not only helped make its coronavirus epidemic one of the current worst in the US but threatens to keep the outbreak going. Until state lawmakers and the public take action, there’s no reason to think Wisconsin’s coronavirus cases and deaths will subside. It’s yet another lesson in the need for continued vigilance against the coronavirus.

“The bottom line is that the vast majority of the population is susceptible to Covid-19,” Amanda Simanek, an epidemiologist, at the University of Wisconsin Milwaukee, told me.

In some ways, Wisconsin reflects the standard Covid-19 story

Part of what’s led Wisconsin down this path is the story that’s been repeated again and again in explaining different states’ Covid-19 outbreaks: The state reopened too early and quickly, while the public and its leaders didn’t take precautions like social distancing and masking seriously enough.

In Wisconsin, Evers tried to maintain a stay-at-home order. After the state Supreme Court struck it down, he’s tried to institute milder restrictions, such as limits on public gatherings and capacity at restaurants and bars. But courts have blocked those restrictions, too.

Republicans in the state have criticized and fought Evers every step of the way, either in the courts or in the legislature. Trump has played into this — telling supporters at a Wisconsin rally, “I wish you had a Republican governor, because, frankly, you’ve got to open your state up. You’ve got to open it up.”

With only local restrictions left in place, much of the state has reopened.

At the same time, the public has become increasingly fatigued with the pandemic and all the hindrances it’s produced in everyday life. The restrictions also may have seemed less necessary to Wisconsinites, as much of the state avoided the kind of large outbreak seen across the US throughout the summer. That mix of fatigue and complacency, experts said, likely led more people to start moving about and gathering together by Labor Day.

So people went out more, with a chance to infect one another during each interaction. The reopening of indoor bars and restaurants poses especially big concerns for experts: In these spaces, people are close together for long periods of time; they can’t wear masks as they eat or drink; the air can’t dilute the virus like it can outdoors; and alcohol can lead them to drop their guards further.

Wisconsin’s current surge appeared to first take off in colleges and universities, with the state’s college towns ranking among the worst Covid-19 outbreaks in the US in September as students returned to campus, partied, and hit up bars and restaurants.

By now, though, the outbreaks have spread much further — nearly statewide. This seemed to start around Labor Day, when friends and family gathered, partied, and spread the virus. Coupled with Wisconsin’s reopening as restrictions have been struck down or eliminated, cases have skyrocketed since then.

This, too, was similar to many of the summer outbreaks, as Memorial Day and reopenings led to new surges of Covid-19 in the South, West, and, over time, much of the rest of the US. Similarly, in the summer, a study from the Centers for Disease Control and Prevention found that increases in cases among younger populations eventually led to increases among older groups — as may have happened after universities and colleges reopened in Wisconsin.

The problem is these places never got Covid-19 cases down. Indeed, Wisconsin’s cases have never consistently declined — at least to levels that experts consider safe. By Labor Day, Wisconsin had more than double the confirmed coronavirus cases that it had at the start of June. That left a large population of infected people to spread the coronavirus to other people as they went out more. “The virus was already there,” Sethi said.

These problems stand to get worse in the fall and winter. The much colder temperatures in Wisconsin will push people indoors, where the virus has an easier time spreading. Friends and families will once again gather for the holidays, from Thanksgiving to Christmas to New Year’s Eve. Another flu season could strain hospitals further, hindering their ability to treat a surge of Covid-19 patients.

In that sense, Wisconsin’s story really is like much of the country’s: Premature reopenings have led to more cases and deaths, and they’ll potentially lead to even more cases and deaths as the fall and winter likely make things riskier.

“It’s not particularly surprising,” Simanek said. “But it’s not necessarily inevitable.”

Political polarization has uniquely hurt Wisconsin’s response

Political divides now drive different levels of social distancing and mask use between Democrats and Republicans across the country. What makes Wisconsin unique is how pronounced political polarization is in a state so evenly divided between Democrats and Republicans — the state doesn’t register voters by party, but the state legislature is held by Republicans while the governor is a Democrat, and Trump in 2016 won Wisconsin by just 0.7 percent of the vote.

This division has made partisan fights about Covid-19 especially fierce and consequential, particularly between Democratic leaders, including Evers, and Republican leaders in charge of the state’s Assembly and Senate. In general, Evers has tried to push for the policies that experts have called for in the face of Covid-19 — social distancing, masking, and so on — and Republican lawmakers have resisted.

Most recently, Evers declared a third state of emergency related to Covid-19 and extended his mask mandate. Republicans responded by threatening to repeal the mandate (but so far have shown few signs of actually doing it, with the state Assembly not reconvening so far).

On top of hindering the policy response, this has also led to mixed public health messages to the public. By and large, Republicans — particularly Trump — suggest that Covid-19 isn’t a real threat. Democrats, including Evers and presidential candidate Joe Biden, claim that the pandemic has to be taken seriously.

That’s led to partisan differences in who takes action against Covid-19. Anecdotally, people in more Republican parts of the state are less likely to wear masks. That’s backed by polling, which has found that Republicans are less likely to wear masks at all and, if they do wear masks, do so less frequently.

“There’s a lot of mixed attitudes with how to resolve this issue and even questioning whether the pandemic is a problem at all that needs to be addressed,” Sethi said. “So there’s a critical mass in the state — particularly in the northeast of the state, but really throughout the state — that just aren’t taking the precautions they should be taking.”

More broadly, experts worry the political fights have muddled guidance even for people who do want to take Covid-19 more seriously. When state leaders give contradictory advice, and that advice appears to differ based on political party, it may become easier for members of the public to tune out in the face of what seems like another partisan battle in a state that already has a lot of political differences and squabbling.

It’s also leading to less clear messaging as to what the public should do. How dangerous is Covid-19, really? Are social distancing and masks really effective? Are treatments already effective enough to not worry about the disease? Is a vaccine around the corner? These are all valid questions with real answers (all of which generally point to continued, sustained action against the coronavirus), but people have to break through political fights, talking points, and misinformation to get those answers.

The political back-and-forth, Sethi argued, “subconsciously gives people permission to believe what they want to believe.”

In normal times, this kind of response from lawmakers and the public might just block important legislation from passing. But today, it’s fueling a deadly pandemic right as it unfolds.

Wisconsin has to get serious on the crisis to turn things around

As grim as things are in Wisconsin today, the truth is that Covid-19 isn’t unstoppable. The solutions are the same things experts have now been repeating for months throughout the pandemic: More testing and contact tracing to isolate people who are infected, get their close contacts to quarantine, and deploy broader restrictions as necessary. More masking. More careful, phased reopenings. More social distancing.

But Wisconsin, its leaders, and its population have to take these measures seriously. And, crucially, they have to keep at it: Until there’s a vaccine or similarly effective treatment, the coronavirus will remain a constant threat. “There’s only so much you can do to contain this if there isn’t a coherent, uniform response,” Simanek said.

The risk now is that Wisconsin’s outbreak could get so bad that a lockdown may become necessary. That’s what’s happened in Israel and European nations, as they’ve seen Covid-19 epidemics spiral out of control.

Of course, no one wants a lockdown. That’s exactly why experts emphasize the need for less restrictive measures now: If the public and its leaders take social distancing, testing, tracing, and masking seriously and sustain such measures, coronavirus cases can come down without a harsh lockdown. At least, that’s what seemed to work in other developed countries, like South Korea.

As things remain, though, the situation in Wisconsin is pretty bad — with cases still rising and Republican lawmakers still resisting the governor’s actions. If that continues as the fall rolls on and winter arrives, the state’s bad coronavirus outbreak stands to get even worse.

“In the current state,” UW Madison epidemiologist Nasia Safdar told me, “there doesn’t seem to be an end in sight.”

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