SIOUX FALLS, S.D. — A surge of coronavirus cases in Wisconsin and the Dakotas is forcing a scramble for hospital beds and raising political tensions, as the Upper Midwest and Plains emerge as one of the nation’s most troubling hot spots.

The three states now lead all others in new cases per capita, after months in which many politicians and residents rejected mask requirements while downplaying the risks of the disease that has now killed over 210,000 Americans.

“It’s an emotional roller coaster,” said Melissa Resch, a nurse at Wisconsin’s Aspirus Wausau Hospital, which is working to add beds and reassign staff to keep up with a rising caseload of virus patients, many gravely ill.

“Just yesterday I had a patient say, ’It’s OK, you guys took good care of me, but it’s OK to let me go,’” Resch said. “I’ve cried with the respiratory unit, I’ve cried with managers. I cry at home. I’ve seen nurses crying openly in the hallway.”

The efforts to combat the quickening spread of the virus in the Midwest and Plains states are starting to recall the scenes that played out in other parts of the country over the past several months.

In the spring, New York City rushed to erect field hospitals as emergency rooms were flooded with desperately ill patients. Then, as Northeastern states got a handle on the outbreak, it spread to Sun Belt states like Arizona, Texas and California over the summer. It then moved into the Midwest.

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Task force’s Dr. Birx warns about ‘very different’ coronavirus spread in Northeast

HARTFORD, Conn. — Dr. Deborah Birx of the White House coronavirus task force said Thursday she’s concerned about the uptick in COVID-19 cases in the Northeast, noting how more people are becoming infected because of indoor family gatherings and social events.

Birx acknowledged the rest of the country learned from the experiences of Connecticut and other northeastern states during the early days of the pandemic. The kind of spread that is happening now, she said, is “very different” from the spread of the coronavirus during March and April.

“The spread of the virus now is not occurring so much in the workplace as people have taken precautions. It’s happening in homes and social occasions and people gathering and taking their mask off and letting down their guard and not physically distancing,” said Birx, noting that was a lesson learned in the South during the hot summer months, when people went indoors for air conditioning.

She repeatedly stressed the need to wear face masks and social distance, as well as more testing for people who have the virus but aren’t showing symptoms and can unknowingly spread it.

Birx met Thursday with Democratic Gov. Ned Lamont, his public health staff, and faculty members, students and staffers from the University of Connecticut at the downtown Hartford campus to discuss the university’s efforts to combat the spread of COVID-19. She credited the university with having one of the highest percentages of students taking in-person classes in the U.S.

Her visit came the same day the Connecticut Department of Public Health issued a COVID-19 alert for New London, urging residents to stay home if they don’t feel well, avoid indoor gatherings with people they don’t live with, limit trips outside the home and wear masks anytime they leave the home.

Between Sept. 20 and Oct. 3, New London recorded at least 115 new cases, which increased the daily case rate to 30.5 per 1000,000. It’s one of the highest rates in the state.

The department issued a similar alert last week for nearby Norwich. Both communities are in a part of Connecticut that did not see large numbers of infections during the height of the pandemic.

Birx said indoor activities with the heat on are “particularly conducive to spreading events without your mask.” She suggested people increase ventilation with outside air, including cracking a window.

UNC delays spring semester and cancels spring break

RALEIGH, N.C. — The University of North Carolina at Chapel Hill will delay the start of the spring semester by nearly two weeks, school officials announced Thursday.

In a message to the campus community, Chancellor Kevin Guskiewicz and Provost Robert Blouin said the college will eliminate its traditional spring break so it can “limit any potential spread of the virus caused by travel during an extended break.”

UNC will instead offer five days of breaks during the semester either individually or in combined clusters.

“The schools and deans will make clear that these wellness days are intended as breaks from the semester – not for studying – so faculty will be instructed to avoid scheduling exams, quizzes and other major assignments on days following these breaks. The dates for the wellness days will be updated on the Registrar’s website soon,” Guskiewicz and Blouin wrote.

Classes will start on Jan. 19 and end on May 5. Commencement is scheduled for May 16.

In-person undergraduate classes were halted in August a week into the semester after a series of COVID-19 outbreaks struck campus.

Doctors and nurses frustrated by battles with virus skeptics

MISSION, Kan. — Treating the sick and dying isn’t even the toughest part for nurse Amelia Montgomery as the coronavirus surges in her corner of red America.

It’s dealing with patients and relatives who don’t believe the virus is real, refuse to wear masks and demand treatments like hydroxychloroquine, which President Donald Trump has championed even though experts say it is not effective against the scourge that has killed over 210,000 in the U.S.

Montgomery finds herself, like so many other doctors and nurses, in a world where the politics of the crisis are complicating treatment efforts, with some people even resisting getting tested.

It’s unclear how Trump’s bout with the virus will affect the situation, but some doctors aren’t optimistic. After a few days of treatment at a military hospital, the president tweeted Monday, “Don’t be afraid of Covid. Don’t let it dominate your life. … I feel better than I did 20 years ago!”

After one tough shift on the coronavirus unit at Cox South Hospital in Springfield, Montgomery went onto Facebook to vent her frustrations about caring for patients who didn’t socially distance because they didn’t believe the virus was real. The hospital later shared her post on its website.

She complained that some people demand the anti-malaria drug hydroxychloroquine and think the only patients who get really sick have underlying health problems.

“The majority of people don’t understand and can’t picture what we are seeing. That has been frustrating for all of us,” Montgomery said in an interview, adding: “It wears.”

Combating virus skeptics is a battle across the country.

In Georgia, at Augusta University Medical Center, visitors have tried to get around the mask requirement by wearing face coverings made of fishnet and other material with visible holes, something the hospital has dubbed “malicious compliance.” People also have shown up with video cameras in an attempt to collect proof the virus is a hoax, said Dr. Phillip Coule, the health system’s chief medical officer, who contracted the virus in July and has seen two staff members die.

“Just imagine that while you are caring for your own staff that are dying from this disease, and while you are trying to keep yourself safe, and you are trying to keep your family safe, and you are trying to deal with a disease that such little is known about, and then to have somebody tell you that it is all a hoax after you have been dealing with that all day,” he said. “Imagine the emotional distress that that causes.”

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Some parts of England – but not others – brace for lockdown

LONDON — The British government is mulling fresh restrictions on everyday life in England, potentially in the big northern cities such as Liverpool, Manchester and Newcastle, amid mounting fears that hospitals in coronavirus hot spots may soon be overwhelmed.

With the number of people needing to go to the hospital with virus-related conditions rising, and in some areas in the north of England alarmingly so, the pressure on the Prime Minister Boris Johnson’s Conservative government to do more is mounting.

“We are currently considering what steps we should take, obviously taking the advice of our scientific and medical advisers, and a decision will be made shortly,” British Housing Secretary Robert Jenrick told the BBC on Thursday. “In some parts of the country, the number of cases are rising very fast and we are taking that very seriously.”

Britain already has Europe’s deadliest outbreak, with over 42,600 dead. The latest daily figures published Thursday showed 17,540 new cases across the U.K., more than double the level of the previous week. The number of people being hospitalized increased by 609 while the death toll rose by 77.

Behind the national numbers lurk huge regional variations, which has led to calls for more concerted local actions.

“We are seeing a definite and sustained increase in cases and admissions to hospital,” said Dr. Yvonne Doyle, medical director for Public Health England. “The trend is clear, and it is very concerning.”

Because the virus has been accelerating at differing speeds around England, the government has opted for tighter local restrictions to combat the spread. But the differing rules have stoked confusion and there is growing speculation the government will back a new simplified three-tier system for England soon.

Hot spots, notably in the big cities of northern England, such as Leeds, Liverpool, Manchester and Newcastle, could see restrictions tightened to those taking effect Friday in Scotland, where pubs in the two biggest cities, Glasgow and Edinburgh, have been ordered to close for 16 days.

In many areas of northern England, it’s not clear the local restrictions have worked — in some areas, the number of new infections is 10 times higher than when the localized virus restrictions were announced.

More Titans test positive, raising case total to 23

NASHVILLE, Tenn. — The Tennessee Titans have had another positive test result to raise their outbreak to 23 cases, a person familiar with the situation told The Associated Press on Thursday.

Also, an inconclusive positive result from Wednesday now is positive. The Titans’ facility remains closed and the team remains prohibited from any in-person activities, putting Sunday’s game with Buffalo (4-0) at risk of at least being postponed.

Now 21 have been returned since Sept. 29 with at least one positive test on eight of the past 10 days with the latest results, according to the person who spoke to the AP on condition of anonymity because neither the NFL nor the Titans announced the latest results.

The NFL already postponed, then rescheduled the Titans’ game with Pittsburgh from Oct. 4 to Oct. 25.

The Patriots are missing a second straight day of practice Thursday after reigning NFL Defensive Player of the year Stephon Gilmore joined quarterback Cam Newton on the reserve/COVID-19 list Wednesday. New England also has a defensive tackle from the practice squad on the list in the league’s other mini-outbreak.

The franchise has continued daily testing since the NFL told the Titans to close their facility on Sept. 29. The league sent all 32 teams a memo Thursday with a list of new protocols for clubs to follow when dealing with an outbreak or having been exposed to an outbreak during the coronavirus pandemic.

British study: 86% infected showed no symptoms

LONDON — A British study has found 86% of people infected with the coronavirus didn’t show the main symptoms on the day they were tested.

Researchers at University College London looked at data from a survey that has been testing thousands of U.K. households every week, regardless of whether the subjects had symptoms.

The study, released Thursday, looked at data for 36,061 people between April and June. Researchers found among those who tested positive, 86% didn’t have a cough, fever or loss of taste or smell.

Lead researcher Irene Petersen says while people may have had symptoms in the days before their test or developed them later, the study suggests many may be spreading the virus while asymptomatic. She says frequent and widespread testing of all individuals is needed to curb “silent transmission.”

Wyoming reports highest number of hospitalized since April

CHEYENNE, Wyo. — Wyoming has reported a new high for the number of people hospitalized for COVID-19 amid a fall surge in coronavirus infections.

Forty-seven people were hospitalized Wednesday. That is up from 24 a week ago, which at the time was the most since daily hospitalizations peaked at 23 in April.

The 47 patients are at 14 hospitals around the state. Wyoming health officials say they are not worried about COVID-19 patients overwhelming any specific hospital. But they do worry about the small intensive-care capacity of most Wyoming hospitals.

Wyoming Medical Center in Casper has the most COVID-19 patients at 12, followed by Sheridan Memorial Hospital with five.

Spanish court says current lockdown violates ‘fundamental rights and freedoms’

MADRID — A court in Madrid has struck down a national government order that imposed a partial lockdown in the Spanish capital and surrounding suburbs.

It sided with regional officials who had resisted stricter measures against one of Europe’s most concerning virus clusters. The judges say travel restrictions in and out of the cities and other limitations might be necessary to fight the spread of the virus but under the current legal form, they were violating “fundamental rights and freedoms.”

The decision means police can’t fine people for leaving their municipalities or businesses that want to close later than 10 p.m. for shops and 11 p.m. for restaurants and bars. It also leaves 4.8 million residents in Madrid and nine suburban towns wondering whether they can travel to other parts of Spain over a long weekend extended by Monday’s national day celebration.

The situation in Madrid has been at the center of a standoff between regional and national authorities of competing political camps that has irked many who see more partisan strategy than real action against the pandemic.

The Madrid region has a 14-day infection rate of 591 coronavirus cases per 100,000 residents, more than twice the national average (257) and five times the European average rate of 113 for the week ending on Sept. 27.

EU to buy remdesivir

BRUSSELS — The European Commission says it has sealed a deal with pharmaceutical company Gilead to buy 500,000 treatment courses of remdesivir.

No treatment has yet proved able to prevent serious illness after a coronavirus infection but the antiviral drug also known by its commercial name Veklury has helped some COVID-19 patients recover faster.

Remdesivir was approved as a treatment for the coronavirus by the Commission in July.

The European Union’s executive arm said the joint procurement contract has been signed by 36 participants including all 27 EU countries and the UK. The agreement will allow countries to purchase the drug for immediate use and stockpiling needs, Gilead said.

“Today we secure access to Remdesivir for the treatment of up to 500,000 patients in need,” said Stella Kyriakides, the Commissioner for Health and Food Safety.

Virus numbers jump in eastern Europe

BRATISLAVA, Slovakia — Coronavirus infections in Slovakia are on a steep rise, surpassing 1,000 cases in one day for the first time.

The Health Ministry says the day-to-day increase of people infected reached 1,037 on Wednesday, up from the previous record of 877 on Tuesday.

Prime Minister Igor Matovic calls the development “a serious moment for Slovakia.” His government imposed strict restrictive measures last week but they have not managed to contain the surge yet.

Slovakia has had a total of 15,726 cases of COVID-19, including 57 deaths, according to Health Ministry figures published on Thursday, still low numbers compared with other European countries.

Neighboring Czech Republic also registered a new record for the second straight day Wednesday with 5,335 new confirmed cases.

ZAGREB, Croatia — Croatia has reported a new record in daily infections with the new coronavirus.

Authorities said Thursday that 542 new cases were confirmed in the past 24 hours, the highest number since the start of the outbreak. One person has died.

Croatia has reported a surge in new infections since the end of the summer tourism season, in which hundreds of thousands of visitors flocked to the country’s Adriatic Sea coast.

So far, there have been 18,989 confirmed cases of the new coronavirus including 310 deaths in the country of 4.2 million people.

Croatia’s official HRT television says authorities are preparing a recreation area in the capital, Zagreb, to host people with COVID-19 who have nowhere to self-isolate.

BERLIN — Germany has recorded a sharp jump in new coronavirus cases in a sign that the pandemic is picking up pace in the country again.

Germany’s disease control agency, the Robert Koch Institute, reported 4,058 additional confirmed infections and 16 deaths over the past 24 hours Thursday. This takes the total number of confirmed cases since the start of the pandemic to 310,144, with 9,578 deaths.

Authorities urged people not to travel to and from regions with over 50 new cases per 100,000 inhabitants in the past week. These regions include the cities of Bremen, Remscheid, Hagen, Hamm and parts of Berlin.

PRAGUE — Coronavirus infections in the Czech Republic have hit a record high for the second straight day, surpassing 5,000 cases in a day for the first time.

Health Ministry figures showed new confirmed day-to-day increase was 5,335 on Wednesday, almost 900 more than the previous day’s record.

The Czech Republic currently has more people testing positive daily than neighboring countries, including Germany with a population eight times higher.

The government is planning to announce a new measures to contain the surge on Friday.

The Czech Republic has reported 95,360 virus cases since the pandemic began, with 829 deaths. Currently, 43,764 are ill with the virus, with 1,563 hospitalized.

India’s case numbers rise to 6.8 million

NEW DELHI — India has registered 78,524 new coronavirus cases in the past 24 hours, driving the country’s total since the pandemic began to 6.8 million.

The Health Ministry on Thursday also reported 971 deaths in the past 24 hours, taking the death toll to 1,05,526.

India has witnessed a steady drop of confirmed coronavirus cases for three consecutive weeks now — from recording more than 86,000 daily cases in the last two weeks of September to an average of more than 70,000 cases daily so far this month. The numbers have also fallen sharply from earlier in September when daily cases averaged around 93,000 in India.

More than 1.1 million samples have been tested daily on an average so far in October, according to the Health Ministry.

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