“Human behavior is very different indoors versus outdoors when it gets cold, so I’m worried that’s going to make things worse, ” said Perencevich, who has treated coronavirus patients. “And then we know Thanksgiving, where we’re all just bracing, given that the hospitals are completely full. ”

Unlike in the spring, when the Northeast faced the worst, and the summer, when the Sun Belt saw explosive growth, this latest surge has begun to move beyond a single region. In fact, it is elbowing back into places like New York City that had brought earlier outbreaks under control and tearing through cities that had not seen many cases all along.

“People just wanted some normalcy and got loose, and here you are, ” said Cyndi Kirkhart, who runs a food bank in Huntington, West Virginia, an area that is averaging a record 250 cases daily, more than triple the number from a month ago. “With the pandemic fatigue and all the politics stuff getting close to Election Day, there were so many things that contributed. ”

The small city of Cumberland, in Maryland’s Appalachian panhandle, also avoided the worst of the pandemic’s first months.

By midsummer, Emmanuel Episcopal Church, a Gothic Revival landmark overlooking the city’s downtown, was inviting people back inside for services, though with disinfectant and temperature checks. The church rector and a part-time priest and their spouses dined together regularly but took precautions, usually staying outdoors.







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