Coronavirus cases and deaths are surging across the US. Officials and doctors in states with high case counts say they’re facing vitriol.

If North Dakota were a country, it would have the most coronavirus cases per capita in the world.
Nearly 9 out of every 100 people in the state have been infected.
Sherry Adams helps lead the state’s coronavirus testing response, a role she’s held since the pandemic started.
“We did our very first scenario for drive-thru testing on April 4, back in the good old days,” she told Business Insider. “We tested in the cold North Dakota wind, with three pieces of paper to keep track.”
Now the state’s electronic system handles around 300 to 400 tests per hour. Those who test positive are told to isolate for two weeks, an instruction many don’t like to hear.
“You get all sorts of threats — get yelled at, screamed at because we’re the evil people who put them in isolation and quarantine,” Adams said. “A lot don’t listen.”
Business Insider spoke with 12 people on the front lines of the coronavirus crisis in the Midwest: doctors, nurses, experts, and public-health officials. Almost all of them said they’ve encountered vitriol from the people whose lives they’re trying to save. Many of them have treated patients who refuse to acknowledge that the coronavirus poses a threat in the first place.
Aaron Billin, an emergency physician and county health officer in Park County, Wyoming, said locals often try to tell him how to do his job.
“I’ve had one death threat,” Billin said. “That’s unusual for a rural state. I’m getting a ton of pushback. I’m sure my cell number is in every bathroom stall in the county — I get calls instructing me to do this and not do that.” 
Renae Moch, who leads the public-health response in Bismarck and Burleigh County, North Dakota, said local residents have called her “Nazi” and “tyrant.”
“Let me tell you, I’m the furthest thing from a tyrant,” she said. “They say I’m lying about the dangers of COVID. Why would I want to do that? Nothing could be further from the truth.”
A healthcare worker takes a break as people wait in line in vehicles for coronavirus testing in Houston, Texas.
Callaghan O’Hare/Reuters
This is all while emergency rooms and testing centers face unprecedented waves of people in need. Many doctors and nurses say their hospitals have either reached or are nearing capacity.
“Our poor healthcare workers, they’re at their wits’ end and feel like no one cares about them,” Moch said. “No one sees what it’s like behind the walls of the hospital.”
Hate mail and protests
The US is in the midst of its largest surge yet of coronavirus infections. Daily cases have reached record highs over the last few weeks, peaking at nearly 183,000 on Thursday. The average numbers of people behind hospitalized and have each risen about 45% in the last two weeks.
The Midwest has been particularly hard-hit. The share of coronavirus tests coming back positive has topped 40% in Idaho and Iowa, and 50% in South Dakota and Wyoming, according to Johns Hopkins University.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said the rate should ideally sit below 3%.
“It’s so out of control at this point,” Moch said. “Our hospitals are moving into their surge plans, looking into getting more staff in place. I know our healthcare workers are fatigued and tired.”
Moch has advocated for stricter mask requirements, more testing and contact tracing, and better education on the need for isolation and quarantines. But she said she’s hit strong resistance since North Dakota businesses started to reopen in May. People have protested outside her office, holding signs and booing, and written nasty messages to her on social media.
“There’s a crowd that hates me and sends hate mail,” she said.
In March, White House coronavirus response coordinator Deborah Birx said Bismarck had the worst COVID-19 protocols she’d seen anywhere in the US. Yet in city commission meetings, locals have continued to ardently condemn mask requirements.  
“I’ve personally, just in the last few weeks, experienced the loss of two close family friends due to consequences of COVID,” one resident said at an October meeting, then went on to explain that despite all that, her anti-mask stance hadn’t changed.
“I cannot… blindly follow the herd and put a piece of cloth over my face,” she said.
After that meeting, Moch said, she was flooded with texts from concerned witnesses: “I can’t believe you’re still working your job after that,” they said.
Three North Dakota state health officers have resigned since the pandemic started. They’re part of a national trend: An August investigation from Kaiser Health News and the Associated Press identified at least 49 US public-health officials across 23 states who’d resigned, retired, or been let go since April. 
“We don’t even have a state health officer right now, so North Dakota is relying on local public health, but none of our opinions are taken into consideration,” Moch said. “We’re not included in the planning or press conferences.”
North Dakota Gov. Doug Burgum didn’t issue a statewide mask mandate until November 13. 
‘It’s still hard to change their mind that it’s real’
Billin said he’s watched first-hand as people dismiss the threat of the coronavirus while everyone around them gets sick. 
“Adults go to work sick. Parents send kids to school sick,” he said. “They don’t want their kids to get tested because they don’t want them to test positive. Then they’d have to isolate, and the parents would get quarantined, and they don’t get to work.” 
Sometimes, even friends and family of hospitalized coronavirus patients downplay the gravity of the situation, Dr. Hilary Babcock added.
Babcock works in the incident command center at the BJC HealthCare hospital system in St Louis, Missouri. She helps organize staffing, bed flow, and the distribution of personal protective equipment.
“Even people who are coming to visit COVID patients in the hospital — like if their personal family member is not in the ICU on a ventilator — they’re like, ‘See? It’s not that bad,'” she said. “There’s a lot of like, unless it’s happening to you, it’s not real.”
Patients, too, either admit to not taking the virus seriously, or continue to ignore it.
“Sometimes it’s still hard to change their mind that it’s real, which kind of is baffling considering everything they’ve been through because of this virus,” Lacie Gooch, a nurse in the coronavirus ICU at the Nebraska Medical Center, said. “But most of the time it’s, ‘I can’t believe I didn’t think this was real. I didn’t think it would happen to me.'”  
A nurse checks in on a COVID-19 patient.
Michael S. Williamson/The Washington Post/Getty Images
Healthcare workers don’t blame individuals for this illogical thinking — they blame leaders and culture. 
“It’s just devastating that we’re in this point where folks have gotten mixed messages, and a lot of people are getting sick because of it,” Dr. Eli Perencevich, an infectious-disease specialist who cares for coronavirus patients at the Iowa City VA Medical Center, said. 
President Donald Trump has frequently contradicted the statements and advice of top public-health experts: He held numerous campaign rallies where masks weren’t required, erroneously blamed increased testing for the US’s high case count, and repeatedly suggested earlier this year that the virus will “disappear” soon.
Even after being hospitalized with the coronavirus himself in October, Trump continued to suggest it wasn’t a big deal.
“Don’t let it dominate you,” he said in a video. “Don’t be afraid. You’re going to beat it.”
But the chances that doctors can save lives diminish as hospitals begin to overflow.
“We have a six-bed ER, and had up to five COVID patients in the hospital at one time,” Billin said. “We’re taking care of sicker patients than we normally feel comfortable with.”
Battling with patients over masks
A nurse adjusts her mask.
Win McNamee/Getty Images)
Of all their recommendations, healthcare workers say they’ve had the hardest time enforcing mask requirements. Support for face coverings has become divided along party lines, with many conservatives viewing masks as an infringement on individual liberty. 
“It’s so embedded in people’s identity,” Perencevich said. “Like they’re wearing their sports team.” 
Babcock said some visitors to hospitals in rural Missouri refuse to wear masks, ignoring requirements put in place to keep the patients and staff safe. 
“Some places have said, ‘You know, if we’re going to have these discussions and arguments all day long, we just can’t have visitors at all,'” she said. “And that’s really disappointing and obviously really hard for all the patients.”
Perencevich said even his high-risk patients with serious underlying health issues like
heart disease and emphysema are opposed to masks.
“You say, ‘You know, when you leave the hospital, the coronavirus outbreak’s really bad, can you please wear a mask?'” Perencevich said. “A lot of the patients, particularly males, said, ‘No, I’m not going to do that. That’s against my freedom.’ And it’s just like, so — you will die.”
Yet counterintuitively, he added, patients still listen to his other recommendations.
“You believe me that your blood pressure medicine works, but you won’t believe me that a mask works?” Perencevich said. “It’s quite bizarre.”
Stalling until there’s a vaccine
Nurse Spencer Cushing, 29, with an indentation on his face from wearing a mask.
Jae C. Hong/AP Photo
Many US residents suffer from pandemic fatigue: After nine months of restrictions, they’re willing to take more risks in exchange for a sense of normalcy and human connection. But doctors say there’s never been a more important time to exercise caution and listen to health guidelines.
“With the advent of the holidays, and the increased indoor time, it means that we are going to be getting potentially older people sicker — people that had managed to avoid infection up until now,” Megan Ranney, an emergency-medicine physician at Brown University, said, adding, “our entire healthcare system is going to be stretched at the same time.”
Recent positive findings about coronavirus vaccine candidates should be an indicator that hope is on the horizon — we just have to wait a little longer. This month, Pfizer’s vaccine was found to be 95% effective in preventing COVID-19, while Moderna’s was 94.5% effective. If those get approved in the coming weeks, some Americans could start receiving shots in December.
But in the meantime, the US is expected to see an unparalleled rise in fatalities. A model from the University of Washington’s Institute for Health Metrics and Evaluation predicts another 70,000 people will die of COVID-19 before the end of this year.
“It’s going to get far worse,” Perencevich said. “Maybe when the morgue trucks start parking outside, maybe people will be moved.” 
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