On a typical day, Dr. Ben Daxon steps from 5 a.m. darkness into the unforgiving fluorescent glare of the Mayo Clinic intensive care unit. He doesn’t have to clock in until 6, but he likes to read up on his patients so he’s prepared with questions for the nursing staff. 

Some things are routine, like the hot coffee in his red canteen that braces him against the cold Minnesota air. At a glance, things appear almost ordinary. There are more cleaning products around, but Daxon’s ICU isn’t a dedicated COVID-19 unit. “The care we provide is business-as-usual,” Daxon said. Doctors assess patients as they normally would, providing consistent care and engaging families. 

But the environment is different. “There’s a nagging sense that we are in for a long, hard winter and it’s going to be exhausting. We have to shoulder a taxing workload and be flexible as units fill up and additional resources are marshaled to handle contingencies.” 

New cases and deaths from the coronavirus in the Midwest are climbing among record-setting days for the whole United States. Johns Hopkins University data show states like Idaho, Iowa, Kansas, South Dakota, and Wyoming have some of the highest rates of new infections in the country, with more than half of COVID-19 tests in South Dakota coming back positive for the virus. 

Nine out of 12 Midwest states have seen record high cases this month. Daxon said one night in early November, his ICU was one of only a few in the region with available beds. One physician told Daxon Mayo was the fourth hospital he had called to transfer a critical patient. The other three were at or over capacity. Senior critical care physicians at Mayo say this is perhaps the busiest they have seen the ICUs: They’re handling regular surgical and medical ICU volumes, plus overflow from COVID-19 patients taking up ICU beds. 

“Normally, ICUs wax and wane with patient volume. Now it’s a constant surge,” Daxon said.

Still, Daxon’s hospital, the Mayo Clinic in Rochester, Minn., isn’t overrun. And with more than a dozen intensive care units between the hospital system’s two campuses, he doesn’t expect it to be. But Joe Biden’s “dark winter” prediction from the final presidential debate rings truer every day, Daxon said. Already, with peak flu season still months away, Daxon and his Mayo colleagues are seeing an influx of COVID-19 patient transfers from other states—the Dakotas, Wisconsin, Illinois—some as far as eight hours away. Many of his patients—a young new mother, a newlywed in his early 20s, both without underlying health issues—are “falling off a cliff” as they battle the virus. “Young people are not immune” to developing serious complications, Daxon said. 

In April, Daxon traveled to New York City as a medical volunteer, one of many in the field offering relief to an overburdened system. Now, he said it’s his region’s turn to accept the extra help.

“There’s really no area of the country that hasn’t had a big surge. Everybody’s very sympathetic to us in this region, just like we were sympathetic to people down in Florida earlier in the year, or Texas,” Daxon said. 

In large part, the medical community saw this coming. Centers for Disease Control and Prevention Director Robert Redfield warned in April that this fall and winter may bring a “second wave” of coronavirus cases, compounded by the seasonal flu. Plus, U.S. officials have watched Europe’s cases escalating for weeks, leading several European countries to announce full or partial shutdowns. 

“There’s that sense of angst that as the winter bears down on us, and people congregate more indoors, the risk of exposure goes up,” Daxon said. “People are afraid this is going to get worse before it gets better.”

Another factor: Society’s general “COVID fatigue,” as Daxon put it, is working against the healthcare system. Even those who took the virus seriously from the start are growing weary of precautions.