Schools should have tested students before they returned and planned “intermittent surveillance” to watch for rising cases, as well as creating a way to isolate students when they “inevitably” get infected, he said.

On Tuesday, Ohio reported 1,453 cases—the most in more than a month—and the state isn’t seeing signs of the virus relenting. Despite mask mandates, a rule closing bars at 10 p.m., and myriad other health orders, the state’s 21-day average of new cases sits around 1,000.

Per-capita, nine of the top-10 counties for increasing cases are rural, DeWine said. A car-pool trip to a lake led to two businesses closing from an outbreak. A card-game resulted in all family members present contracting the virus, he said.

Social gatherings like this are creating “a real movement into our rural areas,” DeWine said.

Illinois Recurrence
Illinois, too, has seen a resurgence of the virus over the last two months, reversing the progress that had lowered counts in May and June. On Aug. 22, statewide daily cases hit the highest since May, and on Tuesday the death count reached the most since June 26.

“We do not want to be part, here in Chicago, of this surge that we’re seeing broadly across the Midwest,” Allison Arwady, commissioner of the Chicago Department of Public Health, said Tuesday.

She noted Iowa, which ranks first in per capita cases, is among the states on the city’s quarantine list and Indiana may be added next week given clusters developing in college towns.

“It is not the time to relax your guard,” she said.

But that seems to be happening in Chicago and across Illinois with more cases developing when people at weddings, reunions and other gatherings are not wearing masks, watching their distance or washing hands.

Testing, Tracing
Outbreaks are going to continue to crop up because many states still don’t have the ability to do widespread testing, tracing and isolating, Johns Hopkins’s Adalja said.