Shutdowns Back as States Face COVID
'Breaking Point'

Ralph Ellis

November 16, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

UPDATED November 20, 2020 // This story was updated with more states and cities adding restrictions.

With the coronavirus setting new records every day, more restrictions such as statewide face mask mandates are being imposed — as governors who at first resisted the public health measures change their minds and others re-impose restrictions that had been lifted.

"This week, the COVID-19 pandemic in the United States accelerated again, driving record numbers of cases and hospitalizations as healthcare systems around the country warned that they are approaching a breaking point," the authors of a COVID Tracking Project blog wrote November 12.

Overall, the United States has more confirmed infections (11.06 million) and coronavirus-related deaths (over 246,000) than any other nation in the world and it took barely a week for the U.S. to go from 10 million cases to 11 million.

Here is a closer look at what cities, states and others are doing in response:

CALIFORNIA: The state public health officer on Thursday ordered a limited stay-at-home order for counties in the state's Tier One zone. It means "all gatherings with members of other households and all activities conducted outside the residence, lodging or temporary accommodations with members of the other households" must stop between 10 p.m. and 5 a.m.

The order takes effect Saturday and lasts until Dec. 21.

Tier One counties include major metropolitan areas in the San Francisco Bay area, as well as every county in Southern California, KTLA reported. The order is similar to one issued in March as the pandemic was first ramping up.

"This limited stay at home order will reduce opportunities for disease transmission with the goal of decreasing the number of hours individuals are in the community and mixing with individuals outside of their household," Public Health Officer Erica Pan, MD, said in a statement. "Every intervention to decrease mixing of households is critical during this unparalleled increase in case rate rise of about 50 percent during the first week in November.

Banned activities during the curfew are mostly "non-essential," she said, although essential businesses will be exempt from the order.

The order comes after Gov. Gavin Newsom on Monday reinstated restrictions as the number of cases doubled in the past 10 days, The New York Times reported.

Emergency health care facilities created early in the pandemic are preparing to reopen.

Newsom ordered the state's largest counties back into the most restrictive tier of COVID guidelines, which bars indoor dining and requires some businesses to close.

Newsom last week issued a travel advisory asking anyone arriving from other states or countries to self-quarantine for 14 days. He asked all residents to avoid nonessential travel.

HAWAII: The state announced Thursday that beginning Nov. 24, anyone wanted to bypass Hawaii's mandatory 14-day quarantine must have a valid COVID-19 test result before departing for the islands.

What's more, Hawaii will only accept test results from "a trusted travel partner," Gov. David Ige said.

"We're taking this added safety precaution now in response to the dramatic increase in COVID-19 cases on the mainland and around the world. The health of our residents and visitors is our primary concern, particularly with more people traveling to Hawai‘i over the holidays," said Gov. Ige.

The test results must be available before boarding any flight bound for Hawaii. IF not, the visitor will be required to quarantine in Hawaii for 14 days or for the length of their visit, whichever is shorter.

More than 7,217 people have been required to quarantine upon arrival since Oct. 19, Lt. Gov. Josh Green said.

NEW YORK CITY: After eight weeks of in-person instruction, New York City schools will close on Thursday, The New York Times reported.

In an email to principals, schools chancellor Richard Carranza said the pandemic in the city has returned to dangerous levels. “As of this morning, November 18, the City has now reached this threshold of test positivity citywide and, as a result, the DOE will temporarily close down all public school buildings for in-person learning, Thursday, November 19,” he wrote 

The decision to close schools comes while New York sitll allows indoor dining and gyms to operate at reduced capacity. Public transportation remains open as well. 

IOWA: Gov. Kim Reynolds on Monday signed a new order requiring everyone age 2 and older to wear face masks when indoors in a public place while within 6 feet of someone from a different household for more than 15 minutes.

Her order took effect Nov. 17 and lasts until Dec. 10.

Reynolds also barred indoor social gatherings of more than 15 people, including wedding and funerals, as well as outdoor gatherings of more than 30 people. The order also bans youth sports (but not high school athletics).

Reynolds, who had resisted a statewide face mask mandate, changed course. As the test positivity rate went over 50% and more than 1,000 people were hospitalized with COVID

“I'm here to tell Iowans I need your help,” she said. “If you want to keep our businesses open and you want to keep our kids in school, if you want to make sure that we have hospitals and long-term care facilities and we have clinics that can treat not only COVID, but other individuals that have serious health conditions, then we all have to buckle down and take this serious.”


NAVAJO NATION: The native American nation on Friday launched a new 3-week lockdown that began Monday and includes a stay-at-home order for all, the closure of executive branch offices, with the exception of essential employees, and temporary closure of schools.

The Navajo Nation, which spans parts of New Mexico, Arizona and Utah, saw 900 new cases in the past week, Navajo Nation President Jonathan Nez said in a statement. Residents may  only leave their homes for emergencies or “essential activities” like buying groceries, picking up medications, and gathering fire wood with appropriate permits.

PHILADELPHIA: The City of Philadelphia has imposed new restrictions on businesses and socializing, starting Friday.

Under the “Safer at Home” rules, indoor dining and all indoor gatherings with people from multiple households are prohibited. That includes weddings, funerals, showers, and household visits.

“We have to take action now,” Philadelphia Health Commissioner Thomas Farley MD said during a news conference Monday. “To keep this virus from jumping from one household to another, and people mixing without masks from different households is exactly how the virus does that.”

Outdoor dining is allowed, but only for up to four members of a household.

“We can’t enforce this but we are asking residents and restaurants: please, people eating outdoors without masks should be there with their household members only,” Farley said.

Youth and community sports are not allowed and gyms, museums, and libraries must close. Retail stores, barbershops and hair salons, hotels, and religious facilities can remain open but with capacity limits.

The city has reported more than 55,000 coronavirus cases and more than 1,900 virus-related deaths. Farley said the city averaged more than 700 cases a day last week with a testing positivity rate around 13%.






NEW MEXICO: Gov. Michelle Lujan Grisham ordered residents to stay at home except in limited situations and ordered close all non-essential businesses. The order allows grocery stores, pharmacies, big box retailers, hardware stores and other “necessary” operations to remain open.

The restrictions, which took effect Monday, last for at least 2 weeks. They include a ban on in-person dining and a requirement that churches limit attendance to no more than 25% of capacity. Outdoor facilities like pools, golf courses and zoos must also close.

MICHIGAN: Gov. Gretchen Whitmer on Sunday ordered high schools and colleges to stop in-person classes, closed restaurants to indoor dining and stopped organized sports. While less intensive than the restrictions Whitmer ordered in the spring, the new ones – which begin Wednesday and will last 3 weeks – are extensive, CBS reported.

The state health department has ordered issue rules that ban indoor residential gatherings of more than two households, restricts outdoor gatherings to 25 people and closes theaters, bowling alleys and indoor water parks. Gyms and pools can stay open for individual exercise but not group classes.

NORTH DAKOTA: As North Dakota hospitals strain under the load of more coronavirus patients, Gov. Doug Burgum reversed himself Friday and imposed a statewide face mask order along with other restrictions.

“Our situation has changed, and we must change with it,” Burgum said in a news release. “Tonight, we’re announcing four measures designed to reduce the spread of infections in our communities to protect our most vulnerable and to ensure hospital capacity.”

OHIO: Ohio Gov. Mike DeWine described a dire situation in which 3,000 people in the state were hospitalized with the coronavirus, and more than 700 in intensive care units. He said 104 people died of virus-related reasons in the first week of November alone.

“If we don’t change this, Ohio won’t be able to provide appropriate care for COVID patients or for Ohioans who require other emergency care for things like accidents, strokes, and heart attacks,” he said in a news release. “Hospitals will again be forced to postpone important, but less urgent, care.”

DeWine extended the statewide face mask mandate with new requirements, such as making each business responsible for ensuring that customers and employees wear masks.

He also put new limits on social gatherings that effectively prohibit dancing at wedding receptions and birthday parties. The state now requires “open congregate areas” to be closed, and people must stay seated unless they’re eating or drinking.

UTAH: In Utah, Gov. Gary Herbert declared a 2-week state of emergency this week and issued a statewide mandate requiring people to wear masks in public. He said the move was necessary to keep from overloading hospitals.

“Lives are at risk as COVID-19 cases surge and we report record hospitalizations and new deaths day after day,” he said. “Our hospitals are full.”

NEW YORK (state):

As of this past Friday, all restaurants, bars, gyms, and fitness centers must close at 10 p.m., though food delivery and pickup can continue after 10 p.m. Indoor and outdoor gatherings must be limited to no more than 10 people.

Gov. Andrew Cuomo said that if these new limits don't work, he may have to shut down businesses again.


COVID Tracking Project blog: “A Nationwide Case Surge Hits US Hospitals: This Week in COVID-19 Data, Nov 12.”

COVID Tracking Project: “Cumulative Cases.”

The Associated Press: "Iowa Gov. Kim Reynolds won't budge on masks, even as virus deaths rise."

Office of the Governor of Iowa, Kim Reynolds: "Gov. Reynolds signs new proclamation continuing State Public Health Emergency Declaration." "Governor DeWine Calls on Ohioans to Recommit to Safety Practices, Announces New Mask, Social Distancing Orders." “Gov. Gary Herbert declares a state of emergency for hospital overcrowding, cases surge.”

Detroit Public Schools Community District: “DPSCD Temporarily Suspends All Face-To-Face School Instruction.”

The Philadelphia Inquirer: "Citing surge in COVID-19, Philly schools reverse reopening plan; will continue virtual instruction until further notice."

Boston Public Schools: “Boston Public Schools Shifts to All Remote Learning Due to Rising COVID-19 Cases Citywide.”

The New York Times: “N.Y.C. Schools May Close Again, a Grim Sign of a Global Dilemma,” “California Issues Tough Restrictions and Iowa Mandates Masks as States Try to Tame Virus.”

Travel advisory, California Department of Public Health.

CBS News: “Michigan orders restaurants to end indoor dining; high schools and colleges to pause in-person classes.”

The Navajo Nation, Office of the President and Vice President: “Navajo Nation to implement more public health measures on Monday as health experts recommend online learning and advise against reopening casinos.”

KOB4: “New Mexico begins lockdown as state looks to curb spread”