INDIANAPOLIS — There’s no other way to slice it — November was the worst month Indiana has seen so far in the COVID-19 pandemic.

After rising steadily throughout October, Indiana hit record highs repeatedly in almost every metric in November.

Cases, positivity rate, hospitalizations, deaths — record high, record high, record high, record-high.

With more serious cases and more deaths than even in the earliest days of the pandemic, November brought with it the worst COVID-19 numbers Indiana has seen since the pandemic started in March.

Like October before it, November more than doubled most of the state’s COVID-19 numbers and, also like October, the state hasn’t shown any convincing signs that the increases are stopping or starting to turn around.

It spurred Indiana Gov. Eric Holcomb to step back from the state’s Stage 5 reopening and led him to reintroduce some new restrictions based on a county’s color-coded rating. Local health officers also took initiative to introduce some restrictions, too, after numerous counties in northeast Indiana hit red ratings, the worst rating from the state representing very high spread.

There’s nowhere else to start when looking at November than with the cost in lives — 1,360 deaths, the most in a single month since the pandemic started.

That surpassed death totals in the initial surge of COVID-19, when the state lost 958 Hoosiers in April and 960 in May.

It also represented the second month in a row that deaths doubled. Indiana suffered about 11 deaths per day in September, doubling to 22 per day average in October and doubling again to 45 per day in November.

And that doubling has occurred despite health outcomes improving for patients compared to the earliest days of the pandemic, when doctors and nurses were still figuring out on the fly the best ways to treat patients.

At its highest point in late April, the state peaked at about 42 deaths per day on a seven-day average but dropped from there and had stayed below that rate for months.

Then came November, when the state surpassed that seven-day average by Nov. 11 and then continued to rise past it, hitting a peak as high as 56 deaths per day average, a number that may still be increasing as more deaths are verified and logged to fill out the remainder of the month.

The four-county area hasn’t been immune to that impact, either, as the region has recorded dozens of deaths in November.

Noble, DeKalb, LaGrange and Steuben counties combined for 55 deaths in the month of November, representing a near doubling of the region’s total from before that point.

DeKalb County had 22 deaths recorded in November, followed by LaGrange County with 16, Noble County with 10 and Steuben County with seven.

The record-high number of deaths can be traced backward to a record-high number of patients in hospitals, another metric where Indiana shattered its ceiling in November.

At the start of the month, 1,759 patients were hospitalized across the state, just shy of the all-time record of 1,799 set back on April 13.

It took just one day in November to break that record as cases surged over 1,800 by Nov. 2 and kept climbing throughout the month, rising past 2,000 on Nov. 5; past 2,500 by Nov. 10; across 3,000 on Nov. 17; and to 3,401 as of Sunday.

Out of the 30 days in November, the total hospital census went down only four of those days. New daily hospitalizations have been over 300 almost every day since Nov. 6.

Throughout the month, state and local leaders have been ringing alarm bells about the strain being put on hospitals and health care systems as some hospitals throughout the state have hit their capacity and had to start diverting patients to other nearby facilities.

Indiana hospitals have worked to maintain capacity and keep intensive care unit beds open primarily by reducing the number of non-COVID patients in their facilities, which has meant canceling non-emergency surgeries and procedures in order to keep beds available.

Hospitals have filled up in part because the virus has once again blasted its way into nursing homes, where it has run roughshod over the older and more vulnerable residents in those facilities.

Nursing homes were already seeing stark increases in patient cases throughout October, but those surged to record highs as November carried on.

At its worst point in early May, nursing homes were reporting 155 cases per day, but broke that record to a seven-day average of 174 per day at its peak in mid-November.

One bit of good news, however, is that despite higher case counts in nursing homes compared to spring, deaths among nursing home residents have been lower than their springtime highs.

After averaging as high as 30 or more deaths among nursing home residents in spring, even despite the ongoing November surge in cases, nursing homes never topped more than 22 deaths per day last month.

That, however, also reinforces the number of deaths that are occurring across the state from patients outside long-term care facilities, showing that more people in the general population are getting seriously ill and dying of COVID-19 compared to spring when the majority of deaths were coming from nursing homes.

The four-county area has seen several large outbreaks at nursing homes that have attributed several of the region’s deaths throughout November.

Once again, the worsening outbreaks in nursing homes can be traced back to wider community spread of the virus, with Indiana hitting record high case counts that blew away anything previous.

Case counts had been rising all throughout October and had risen as high as 3,600 positive Hoosiers in one day.

It didn’t take long though for Indiana to continue on an exponential curve up, with the state breaking all-time case counts highs just about every week in November.

Indiana passed 4,000 cases in one day on Nov. 5; passed 5,000 in a single day on Nov. 11; topped 6,000 the next day on Nov. 12 when cases surged over 6,500; then set an all-time high at more than 8,300 cases on Nov. 14.

The good news is case counts have fallen off a bit since that one-day peak at the midpoint of the month, but they haven’t fallen off too dramatically as the state has averaged about 5,900 per day since Nov. 14.

Again, November represented more than a doubling of the state’s case counts. After averaging 861 cases per day across the entire month of September, Indiana more than doubled to 1,914 cases per day average in October and then more than doubled again to 5,321 per day average across all of November.

That represented an increase of 178% from October’s monthly average.

Although testing numbers have increased — from about 27,200 tests per day in October to about 45,000 per day in November — that percentage increase of 65% is smaller in proportion to the rise in cases.

Because of it, the state’s average positivity rate rose from about 7% across October to close to 12% average for November, indicating a much wider spread of the virus.

Again, the four-county area was not immune from the trend, with overall case counts more than doubling their totals from the previous eight months combined.

DeKalb County went from 892 to 1,934 cases overall, a 117% increase; Steuben County rose from 735 to 1,581, a 115% increase; Noble County shot up from 1,344 to 2,741 total, a 104% increase and LaGrange County increased from 874 to 1,522 cases, a 74% increase.

With those rapidly rising case counts and positivity rates over 15% — LaGrange County hit as bad as 30% on a seven-day average in November — LaGrange, Steuben and DeKalb counties were put into the state’s worst red rating in the second-to-last week of the month, while Noble held into the second-worst orange rating.

Multiple school districts in the region have either had to temporarily close or revert some grade levels or full buildings to temporary virtual-only learning due to the number of students or staff members out sick or on COVID-exposure quarantines, while events have again been canceled and some businesses have tightened up access and capacity either voluntarily or by order of the health department.

One positive takeaway from the month just ended is that numbers had started to modestly stabilize and even show the most minor of improvements into the last week of the month.

But with the Thanksgiving holiday occurring last week and concerns from health officials that family gatherings may lead to more widespread transmission of the virus, time will tell whether December will finally be the month where Indiana bends the curve and starts to see more positive progress, or whether the last month of the year is one more bend upward to new records yet to come.

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