For the first nine months of the year, Kevin Kopplin saw exactly one person wearing a mask when he showed up at the door with their pizza delivery.
Kopplin, who delivers for two restaurants in Watertown, said he's been frustrated by the way people in his area have disregarded the statewide mask mandate and other measures aimed at slowing the spread of COVID-19. The one time a customer did wear a mask to interact with him, he made a point of thanking her for it.
Then on Oct. 2, President Donald Trump's COVID-19 diagnosis became national news. Wisconsin's cases had been spiking for a month, and hospitals across the state were saying they were reaching a crisis point. That night, Kopplin saw five customers wearing masks.
"I had five times as many people (wearing masks) in one day as the previous eight to 10 months," Kopplin said.
Kopplin's experience may be a small, unscientific measure of people’s behavior. But it's an example of the sort of change public health experts say Wisconsin will need to see for the state to bring the pandemic under control.
It was also a fleeting change, Kopplin said. He said he hasn't seen many masks since that night.
Statewide evidence suggests Wisconsinites are not making changes to their behavior — even as public health officials issue grave warnings, the state's hospitals are on the verge of overflowing, and more people are dying from the disease than at any time in the pandemic. New data from the White House Coronavirus Task Force found Wisconsinites are still traveling in their communities about as much as they did before the pandemic.
The task force report, released Wednesday, also said Wisconsin ranks as the fourth-worst state in the nation for new infections. It called Wisconsin's rising hospitalizations an "extreme concern" and wrote the situation in Wisconsin will "continue to worsen" short of real changes in state policy or public behavior. As of Monday afternoon, according to the New York Times' tracking tool, 8 of the 20 worst-hit metro areas in the country are in Wisconsin.
"This is clearly another wave of the pandemic," said Julie Willems Van Dijk, deputy secretary of the state Department of Health Services, in a media call Wednesday.
But even as Wisconsin's outbreak gets worse, there are still high-profile examples of residents choosing not to stay home. Three days after the White House task force called for caution in its report, President Donald Trump held a rally in Janesville that attracted thousands.
Wisconsin has few statewide public health measures in place, and those it has have been the subject of court challenges.
The Republican-controlled Legislature and a conservative legal group have said they'll take their lawsuit against Gov. Tony Evers' statewide mask mandate to the state Supreme Court.
In response to the state's soaring infection rates and hospitalizations, state DHS Secretary Andrea Palm issued an order Oct. 6 limiting capacity at bars, restaurants and retail shops. The order was in place for less than a week before a Sawyer County judge issued an injunction that temporarily blocked it, after the state's Tavern League filed a lawsuit. On Monday, a different judge put the order back in place.
In the absence of state policies, individual actions are among the only ways Wisconsinites can slow the spread of the disease, which as of Monday had killed 1,600 state residents. Dr. Nasia Safdar of UW Health said people would need to be united in their efforts to comply with basic public health measures of staying home from nonessential activities, wearing masks in public and keeping social distance whenever possible.
"The problem with all of these things," Safdar said, "is that they have to be done most of the time in order for them to be effective. Your weakest link, then, becomes the main reason why they fail."
'It Has To Hit Close To Home': Rural County Saw Local Spike Subside
In late July, Iron County was Wisconsin's hot spot for new coronavirus infections. The sparsely populated, far-northern county had seen few COVID-19 cases through the end of June. Some people speculated that because the virus spread more easily in denser urban areas, rural communities might be spared.
Residents of Iron County had graduation parties, Fourth of July gatherings and other social events. And as a result, the county saw a spike in new cases, even as the statewide total was relatively flat. By the end of July, Iron County had the state’s highest rate of active COVID-19 infections.
"Sometimes it has to hit close to home to make an impact," said Zona Wick, a public health nurse in Iron County. "Until they knew somebody personally (who was infected), it didn't matter to them. It was downstate, or it was in a different state. ... But when you see cases among your friends and family, it does make a difference."
By the beginning of September, when Wisconsin's statewide numbers began to increase sharply, the spike in Iron County had subsided, and new cases have stayed low there ever since.
Wick said the end of the region's summer tourism season may have led to less activity. But she also thinks public messaging about changing individual behavior got through after the county's spike made news in late July and early August. In October, Iron County has averaged less than one new case per day.
"We have to be concerned, and we have to be cautious," Wick said. "I'm not saying Iron County is out of the woods. I would be naive as a public health nurse to think that we aren't going to have another uptick."
But on a small scale, what happened in Iron County is what health experts say needs to happen statewide: People saw that their actions had led to a spike in new cases, and they changed their behavior.
Wisconsin isn't the first state to experience out-of-control growth of new cases after stay-at-home orders were lifted. In July, Florida and Arizona saw cases peak and begin to subside after a period of rapidly rising infection numbers. In those states, new cases grew for about six weeks, then spent about six weeks declining before leveling off.
But there is no guarantee Wisconsin will follow that pattern. Wisconsin's spike could be worse, and could last longer than it did in other states.
Ajay Sethi, a public health professor with the University of Wisconsin-Madison, said in the absence of a vaccine, the disease's spread slows only in one of two ways: because the population achieves "herd immunity," where most people are protected from prior infections, or because people follow public health practices. And every available study, Sethi said, shows Americans are nowhere close to herd immunity, and that attempting to achieve it would require mass infections and deaths.
"If everybody got the virus, that's one reason it will peak, because everybody would be immune," Sethi said. "In our case, it peaks and then goes down because we learn our lesson."
In Some Settings, 'It Only Takes One Person' To Infect Many
The evening after the Evers administration's order on capacity limits first went into effect, groups of people gathered at bars and restaurants in downtown Wausau.
At eight different taverns, there were no signs of large, packed crowds, but there were people sitting at the bar, masks off, drinking and socializing. None of the bars appeared to be in violation of the capacity limit. But that doesn't mean patrons that night couldn't have spread the disease.
Scientists have focused on "super-spreader events" as one of the primary drivers of the pandemic. In the right setting, said Huong McLean, an epidemiologist with the Marshfield Clinic Research Institute, it's possible for even a single infected person to spread the coronavirus to many other people.
"It only takes one person," McLean said. "If one person doesn’t follow guidelines, that can impact the community significantly."
When people do decide to go out, public health experts agree it's possible to mitigate risk by spacing out, masking up and doing things outdoors. Outside of the downtown Wausau pub Malarkey’s that evening, a band played to an audience sitting outside. Mask-wearing servers took drink orders. The audience sat at outdoor tables, some across the street.
The street-corner concert would be the last one to be held for a while, since Malarkey's shut down shortly after due to Evers' order. But it was an example of the sort of pandemic-era activity intended to help people avoid high-risk places.
So far, Wisconsin's results show that not enough people are sticking to low-risk activities.
Symptoms of COVID-19 don't show up right away. The new infections reported today are, in some cases, the result of choices made weeks ago. That means that even if some people make changes now, it could be November before the state sees their effects.