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Tennessee has reported the country’s most cases per 100,000 people on average over the last seven days. Gov. Bill Lee has refused to enforce a mask mandate, but an employee at a Memphis grocery store wears a mask as he hauls shopping carts.
Credit…Whitten Sabbatini for The New York Times

As many Americans are winding down for the holidays, an explosion of coronavirus cases and deaths across the nation is hitting with perilous force, particularly in the South, which avoided much of the fall surge.

Six Southern states have seen sustained case increases in the last week: Tennessee, Alabama, Georgia, South Carolina, Florida and Texas.

Tennessee reported the country’s most cases per 100,000 people on average over the last seven days, and Alabama set a single-day death record for the state on Wednesday, with 135, according to a New York Times database. In Florida, a virus surge in the past week means cases could soon surpass the state’s summer peak.

These increases are not just indicative of more testing. Florida’s more than 20 percent rise in cases over the last two weeks matches the growth in hospitalizations, although far fewer residents are hospitalized now than in the summer. In Texas, which has also had an upswing of more than 20 percent over the same time period, Dallas County has added more than 15,000 cases in the last week, a record.

A somber holiday season comes as the national death toll surpassed 326,000 on Thursday, more than any other country. More than 3,400 deaths were reported on Thursday, the second-highest daily total of the pandemic.

Credit…Julie Bennett/Associated Press

In Tennessee, home to six of the nation’s 20 metropolitan areas with the most recent cases per capita, frontline medical workers say hospitals are overwhelmed with virus patients.

Dr. Jason Martin, a critical care specialist outside Nashville, said the intensive care unit where he works has been at or near capacity for weeks, an unsustainable level compounded by lax state public health restrictions. Although Gov. Bill Lee recently placed some limitations on indoor public gatherings, he has refused to issue a statewide mask mandate. That has left many rural counties, where officials have resisted imposing mask requirements, more vulnerable to the virus.

But Dr. Martin said his patients have little doubt about the seriousness of the coronavirus. “The people who come in, they believe, by the time they’ve gotten to me,” he said. Many of his patients have expressed regret about their decisions, like going to a relative’s funeral or socializing with people who showed no symptoms.

“What makes this so maddening is that we know how to stop it,” Dr. Martin said, “and we choose not to.”

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