FILE - In this Aug. 26, 2020, file photo, first-grade teacher Jessica Johnson asks students if they've been sick or near anyone who's been sick before the start of the first day of school at Our Lady of Lourdes Catholic School, in De Pere, Wis. Gov. Tony Evers has extended Wisconsin's mask mandate until Nov. 21, citing a surge in coronavirus cases across the state. (Sarah Kloepping/The Post-Crescent via AP, File)

MISSION, Kan. - It began with devastation in the New York City area, followed by a summertime crisis in the Sun Belt. Now the coronavirus outbreak is heating up fast in smaller cities in the heartland, often in conservative corners of America where anti-mask sentiment runs high.

Elsewhere around the country, Florida's Republican governor lifted all restrictions on restaurants and other businesses Friday and all but set aside local mask ordinances in the political battleground state, in a move attacked by Democrats as hasty.

Meanwhile, confirmed cases of the virus in the U.S. hit another milestone — 7 million — according to the count kept by Johns Hopkins University, though the real number of infections is believed to be much higher.

The spike across the Midwest as well as parts of the West has set off alarms at hospitals, schools and colleges.

Wisconsin is averaging more than 2,000 new cases a day over the last week, compared with 675 three weeks earlier. Hospitalizations in the state are at their highest level since the outbreak took hold in the U.S. in March.

Utah has seen its average daily case count more than double from three weeks earlier. Oklahoma and Missouri are regularly recording 1,000 new cases a day, and Missouri Gov. Mike Parson, a staunch opponent of mask rules, tested positive this week. Kansas and Iowa are also witnessing a spike in cases. And South Dakota and Idaho are seeing sky-high rates of tests coming back positive.

“What we’re seeing is the newer hot spots rise over the course of the last several weeks, predominantly in the Upper Midwest," said Thomas Tsai, a professor at Harvard's Chan School of Public Health.

The U.S. is averaging more than 40,000 new confirmed cases a day. While that number is dramatically lower than the peak of nearly 70,000 over the summer, the numbers are worrisome nonetheless. The nation's death toll eclipsed 200,000 this week, the highest in the world.

In the Midwest, the virus is now landing squarely in places where there is strong resistance to masks and governors have been reluctant to require face coverings.

In Springfield, Missouri, hospitals are starting to fill up with COVID-19 patients and the city has seen a big spike in deaths over the past month.

Amelia Montgomery, a nurse working in the COVID unit at Cox South Hospital in Springfield, describes a maddening routine where family members of sick patients call up medical staff on the phone on a daily basis and question whether their loved ones truly have the virus and and the veracity of positive test results.

“We know what COVID looks like now after six months of dealing with it," Montgomery said. “It is like beating your head against a brick wall when you are constantly having patients, family members of these patients and the community argue so intensely that it is not real or we are treating it in the wrong way.”

The skepticism about the virus coincides with deep frustration over mask requirements in the Midwestern cities that actually have them.

Mike Cooper, a 59-year-old and sign shop owner from the Branson, Missouri, area, is among those who have grown weary of virus restrictions that he sees as out-of-control government overreach. He has no doubts about the seriousness of the virus, but says the financial toll of business and school shutdowns creates its own set of health problems, such as alcoholism, suicide and depression. “Financial ruin kills people too,” he said.

“To me, flatten the curve means extend the plague. Flatten the curve means you are just going to kill the same number of people over a longer period of time, so they are going to extend the plague," Cooper said.

In Florida, Gov. Ron DeSantis, a major ally of President Donald Trump, gave businesses the OK to reopen, declaring, “We’re not closing anything going forward.”

The governor, who has resisted making mask-wearing mandatory statewide, also said he will stop cities and counties from collecting fines from people who don’t cover their faces, virtually nullifying local mask ordinances.

Florida was a major hot spot over the summer, and the death toll there stands at nearly 14,000. Deaths are running at over 100 a day, and newly confirmed infections at about 2,700 a day.

Like Trump, DeSantis has questioned the effectiveness of closing down businesses, arguing that states that more aggressively shut down, including California, have fared no better.

“The state of Florida is probably the most open big state in the country,” he boasted Friday.

Florida Democrats have bemoaned the governor's push to reopen.

“No one is advocating for a full-scale lockdown in Florida. But we have been and continue to ask for common-sense prevention measures such as face masks, which are essential to preventing further spread,” state Sen. Audrey Gibson said Thursday.

In other developments:

— Virginia Gov. Ralph Northam announced he and his wife have tested positive, though he said he has no symptoms. Northam, a Democrat who is also a doctor and usually wears a mask in public, has been criticized by Republicans who say his restrictions aimed at slowing the spread of the virus are too stringent.

— Two former administrators of a Massachusetts veterans home where nearly 80 people died were charged with neglect over their handling of the outbreak. They could go to prison if convicted. It is believed to be the nation's first criminal case brought against nursing home officials for actions during the crisis.

— In New York City, which beat back the virus after a disastrous spring, four Orthodox Jewish schools were closed for violating social-distancing rules. Health officials said if virus cases in these neighbourhoods continue to build, the city might roll back the reopening in some places and require businesses to close back down.

Mask and social distancing rules are starting to cause fatigue in some areas of the Midwest and West.

In Joplin, Missouri, a mask ordinance was allowed to expire in mid-August as virus fatigue grew. Since then, the number of positive cases there and in surrounding Jasper County — a deeply conservative county that Trump won by more than 50 percentage points over Hillary Clinton in 2016 — has risen about 80%.

“I am getting sick and tired of telling people to wear their masks, and I know they are sick and tired of me saying it,” said Tony Moehr, chief of the Jasper County Health Department. “And it just seems like people have heard it so many times, I’m not sure if they really even hear it anymore when we say it.”

At the home of the University of Oklahoma, the Norman City Council voted 5-3 this week to require that masks be worn indoors at house parties if more than 25 people are present. The ordinance passed over objections from members of the public.

“You can make any law that you want to. You come into my house telling me that I got to wear this stupid thing and you’re going to have a firefight on your hands,” said Josh Danforth, holding a mask, who identified himself as an Iraq war veteran.

___

Forster and Noveck contributed from New York.

News from © The Associated Press, 2020