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 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-yearold 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 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.