The new hospitalization record underscores that we’ve entered the worst period for the pandemic since the original outbreak in the Northeast. Although the number of detected cases was much lower back then because of test shortages, the large number of hospitalizations (and deaths) indicate that there were many more times the number of infections than our then-embryonic and broken testing system could confirm.

In the following months, some commentators, including government advisers, have played down the large case counts by saying tests were detecting people who weren’t actually sick—or if they were sick, only mildly sick. These hospitalization numbers prove that the current surge of COVID-19 cases is not merely the result of increased screening of asymptomatic people. Rather, the cases we’re detecting are a leading indicator that many people are seriously ill. Although case numbers are heavily influenced by the number of tests accessible in a particular area, hospitalizations are not.

The burst of hospitalizations is primarily located in the Midwest, where cases began to rise weeks ago. We have seen no indication that there is an end in sight to the outbreaks in the region. The outbreaks in Illinois, Michigan, and Ohio began spiking more than three weeks after early outlier Wisconsin—and cases and hospitalizations in Wisconsin are still rising.