Noam Galai via Getty Images
Two months ago, it looked like the United States’ coronavirus outbreak might be following the same trajectory seen in countries such as Spain and Italy: an initial devastating peak of cases followed by a slow but steady daily decline. In late April the country saw a one-day peak of over 48,000 new confirmed cases, but by mid-June the daily figure was starting to dip below 20,000.
Then this downwards trend made a dramatic about-turn. In late June the number of confirmed cases started rising again, even while the data showed that the country was not doing nearly enough tests to accurately track the outbreak. The country is now seeing an alarming coronavirus resurgence that is eclipsing its April peak. So what went wrong?
During the month of May, states across America had begun to open up for business despite the US government’s top infectious disease expert Anthony Fauci warning against a swift reopening. While some took a much more cautious, tentative approach, many US states went faster. By the end of May, people in more than 30 states were allowed to dine out in restaurants, go to their local bowling alley, drink in their favourite bar and get their nails done in the local barbershop or parlour.
While these restrictions were easing, coronavirus cases were already heading back up again. By late June cases were rising consistently, and on July 2 the daily number of new infections passed 50,000 for the first time. On July 2, PBS reported that infections were rising in 40 of the country’s 50 states, and on July 5, the country’s seven-day rolling average hit a record number of new cases for the 27th day in a row.
While the epicentre of the outbreak was initially concentrated in the north east, Covid-19 is now shifting to southern and western parts of the country. States such as Texas, Arizona, Florida and Southern California have emerged as the latest Covid-19 hotspots as they see new coronavirus cases spike dramatically. But what’s behind the increase?
“Where these increases in incidence are going on is in places which have reopened their businesses,” says Katia Koelle, an associate professor in evolutionary biology and virology at Emory University, who hesitates to call what’s happening a second wave as she says the US hasn’t technically reached the end of its first wave. “It seems like the reopening of states that have facilitated people aggregating in close quarters is really what’s responsible for the increase in cases.”
As New York and other states opted for a slow and cautious phased reopening, states like Texas had been easing lockdown measures since late April when stay at home orders were not renewed. On May 1, restaurants were already allowed to open at 25 per cent capacity, with bars, bowling alleys and rodeos opening at 25 per cent capacity three weeks later. Businesses were allowed to run at half capacity by early June. In Arizona, retail stores, barber shops and salons were allowed to open from May 8, with people permitted to dine in at restaurants from May 11. Gyms opened up two days later. On June 5, Florida reopened Universal Orlando Resort, and bars, cinemas and massage parlours were allowed to open in most of the cities in the state.
By July 4, hospital admissions in the state of Texas had shot up to 7,890, which is an alarming number of cases when compared to other states in the country. New York, for instance, reported just 844 new hospital admissions that same day. The common thread that connects these states together is that not only that they opened up relatively quickly but, until recently, many of them did not have state-wide mandatory mask-wearing policies. “I know that Georgia and Texas and Arizona opened up really quickly, and they did not require masks in public,” says Loren Lipworth-Elliot, an epidemiologist at Vanderbilt University in Nashville, Tennessee. “The feeling is that maybe some of the states started relaxing their social distancing and other behavioural restrictions before they had really reached anything like what you would call the bottom of a wave.”
States like New York, New Jersey and Illinois, which all have strict face mask-wearing policies, saw new cases fall by 25 per centin the two-week lead up to June 24. Texas and Arizona, on the other hand, which – at the time – only had state-wide face mask ‘recommendations’, saw new coronavirus cases rise by 84 per cent. Florida’s governor Ron DeSantis has yet to mandate the wearing of face masks, while California mandated the use of face masks on June 19 after cases began ticking upwards.
“The states that are going to have success are going to be the ones that implement strict masking and social distancing policies going forward,” says Lipworth-Elliot. “This is not going to be a couple of weeks. If we can get people to wear masks, we can have a huge impact on what happens between now and whenever we have a vaccine.”
Like Texas, Florida saw its largest daily jump in coronavirus cases over the last few days as cases leapt by 11,443 on July 4, which was the second time in three days that cases have risen by over 10,000. In Arizona, new cases topped 4,878 for the first time on July 1, its highest since the outbreak began. On July 8, California saw its largest increase in new cases as a further 11,529 were diagnosed, with hospitalisations increasing by 50 per cent over the past two weeks to 5,800.
Still, California is a relative outlier within the group of hotspots, especially as California was the first state to go into lockdown. The reason for the increase might lie in who exactly is being infected with the disease. Data from the California Department of Public Health on July 6 show that people aged 18 to 50 make up over 60 per cent of the newly diagnosed cases in California, while an analysis from mid-June revealed that 44 per cent of new diagnoses were from those aged 34 or younger, hinting that the younger demographic, who are more likely to go out to bars, could be contributing to the increase in cases across the US.
In late June, president Donald Trump blamed the spike in confirmed cases on the country’s increased testing regime. Testing for coronavirus has almost doubled since early April, with roughly 550,000 tests now being done every single day, which is five times more than it was three months ago. Lipworth-Elliot says that initially the country was testing symptomatic people, and that skewed the positive test results to older people. “Now we’re seeing a lot more testing and it’s asymptomatic testing, and so that I think that’s one explanation for why we’re seeing this rise in cases among younger people,” she explains.
But that doesn’t account for the fact that the proportion of people testing positive as a percentage of overall tests are currently spiking in 28 US states, according to data from John Hopkins University. The World Health Organisation says that positivity rates should be under 5 per cent for 14 consecutive days if the population being tested in an area is being done at an adequate level. On Tuesday, the positivity rate in California was at 7.5 per cent, in Texas it was 14.4 per cent, in Florida, it was 18.9 per cent and highest of all, Arizona’s positivity rate was at 26.8 per cent. If an adequate number of tests were being administered; the positivity rate should fall. This indicates that states are testing those who are getting sick, rather than a broad spread of the population.
In response to the uptick in coronavirus cases, many states have now reversed reopening efforts. Ahead of the July 4 holiday, California officials ordered the shutdown of bars and nightclubs in seven counties, while Arizona’s gyms, cinemas and water parks will be closed until at least July 27. But even with states rolling back their reopening, it still might not be enough to curb the disease. Monica Ghandi, professor in infectious disease at University of California San Francisco says that the virus could still circulate for much longer. “I believe that [Covid-19] has become endemic in this country,” she warns. “Even with a little bit of opening, any opening, we are going to see upticks in cases.”
Alex Lee is a writer for WIRED. He tweets from @1AlexL
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