It’s been months now since U.S. President Donald Trump predicted his miracle. That was back in February, during the early days of the COVID-19 pandemic, when the president announced that come April, when the weather got warmer, the coronavirus would “miraculously [go] away.”
It didn’t. And nor has it been reduced to “ashes,” as Trump claimed on June 5 when, arguing for a rapid reopening of the economy, he said, “We want the continued blanket lockdown to end for the states. We may have some embers or some ashes, or we may have some flames coming, but we’ll put them out. We’ll stomp them out.”
Instead, the U.S. is very much on fire, well into a second phase of the crisis, with the COVID-19 caseload steadily rising to more than 2 million confirmed cases and more than 113,00 deaths.
According to a NRM analysis, 25 states are continuing to see case counts grow day by day. Four of those states—Arizona, California, Mississippi and North Carolina—have yet to decline for any extended window even temporarily; the rest appear to have initially bent the curve downward and are now experiencing a second wave of infections.
And in many of those cases, the second phase is worse than the first, or on track to erase any encouraging declines in the past month. In Oregon, for example, the state appeared to flatten the curve very early, peaking at 1.76 cases per 100,000 people on April 2 and declining to 0.8 by May 24. In the intervening two weeks, a resurgent wave has pushed that figure past its previous peak to 2.3 as of June 8—and still likely to grow.
These disparate trends are invisible on a national level. Improvements in some areas—New York, New Jersey and other parts of the Northeast—have been offset by worsening conditions elsewhere, leaving the U.S. as a whole stubbornly plateaued at about 6 cases per 100,000 people.
In Texas, the seven-day average of new COVID-19 cases per day has been over 1,000 since May 25. This development led Governor Greg Abbott to concede on a local news broadcast, “I am concerned, but not yet alarmed.” He should be, though. On May 14, the state’s seven-day average crested at 1,305 cases per day and then started to fall. But in recent weeks, it’s climbed back up, and is now at 1,703.
These alarming spikes are apparent even when a state never enjoyed a temporary lull. Arizona, which has yet to appear to peak even momentarily, has seen 7,700 new cases in the first week of June, with patient load tripling in the past three weeks in hospitals owned by Banner Health, the state’s largest hospital provider.
Yet the pandemic, if not remotely yesterday’s news, has begun to fade as a front-of-mind issue, pushed out both by the recent demonstrations against police brutality and systemic racism, triggered by the May 25 murder of George Floyd, and perhaps a sort of cultural numbing to all things COVID. The White House Coronavirus Task Force, whose press conferences were daily fixtures in the early months of the crisis, now convenes three times a week instead of daily—with Vice President Mike Pence, the group’s chair, attending only one of those three regular sessions—and there has not been a press conference in the last month. On June 12, the U.S. Centers for Disease Control and Prevention had its first media telebriefing since March 9; previously these were held at least weekly.
“I’m worried that people have kind of accepted where we are as a new normal, and it is not normal,” says Dr. Tom Inglesby, director of John Hopkins’ Center for Health Security at the Bloomberg School. “Some states have hundreds or even thousands of new COVID cases every day, and we can do better than this. Some countries have driven their [daily] cases down to zero.”
The U.S. most certainly hasn’t, but the pain is not spread evenly across the map. New infections are falling precipitously in some states, including New York, Connecticut, Delaware, New Jersey and Kansas, while resuming a rise after initially plateauing or falling elsewhere, including in Washington, Oregon, Nevada and Michigan.
If there is concern among residents and leaders of affected states, it’s hard to spot. In Florida, most beaches are open, as are the Universal Orlando theme park and all five SeaWorld Parks. Disney World plans a phased reopening beginning July 11. Like Abbott in Texas, Florida Governor Ron DeSantis does not seem especially alarmed at the rise in cases in his state.
“As you’re testing you’re going to find more cases,” he said at a June 11 press conference. “Most of the cases are sub-clinical cases, and we expected that from the beginning.”
Governor Doug Ducey of Arizona has been similarly sanguine—if more defensive—claiming that reports of dwindling hospital-bed capacity are exaggerated. “The information that was out there nationally was inaccurate,” he said at a Thursday briefing, according to the news site Arizona Central. “I’m listening to the experts inside Arizona that serve the people of Arizona.”
But at least some of those people do not share Ducey’s confidence. “I agree with him that we have hospital capacity today and probably we will next Friday,” Will Humble, executive director of the Arizona Public Health Association, told the Central. “If we don’t change course and put in some simple interventions now, it might not be that way on July 4.”
In South Carolina, most beaches and retail businesses remain open, even as the state recorded its highest one-day total of 687 new cases on June 10. Thirteen people died of the disease in that 24-hour period. Governor Henry McMaster extended South Carolina’s state of emergency—originally imposed in April and set to expire on June 11. The state of emergency authorized school and business closures, activation of the National Guard, postponement of elections and more. Still, McMaster made it clear that the extension would not require businesses that have reopened to close again, nor would he mandate mask use. “It is a matter of personal responsibility,” he said at a press conference. The farthest McMaster said he would go is to encourage people to wear masks and practice social distancing.
If the governors of the stricken states aren’t feeling skittish yet, the markets are. On June 11, the Dow Jones Industrial average shed 1,900 points, a 6.9% plunge, and the S&P 500 lost 5.9%, as reports of the second wave of infections made it clear that the overall economy would not be bouncing back to its pre-viral vigor any time soon. “This is the biggest economic shock in living memory,” Federal Reserve Chairman Jerome Powell said in a June 10 news conference. “The extent of the downturn remains extraordinarily uncertain.”
The health of the nation, three months into the COVID crisis, does too.
Trump was not alone in optimistically predicting that a combination of warm weather and a period of sheltering in place would be sufficient to snuff the COVID-19 wildfire by summer. Every state in the country, plus Washington D.C., imposed some kind of quarantine rules, the earliest going into effect in mid-March—and, since the middle of springtime, all of them have slowly been reopening, pressed by a combination anxiety over the economy, a restive population, and no small amount of epidemiological hope. That hope has not always been fulfilled.
South Carolina was the first state to begin lifting restrictions, on April 20. Others went much later, especially New York, which remains the epicenter of the crisis, and did not begin opening back up in some regions of the state until May 15—pointedly excluding hard-hit New York City. Only on June 8 was the city permitted to resume non-essential construction and manufacturing and reopen non-essential stores. Museums, theaters, restaurants, bars and other high-traffic venues remain shuttered.
The apparent result of this disparate approach: South Carolina is back in crisis mode, while New York is seeing its lowest infection levels since March 1.
But that recovery is fragile.
“You can make a mistake today that wipes out everything we’ve done so far, so we have to stay smart,” said New York Governor Andrew Cuomo, at a June 11 briefing.
The biggest of those mistakes may involve timing. Overall, as NRM analysis of state-by-state data found, the date that states closed and reopened had at least some effect on how severe their second wave has been—or whether they have had one at all.
From closing schools to mandatory stay-at-home orders, the Northeast was both the earliest region in the country to institute interventions, and the most hesitant to roll them back. On average, Northeast states put restrictions into place on March 25, followed by the West on March 27, the South on March 29 and the Midwest on March 31, according data collected by the Institute for Health Metrics and Evaluation at the University of Washington.
More telling is how many of these intervention measures remain in place as states cautiously crack open once-shuttered doors. In the Northeast, only 30% of restrictions had been lifted on May 21 on average, when one totals all unique measures, counting each state several times. The other three regions have lifted around 40% by the same metric. The West was the first to do so, on May 17 on average, followed by the South on May 20 and the Midwest on May 23. (These dates do not account for programs that have yet to conclude.)
The result of those policies seems clear: The Northeast, which was far and away the hardest-hit part of the country, has now seen the greatest improvement and seems to be on the best trajectory—driven mostly by New York’s and New Jersey’s aggressive policies. The region’s rates of new daily infections per capita peaked on April 6 at 31.5 new cases per 100,000 residents. The Midwest, a distant second, peaked at 10.3 on May 4, while the South and West have remained relatively static at about 5.
As of June 10, that sequence has reversed. The Northeast is now the region with the lowest daily case rate, at 3.7. The Midwest, at 4.4., isn’t too far behind. Both have flattened the curve significantly in the last month or so. Meanwhile, daily case rates in the West and South have been on the rise, and are both now at about 6.5 per 100,000 residents.
But while the timing of a state’s closing and reopenings certainly play a role in its current disease arc, there are other state-by-state considerations that make things more complicated. That might be best exemplified by California, with its massive 39.5 million-person population, huge geographic range and aggressive approach to testing. The state closed its doors on March 19 and did not begin to reopen them until May 8, yet case counts are rising.
“We have seen cases increase in some areas, which is expected as testing capacity increases and people leave home more,” says Dr. Sonia Angell, director of the California Department of Public Health, “but we are prepared for that.”
Johns Hopkins’ Inglesby backs California’s position that at least some of its rising caseload may simply be an artifact of better screening. “Even though the number of daily cases is higher on a day-to-day basis than it was weeks ago, the overall hospitalization rate on their dashboard is stable,” he says. “So that would suggest perhaps there’s more testing going on in California and maybe they’re finding more mild and moderate cases.”
Other states get no such pass from Inglesby. “In Texas, you can see that the hospitalization rate is going up,” he says. “Similarly in Arizona, ICU beds [and] hospitalization rates for COVID patients are going up. So those are real changes. There are more sick people than there were a month ago. Substantially more.”
And nationwide, they’re coming substantially faster too. It took more than three months for the U.S. to record its millionth case of COVID-19. The jump to two million took just 44 days, and the numbers continue to rise. The U.S. is a loud, sprawling, brawling nation, and it’s no surprise that, as with so much else, regional differences are determining how we meet the current crisis. At the CDC’s June 12 media briefing, the agency’s deputy director for infectious diseases, Dr. Jay Butler, noted that “If cases begin to go up again, particularly if they go up dramatically, it’s important to recognize that more extensive mitigation efforts such as what were implemented back in March may be needed again. The decision really needs to be made locally based on what is happening within the community regarding disease transmission.”
But with lives on the line we need to do better—to address the problem with a discipline and uniformity we have yet to show.
“Are we resigned to losing a thousand Americans a day until we have a vaccine?” Inglesby asks. “I hope we aren’t.”
On that score, at least, he could likely claim a national consensus.