The COVID-19 pandemic is entering a complicated, hold-your-breath stage as states work to stamp out flare-ups and hope their hospitals can handle an anticipated rise in cases as their economies reopen and Americans socialize again.
The New York City region that endured the worst of the pandemic is doing far better, though parts of California and Texas are reporting increases in cases. Hospitals in the Minneapolis-St. Paul area are filling with COVID-19 patients and are concerned about a spike in cases after protests over the death of George Floyd.
Many of the protesters are young and less vulnerable to COVID-19, though marchers could catch the coronavirus while gathering and further spread it in minority communities that are already reeling from the pandemic, scientists say.
Newly confirmed cases are rising in more than a dozen states, sometimes because of increases in testing, and clusters of hot spots are erupting in rural areas with prison and meat-processing plants that are vulnerable to outbreaks.
The U.S. is approaching 2 million confirmed infections and faces a complex struggle to hold down transmissions that increased with frightening speed earlier this year.
“If I were to describe the pandemic in the United States overall now, it would be that there are low embers burning within the metropolitan areas and there are little sparking fires heading off all over the heartland,” said William Hanage, an associate professor of epidemiology at Harvard University. “Numbers are hovering around steady, but we have to remember that is reflecting a decrease in the Northeast and a slow increase which is replacing that elsewhere.”
Experts said they should be able to tell by the latter half of June whether efforts to reopen and mingle once again have resulted in a spate of new infections.
“The metric that is most firm, even though it is delayed, is hospitalizations of people with lab-confirmed COVID-19,” said William Schaffner, an infectious disease specialist at Vanderbilt University. “If that starts to tick up, then we start to frown because it means there is, indeed, more transmission out there.”
About 40,000 COVID-19 patients were in U.S. hospitals at the start of June, up from 34,000 in mid-May.
Many states, especially in the Northeast, are reporting fewer hospitalizations, and more than a dozen have relatively steady numbers. A handful are showing upticks, however.
Hospitalizations in Arizona surpassed 1,000 for the first time Monday, sparking debate about actions after lifting the state’s stay-at-home order in mid-May.
“A state like Arizona is concerning. The scope of the rise and the velocity is concerning,” former Food and Drug Administration Commissioner Scott Gottlieb told CNBC. “It’s going to be very hard, though, for a lot of these governors to go backward and start implementing mitigation again.
“They’re probably going to tolerate a higher level of infection than we were willing to on the first go-round, and that just sets up more risk,” he said.
Flare-ups in some states, he said, could “reseed” parts of the country with the coronavirus.
Hospitals in Montgomery, Alabama, and in Minnesota also have been taxed recently with COVID-19 patients.
“We are getting closer and closer to being overly full,” Caitlin Eccles-Radtke, an infectious disease physician at Hennepin County Medical Center in Minneapolis, told MedPage Today.
The national conversation has pivoted to protests after the death of Mr. Floyd, a black man who died after a white Minneapolis police officer knelt on his neck for nearly nine minutes. Still, the coronavirus that dominated global headlines since the start of the year remains a challenge, infecting 1.8 million people and counting in the U.S. and killing more than 107,000.
States are trying to make sure high-risk populations are tested. That includes prison inmates, meat processing workers and nursing home residents. The Trump administration recently announced data linking 26,000 deaths to nursing homes across the country.
The pandemic also continues to have an outsized effect on minority populations.
Federal data shows black Americans, who make up 13% of the population, account for 23% of COVID-19 deaths in the U.S. and account for more than half of infections in multiple Southern states.
Experts say the racial disparities are results of underlying health issues in minority populations, and frustrations with the U.S. response to COVID-19 are further fueling protests over racial injustice.
Some parts of the country are reporting good news.
New York, the hardest-hit state, reported fewer than 1,000 new cases on June 1, compared with about 4,000 on May 1 and 8,000 on April 1. Although the numbers in New York are still much higher than other parts of the country, the trend line is positive.
“The tri-state region actually looks very good right now,” Dr. Gottlieb told CNBC.
New York officials said buses and subway lines will have social-distancing decals and hand sanitizers in stations when the city begins to lift restrictions next week.
In Pennsylvania, a large number of counties will move Friday to the “green phase,” which eases many restrictions and lets businesses move from 50% capacity under the yellow stage to 75%. Areas of southeastern Pennsylvania and Philadelphia will enter the yellow phase, in which some business may open but teleworking is mandated “where feasible.”
“We continue to see around 500-700 cases a day, and these are among different populations, but long-term care facilities remain a concern that we are continuing to assist,” Pennsylvania Health Department spokesman Nate Wardle said.
Scientists are worried that the coronavirus will strike in a “second wave” this fall after a potential lull in transmission because of hot and humid weather, yet it is starting to wreak havoc in Latin America as countries in the Southern Hemisphere enter winter.
Disease trackers are looking backward to try to get a better sense of overall exposure to the coronavirus since the start of the outbreak. They are producing statistical averages based on serological testing that checks for antibodies.
Exposure ranges widely, from an estimated 2% of the population in Boise, Idaho, to roughly 20% in New York City, based on figures compiled by the American Enterprise Institute.
Elsewhere, antibody testing suggests roughly 17% of London’s population has been exposed, compared with 10% in Paris and Wuhan, China, about 6% in Miami and nearly 5% in Los Angeles.
The virus was discovered in Wuhan in December and spread around the globe in the early months of this year, upending American life as President Trump urged people to work and learn at home and avoid large gatherings.
Governors issued a patchwork of state-at-home orders that closed most businesses while allowing food and other essential services to continue.
The Centers for Disease Control and Prevention said emergency department visits plummeted by 42% in the early pandemic period from late March to late April compared with similar dates in 2019 as people hunkered at home. The biggest declines were among children younger than 14, females and residents of the Northeast region, the CDC report said, suggesting the illness scared people away from seeking care.
“The striking decline in ED visits nationwide, with the highest declines in regions where the pandemic was most severe in April 2020, suggests that the pandemic has altered the use of the ED by the public,” the agency said.
The CDC said hospitals should maintain clear triage procedures to keep COVID-19 patients separate from other emergency room patients. Health care providers also should set up telephone lines to help people swiftly understand whether they need to report to the emergency room for injuries or other conditions, the agency said.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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