The past week has ugly reminded America that the coronavirus pandemic threat is far from over. The cases are rapidly increasing again. The nation set a new record for daily new infections on Wednesday and then set a new record again and again over the next two days.
There is some debate about whether this is the "second wave" of infection or whether it is a continuation of the first wave that started in early 2020 and never really ended. However, it is clear that the United States is currently suffering from a rapid increase in coronavirus cases. So far, this has not been associated with an increasing death toll, probably because rising and falling deaths tend to lag behind rising and falling deaths.
But between Monday and Friday, the U.S. rose from more than 30,000 reported cases in one day to more than 45,000. Arizona, Florida, Texas and several other states in the south and west are most affected.
German Lopez / Vox
President Donald Trump and his allies have suggested that the increase is due to an increase in tests, but the data do not confirm this. The number of cases has increased faster than the number of tests, with the percentage of tests that are positive – an indicator of the severity of an outbreak – rising above 10, 15 and even 20 percent in some states. (The recommended positive rate is less than 5 percent.)
There is a significant shift from May to June as testing increased, cases plateaued nationwide, positive rates slumped across the country, and it finally looked as if restrictions and social distancing measures were inhibiting coronavirus growth.
So what went wrong? The simple answer is: States have started to relax their restrictions and reopen their economies. This gives employers, workers, and their customers the opportunity to return to the world and interact to spark new cases.
Restrictions can be lifted slowly and safely, and some countries meet the benchmarks recommended by experts. But most of them have never completely controlled their outbreaks, but pushed ahead with the reopening.
A mixture of negligence and partiality is to blame. Under Trump, the federal government and some states seemed to give priority to public health to the economy and expressed dissatisfaction with the restrictions. Trump was called to "LIBERATE" states after the shutdown. Some Americans picked up the news, reopened their shops and went out. Wearing masks became a politicized issue, and sections of the population refused to wear facewear and other precautions against Covid-19.
The effects were unfortunately predictable. Citing the 1918 flu pandemic investigation and recent studies, experts pointed out that locking would slow the spread of the coronavirus and, in some cases, ending restrictions would increase unless other preventive measures were taken. However, the warnings from the experts were ignored.
"It's a situation that didn't have to be," said Jaime Slaughter-Acey, epidemiologist at the University of Minnesota. “For almost three months, you had the opportunity to proactively tackle the Covid 19 pandemic and normalize the culture to use practices that curb the flood of transmissions and the development of Covid 19 complications. … It was not prioritized over the economy. "
The result: America is currently in the middle of a predictable, avoidable wave of Covid 19 cases that is exacerbating the world's most widespread coronavirus crisis.
Different countries are suffering this time
The New York City region was hit hardest in the first wave of Covid-19 cases, with New York, New Jersey and Connecticut leading the country in Covid-19 cases and deaths. There were also significant outbreaks in other parts of the Northeast, Michigan and Louisiana.
The latest wave has hit the south and west, with alarming increases in Arizona (125 percent more new cases every two weeks), Florida (250 percent) and Texas (177 percent), but also in Alabama (20 percent), California (74 percent), Georgia (112 percent), Mississippi (74 percent), Nevada (103 percent), North Carolina (15 percent), Oklahoma (212 percent) and South Carolina (107 percent). In most of these countries, positive test rates have risen, indicating that the increase in cases is not just a result of further testing.
German Lopez / Vox
In most of these countries, it is not entirely correct to say that they are going through second waves – because many of them have never really got their first wave under control. Instead, they have seen a steady increase in coronavirus cases, culminating in exponential growth in recent days and weeks.
Many countries "have never flattened out," said Pia MacDonald, epidemiologist at the RTI International research institute. "This means that states have not followed the public health measures that we all need to take to ensure that the outbreak does not increase."
For example, in Arizona there has been a steady increase in coronavirus cases for months before the recent exponential increase occurred. There has never been a sustained decline, as this graph shows:
German Lopez / Vox
While coronavirus outbreaks can be concentrated locally, current outbreaks appear to cover entire states – with the majority of counties in many states, especially in the south, reporting a high number of cases.
This was not inevitable. Connecticut, New Jersey and New York, for example, all managed to suppress their coronavirus cases after the worst pandemic, and all kept their coronavirus cases low. Others, such as Maryland and Rhode Island, have also managed to suppress the number of their coronavirus cases.
The difference is that the countries with the largest increases were the slowest to close their economies and the quickest to reopen in response to the outbreak. For example, ordering Texas at home was one of the shortest in the United States – it took less than a month, according to the New York Times. When these commands ended, people leaked, interacted, and spread the corona virus. (Since the incubation period can take up to two weeks, there is a delay between the start of the spread of the virus and the reporting of cases.)
The increase in Covid 19 cases coincides with the protests against Black Lives Matter, but research and data to date suggest that the protests have not caused a significant increase in the cases. Experts argue that this may be due to the demonstrations, which are mostly outdoors, and demonstrators who take steps such as wearing masks to reduce the risk of transmission.
In some countries, the increase in cases appears to affect a younger population. For example, some counties in Texas and Florida reported that people under the age of 30 made up an increasing proportion – and even a majority – of coronavirus cases.
This is likely due to the fact that young people are most likely to move when social distance ends, perhaps because they perceive themselves as less at risk. While young people are at lower risk and this could result in fewer deaths due to the current fall wave, there are still many examples of younger patients becoming ill, having long-term complications and dying.
Relaxed social distancing is probably to blame
Across the board, the experts were pretty clear as to why states rose in Covid-19 cases: loose restrictions that forced social distancing.
“The economies are opening up. People venture out. They interact more with others, ”said Slaughter-Acey. "This creates opportunities for transmission."
Research is increasingly showing social distancing measures to reduce the spread of the coronavirus. A study in Health Affairs concluded:
With the introduction of state social distancing measures, the daily growth rate increased by 5.4 percentage points after 1 to 5 days, by 6.8 percentage points after 6 to 10 days, by 8.2 percentage points after 11 to 15 days and by 9 after 16 to 20 days , 1 percentage point decreased. Assuming constant voluntary social distancing, these results imply a ten times greater distribution until April 27 without (on-site protection) (10 million cases) and a more than 35 times larger distribution without one of the four measures (35 million). .
The opposite is likely to be the case: without social distancing measures, places are more likely to increase in Covid 19 cases.
This is suggested by the epidemiological evidence from previous outbreaks. Several studies of the 1918 flu pandemic found places where faster and more aggressive steps were taken to enforce social distance and save lives. But this study also shows the consequences of withdrawing restrictions too early: A 2007 JAMA study found that St. Louis – widely praised for its response to the 1918 pandemic – closed schools, banned public gatherings, and other restrictions eased saw an increase in deaths.
This is what it looks like in diagram form: The line diagram shows excessive cases of flu death and the black and gray bars below indicate when social distance measures were taken. The highest peak is seen after the removal of the social distancing measures, with the mortality rate falling only after their reinstatement.
This didn't just happen in St. Louis. The JAMA study analyzed data from 43 cities and found this pattern repeatedly across the country. Howard Markel, author of the study and director of the Center for History of Medicine at the University of Michigan, described the results as a series of "double hump epicurves" – officials initiated social detachment measures, then saw flu cases withdrew, and saw flu cases rise again.
Overall, the United States is essentially experiencing this second hump in the epi curve: after the states managed to suppress the growth of coronavirus cases through social detachment measures, they have subsided, and now the cases are increasing again.
This does not necessarily mean that everything has to be shut down again. When the pandemic struck the United States for the first time, many states quickly closed as many public places as possible, as little was known about where the greatest risk of coronavirus transmission was. Now we have a better – if not perfect – understanding of how the SARS-CoV-2 corona virus works.
For example, outdoor spaces appear to be much safer because the outdoor droplets are more difficult to float from person to person, and the warmer weather, humidity, and UV light may also play a role. This suggests that states could likely keep parks, beaches, and other outdoor venues open – as long as people follow recommended safety practices, such as wearing a mask and holding 6 feet from others.
In this sense, personal precautions seem to be more effective than originally expected. Several recent studies have found that masks alone reduce transmission. Some experts believe – and early research suggests – that masks have played an important role in containing Covid 19 outbreaks in several Asian countries where they are commonly used, such as South Korea and Japan.
All of this suggests that some places, especially those outside, could be safely reopened or left open with the right precautions.
The key, experts said, is to slow down the process. States should open things up, step by step, in different phases to see what leads to an unmanageable increase in coronavirus cases and what not, while building a public health surveillance system to accommodate these increases through testing and contact tracking can. Over time, this approach can strike a balance between public health needs and restoring a sense of normalcy.
"Since this is new and we don't have data and experience, it makes sense to take things slowly," said Lauren Meyers, a math biologist at the University of Texas at Austin. "Relax bit by bit and check if it works. If we relax some measures, we will observe the data for a few weeks. If it does not increase, we may be able to relax a little more."
A key element of this – and one where states have generally failed – is the plan to withdraw the reopening if things go bad again. "One of the most important parts of this entire reopening experiment is knowing when the reopening needs to be slowed down based on public health criteria," said Abraar Karan, a doctor at Brigham and Women’s Hospital and Harvard. "That is why it is so important to have a public health surveillance system in place."
And when things get out of control, a community may have to close everything down to get things under control. "What we want to do is avoid a situation where the only measure that will change things is a complete arrangement of the accommodations on site," said Meyers. “However, if we exercise caution and do not take these small steps to protect ourselves, we may find ourselves in a situation where this is the only thing we can do to prevent overwhelming hospitalization and alarming deaths. "
It is not clear what states will do now
It is currently unclear whether local and state officials will take the precautionary measures recommended by experts.
The federal government could encourage stronger measures. However, the Trump administration has been largely absent in recent weeks. She stopped the daily coronavirus briefings, denied there was any new increase in Covid 19 cases, and generally made little comment on the latest trends. The White House guidelines have also suggested that the Trump administration wants most of the problem left to states, local governments, and private actors.
In some cases, the administration has promoted the opposite of what experts have asked for. Trump has repeatedly urged states to reopen their economies – which was clearly an early step. He has also taken bizarre positions, such as his comments that the US should slow down tests and that masks do more harm than good.
The problem for local and state officials is that many of Trump's supporters and Republicans generally take what Trump says seriously. When Trump downplayed the Covid-19 threat and the benefits of masks, his followers are listening – and that may make his supporters more resilient to their local and state leaders taking aggressive measures against new coronavirus outbreaks. In this context, it is no coincidence that most of the countries that are currently suffering the worst are led by republican governors.
Then there is the economy. Although research suggests that it is better for the economy to control an outbreak in the long term, closing jobs means economic pain in the short or medium term. Local and state leaders have to balance these tensions.
Still, it can get so bad at some point that officials feel compelled to act independently. According to reports that some hospitals in Texas were approaching capacity due to an increase in Covid-19, Governor Greg Abbott slowed down the reopening of his state, held or shut down some companies with reduced capacity, or closed them entirely and closed bars. (This happened after months of Abbott pushing the state to reopen and overriding local governments trying to stay closed.)
Apart from government measures, people may act independently. Even after the state and local governments went to reopening, people were slow to take a rosy look at the situation with Covid-19 at times, and still chose to stay home. If people see first-hand the effects of the corona virus in their communities, they may be pushed back to a strictly social distance, regardless of what their political leaders tell them.
How all these factors could come together, from individual decisions to government measures, will determine how bad and long-lasting this new spike in coronavirus cases is. According to experts, however, part of the increase has already occurred – it will likely take weeks for new measures to take effect and lead to a decrease in Covid 19 cases.
"We have to brake long before we reach hospital capacity," said Meyers. “New York hit the brakes in mid-March. Only in early or mid-April did the deaths finally peak and start to decline. You can brake today, but you won't see the effects until a few weeks later. "
Therefore, it was important to act before the situation came and why it was so dangerous for officials to loosen social detachment measures before the cases of Covid-19 began to fall. Several countries see and will continue to suffer the consequences.
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