As coronavirus cases rise nationwide, public health experts urge caution - MSN Money

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When Gov. Doug Ducey allowed Arizona’s stay-at-home order to expire on May 15, 340 patients were in intensive care units statewide due to the novel coronavirus — the largest number since the beginning of the pandemic. Public health experts at the University of Arizona spent the week before publicly pleading with Ducey to postpone reopening, suggesting cases in the state were still projected to grow.

© Caitlin O’Hara for The Washington Post People spend time in a coffee shop at the Scottsdale Quarter shopping center in Scottsdale, Ariz., on Wednesday.

About two weeks later, the maximum amount of time it takes the virus to incubate, Arizona began seeing a precipitous rise in cases and a flood of new hospitalizations, straining medical resources and forcing the state’s top medical official to reissue a March order urging all hospitals to activate emergency plans.

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What Arizona is experiencing could be an ominous sign. More than a dozen states are showing new highs in the number of positive coronavirus cases or hospitalizations, according to Washington Post data, a few weeks after lifting restrictions on most businesses and large gatherings.

Democratic presidential candidate and former Vice President Joe Biden speaks at a campaign event devoted to the reopening of the U.S. economy during the coronavirus pandemic in Philadelphia, Pennsylvania on June 11.

Barber Michael Nasimov cuts hair with a protective face mask between plastic separations as phase two reopening continues during the outbreak of the coronavirus disease at Joseph Hair Salon in Port Washington, New York on June 11.

Guests wearing face masks ride a roller coaster at SeaWorld as it reopened with new safety measures in place on June 11 in Orlando, Florida. The park had been closed since mid-March to stop the spread of the coronavirus.

Dan Abrams carries a box of food to a car during the Greater Cleveland Food Bank food distribution on June 11 in Cleveland, Ohio. 

Compton Early College High School graduating student Chelsea Donis adjust her mortar after picking up her diploma in a parking lot during a drive-thru graduating ceremony, during the outbreak of the coronavirus disease in Compton, California on June 10.

Sea World Orlando president Kyle Miller, left, talks to invited guests during a media preview on June 10, ahead of the formal reopening to guests.

New York Governor Andrew Cuomo speaks at a press conference held in LaGuardia Airport's new Terminal B on June 10, in New York City. Citing LaGuardia Airport's old age and criticisms comparing it to a "third-world country," Cuomo praised the airport's drastic remodeling, a mutli-year, multi-billion-dollar construction project.

Beachgoers take advantage of the opening of South Beach on June 10, in Miami Beach, Florida. Miami-Dade county and the City of Miami opened their beaches today as the area eases restrictions put in place to contain COVID-19.

A COVID-19 screening site stands without anyone to be tested outside VA Long Beach Healthcare System on June 10, in Long Beach, Calif.

An American Airlines ticketing agent helps a woman as she approaches the counter in Denver International Airport as travelers deal with the effects of the new coronavirus on June 10.

Boaters are silhouetted on Wyandotte County Lake, on June 10, in Kansas City, as people continue to get outside more since restrictions meant to limit the spread of the coronavirus are lifted.

Compton Early College High School graduating students wait after picking up their diplomas in a parking lot during a drive-thru graduating ceremony, in Compton, California on June 10.

An Iowa State Fair marquee stands next to an empty grand concourse on the fairgrounds on June 10, in Des Moines, Iowa. This summer's Iowa State Fair was cancelled Wednesday due to concerns about the coronavirus, marking the first time since World War II that the annual gathering won't be held in Des Moines.

Brett Kraus of Oakdale works out on the first day the gym reopened in Minnesota at Anytime Fitness in Oakdale, Minn., on June 10. 

An aerial view of people eating dinner at the Bracco's resturaunt on the Nautical Mile on June 10, in Freeport, New York. 

Leah Ginnis, 3, hands out gift bags in advance of her fourth birthday during a short graduation ceremony for her Pre-K class in front of their school in Jersey City, New Jersey on June 10. Among other gifts, the children received face masks and parents received a certificate of appreciation. New Jersey eased its restrictions on gatherings Tuesday, allowing up to 50 people to get together inside and as many as 100 outside as the state begins to lift measures meant to slow the spread of the coronavirus.

A staff member at Mad Men Barbershop tends to a client on June 10 in Wantagh, New York. Hair salons and barbershops on Long Island were permitted to open today as the region entered Phase II of New York State's plan to return to normalcy after closings were mandated due to the coronavirus pandemic.

Two girls walk past a store with sale signs displayed at Great Lakes Mall on June 10 in Mentor, Ohio. Sales for retailers have plunged since the coronavirus pandemic.

Washington D.C Mayor Muriel Bowser greets nurses before being tested for coronavirus at a testing site in the Anacostia neighborhood June 10 in Washington, D.C. Earlier in the day Bowser held a press conference to give updates on the response to COVID-19 in the nation’s capital.

Beachgoers walk past a social distancing sign on the ground as beaches are reopened with restrictions to limit the spread of the coronavirus disease, in Miami Beach, Florida, on June 10.

Jennifer Udvadia and Patrick Bounaiux share drinks at Bright Eye Beer Company on June 10 in Long Beach, New York as Long Island progressed to phase two of the state's reopening plan during the current coronavirus outbreak.

Matt Comstock wearing a protective face-mask, takes the temperature of a guest at Busch Gardens Tampa Bay on June 10 in Tampa, Florida.

Ann-Marie Gomes (L) and Juanita Thompson count and verify mail ballots at the Clark County Election Department, which is serving as both a primary election ballot drop-off point and an in-person voting center amid the coronavirus pandemic on June 9, in North Las Vegas, Nevada. This is the first time ballots have been mailed to all registered active voters in Nevada's history as the state holds its first-ever election done almost entirely by mail due to the risk of spreading COVID-19. 

A couple gets their temperature checked as they enter a restaurant on Ocean Drive in South Beach, Miami, on June 9. 

New Jersey Gov. Phil Murphy speaks during a coronavirus briefing in Trenton, N.J., on June 9. New Jersey has eased its restrictions on gatherings, allowing up to 50 people to get together inside and as many as 100 outside as the state begins to lift measures meant to slow the spread of the coronavirus.

Travis Strobel, an auto glass technician at Binswanger Glass, cuts half-inch thick plexiglass into legs for plexiglass shields for Kansas election polling places, on June 9, in Topeka, Kan. The Kansas secretary of state's office is buying more than 2,000 shields ahead of the state's Aug. 4, 2020, primary election.

(L-R) Redwood High School seniors Piper Tonne, Gabe Lewis and Charlie Tantum work on decorating their graduation caps on June 9, in Tiburon, California. 

A person walks over signs on the floor asking people to follow a particular direction of travel, and to maintain 6 feet of social distance in Spring Township, PA on June 9 at P.J. Whelihan's.

Tourists walk by newly reopened restaurants, on June 9, in Boothbay Harbor, Maine. Many Maine tourists towns have seen a sharp drop in the number of visitors due to the coronavirus pandemic.

Voters cast their ballot at Dekalb County's Decatur Recreation Department precinct in the coronavirus-delayed Georgia presidential preference primary election in Decatur, Georgia, on June 9. 

Rep. Charlie Baum, R-Murfreesboro, front left, and other House members sit behind glass partitions due to the coronavirus pandemic during a House session on June 9, in Nashville, Tenn.

An employee works to make masks at New Balances factory in Lawrence, MA on June 9, which has converted its operations to produce personal protective equipment (PPE) with the assistance of the Massachusetts Emergency Response Team (M-ERT).

Labor Secretary Eugene Scalia(L), elbow bumps Chairman Chuck Grassley, before the start of a Senate Finance Committee for a hearing on COVID-19/Unemployment Insurance on Capitol Hill in Washington,D.C on June 9.

Dr. Sylvia Stellmacher, sits as Seattle Fire Department paramedic Stuart Patterson prepares to take a nasal swab sample to test for coronavirus at a testing site on June 8, in Seattle. The new citywide testing program expanded testing criteria to include individuals who participated in demonstrations throughout the past week, where people who have been protesting the death of George Floyd, a black man who was in police custody in Minneapolis.

Manager Angel Ramos arranges shoes on a display in Top shoes on June 8 in New York, after retail stores were allowed to reopen to customers, but with some restrictions, like curbside pickup on orders, and required wearing of face coverings, as part of the state's phase one reopening plan.

Hand sanitizer and a card explaining there will be no smoking or eating at gaming tables await the return of gamblers at Rivers Casino in Pittsburgh on June 8. The casino is scheduled to re-open at 9 a.m. Tuesday, operating at 50% capacity to comply with Pennsylvania Gaming Control Board COVID-19 protocols. 

Roadway sign on the Manhattan Bridge stating "Social Distancing Required" as New York City enters Phase 1 of Coronavirus reopening in , New York on June 8.

Nyasha Sarju sits as a Seattle Fire Department paramedic takes a nasal swab sample to test for coronavirus at a testing site on June 8, in Seattle, after Sarju came in to be checked following her protesting over the past two weeks in the city. The new citywide testing program expanded testing criteria to include individuals who participated in demonstrations throughout the past week, where people who have been protesting the death of George Floyd, a black man who was in police custody in Minneapolis.

Construction workers assemble a scaffold at a job site, as phase one of reopening after lockdown begins, during the outbreak of the coronavirus disease in New York City, New York, on June 8. 

Assemblyman Ian Calderon, D-Whittier, top center, presents a measure before the Assembly at the Capitol in Sacramento, California on, June 8. The Assembly held its first full session since going into a recess in March due to the coronavirus pandemic. Lawmakers practiced social distancing by having only one person per pair of desks and other legislators moved to different areas of the chambers.

Plastic coverings overlay individual booths at a reopened restaurant after restrictions to prevent the spread of the coronavirus disease are eased in Bloomfield Hills, Michigan, on June 8. 

Wearing masks to protect against the new coronavirus, Miami-Dade County Mayor Carlos Gimenez, left, gives a tour to Acting Secretary of Homeland Security Chad Wolf, and Admiral Karl Schultz, right, Commandant of the U.S. Coast Guard, of the Miami-Dade Emergency Operations Center, on June 8 in Doral, Florida. Wolf, who also toured the National Hurricane Center, spoke during a news conference on the on DHS's operational readiness for the hurricane season. 

Commuters ride the subway on the first day of New York City's Phase 1 reopening during the outbreak of the coronavirus, on June 8.

Diners eat outdoors at Mother Anna's restaurant on June 8 in Boston's North End neighborhood.

Press conference held by New York Gov. Andrew Cuomo on the first day of the phase 1 reopening amid the coronavirus outbreak, on June 8.

A woman and child use hand sanitizer at CambridgeSide in Cambridge, during the first day of Phase 2 of re-opening in Massachusetts on June 8.

Pedestrians wear face coverings and protective masks as they cross Mains street, on June 8, in the Flushing section of Queens, New York.

A passenger wears personal protective equipment (PPE) while aboard a Southwest Airlines flight from Los Angeles to Houston, on June 7. All passengers were required to wear face coverings and middle seats were left unoccupied to allow for social distancing.

Amid the COVID-19 outbreak and unable to hold formal graduation exercises, high school seniors in Arlington, Mass., hold a caravan parade to celebrate graduation on June 7.

A picture-perfect day at Venice Beach, California, on June 7.

50/50 SLIDES

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The spikes provide disturbing data points for the ongoing tug of war between federal, state and local officials weighing the economic costs of restrictions meant to stop the spread of the virus with the human cost of lifting them.

“Worse times are ahead,” said Joe Gerald, an associate professor and public health researcher at the University of Arizona who has been part of an academic team providing projections to the state health department. “The preponderance of evidence indicates community transmission is increasing.”

Texas, Arkansas, South Carolina, Nevada, Arizona, North Carolina, Oregon, Florida and Utah all set new highs in seven-day rolling case averages Wednesday, according to Post data.

Montana, Arkansas, Utah, Arizona and Texas have all seen coronavirus hospitalizations rise by at least 35 percent in the weeks since Memorial Day.

Some states are pressing forward with reopening even as local officials point to data that suggests an increase, not a reduction, in the risk of transmission. The uptick may not directly correlate to reopenings in all states, as more robust testing or other localized factors could play a part.

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Officials have also expressed concern that the virus could have spread among thousands of people protesting against police brutality, but experts said it is too early to determine the impact on case numbers.

Texas will begin allowing restaurants and businesses to operate at 75 percent of their normal capacity on June 12. The state set a new high in coronavirus hospitalizations for the third straight day on Wednesday and now has 2,153 patients hospitalized with the virus — more than at least 15 states have reported for the entire pandemic, according to The Post’s data.

Gov. Greg Abbott (R) let his state’s stay-at-home order expire April 30. As he lifted restrictions, Abbott said he was keeping a close watch on hospitalizations and the rate of positive cases as the state rapidly expanded testing capacity.

“Every Texan who needs access to a hospital bed will have access to a hospital bed,” vowed Abbott spokesman John Wittman.

Steve Love, president of the Dallas-Fort Worth Hospital Council, said the steady uptick in cases was likely linked to activities on Memorial Day.

“People need to be very careful and continue to social distance,” he said.

Arkansas Gov. Asa Hutchinson (R) announced Wednesday that despite rising case numbers, his state will be moving into Phase 2 of its reopening beginning Monday.

“Americans are on the move, and they can’t be tied down, and they can’t be restrained unless they make a voluntary decision that this is right for me and my health or my family,” said Hutchinson, who added “there is no evidence of a correlation” between reopening of businesses and the rising case rates.

Appathurai Balamurugan, the state’s deputy chief medical officer, said Arkansas is moving forward with reopening because the hospitalization rate had not dramatically spiked and the state is relying on contact tracers to determine the effect of reopening. He said only a small percentage of new cases were in people who visited restaurants, salons or other businesses.

Arkansas has established a new high in average daily coronavirus cases nine times in the past 15 days, according to Post data.

In Arizona, Ducey (R) has insisted he and his team expected a rise in cases to follow reopening, in part due to the doubling of testing statewide since mid-May. Leaders in Mississippi, Alabama, Florida, Texas and other states have also made similar statements in recent weeks.

“We have anticipated increased cases in June,” said Ducey spokesman Patrick Ptak. “We’ve spent the last few months working to increase capacity to ensure every Arizonan has access to care, should they need it.”

South Carolina, which reopened most businesses by the end of May, has more daily cases than ever before, higher than a previous peak in April. Nearly 15 percent of all coronavirus tests statewide have come back positive. Hospital bed use is also increasing, although public health officials say that could be attributed in part to elective procedures put off earlier this year. The state set a new seven-day average for new cases Wednesday, the 14th time in 15 days it has done so, according to Post data.

“I am more concerned about covid-19 in South Carolina than I have ever been before,” said Linda Bell, the state epidemiologist, at a Wednesday afternoon news conference, referring to the disease the virus causes.

Gov. Henry McMaster (R) said the state would not reimpose any restrictions.

“Shutting down is not the answer,” he said. “People have to be able to go and work for a living.” He said South Carolina slowed the spread enough to “arm ourselves with the knowledge of what we need to do to be safe . . . We now need to practice what we have learned.”

Tom Frieden, former director of the Centers for Disease Control and Prevention, said drawing direct lines from reopening to increases in cases skips potential nuances that exist in each state. In Michigan, he said, a large influx of tests is contributing to a rise in cases. In other states, like Arizona, positive test rates are outpacing the increase in testing, suggesting testing is not behind the rise.

“It’s not a question of opened versus closed. We were never fully closed and until there’s a vaccine, we won’t be fully open. It’s a question of modulating,” Frieden said.

Traditional public health strategies usually value the insight local authorities have and prioritize the decisions they make for those they serve. But as states like Arizona and Arkansas reopen, local officials have found their hands tied by state restrictions.

Ducey’s executive order lifting restrictions includes language that prohibits mayors and county officials from imposing further restrictions to help limit the spread of the virus locally.

“I can no longer put in place restrictions, for example, on nightclubs. We can’t do additional health restrictions on things such as masking,” said Phoenix Mayor Kate Gallego (D), who is prioritizing messaging urging people to wear masks and social distance.

“But we do still have control over our city facilities. Our senior centers are still closed. Our libraries are curbside only. With our city services, we’re trying to send a message that we can’t go back to normal.”

Little Rock Mayor Frank Scott Jr. (D) has experienced similar challenges in Arkansas. As state officials resisted implementing a state-at-home order, Scott and his administration used executive orders to create what he called a “modified shelter-in-place policy” that included nighttime curfews, closing city parks, and limiting restaurants to delivery and takeout. But Scott said he eventually had to rein in curfews and other restrictions to comply with state law allowing bars and restaurants to open.

“That’s the reason we’ve ramped up even more testing, data and mask distribution,” Scott said. “And we’re going to continue to find ways to get creative from a communications standpoint to try to continue to slow the community spread.”

Different states have touted different metrics, making it difficult to assess local conditions.

Florida has not reported hospitalizations for influenza-like illness since the end of May, when the rise in cases began. In Utah, Republican Gov. Gary R. Herbert and members of his task force have emphasized the low fatality rate among those sickened with the virus, which is about 1 percent, according to Michael Good, CEO of University of Utah Health.

Health and emergency operations staff have pressed for further analysis about the impact of the rising case load on Utah hospital capacity, according to an official privy to the discussions who spoke on the condition of anonymity to reveal internal deliberations.

Herbert’s office did not return a request for comment.

In Arizona, Gerald argues the spike is not due to increased testing. He says the statistical impact of a testing blitz toward the end of May has subsided, and two weeks of relatively stable levels of testing have still seen a surge in new infections. Mounting caseloads, combined with a corresponding increase in coronavirus-related hospitalizations and ICU care, he said, roughly correspond to the state’s relaxation of distancing requirements.

“At the current pace of viral spread, we risk reaching or exceeding our hospital capacity sometime in July,” he said.

Banner Health, Arizona’s largest hospital system, sounded a similar alarm in a news briefing last week when Chief Medical Officer Marjorie Bessel showed data that the number of coronavirus patients in Banner hospitals had tripled in the past three weeks.

Banner Health told the state Tuesday it is unable to take any new patients requiring extracorporeal membrane oxygenation — a machine that helps patients whose lungs are so damaged that a ventilator is not enough. Bessel said her hospitals still have ventilator and ICU capacity for now.

Hospital capacity continues to be a concern in many states with spiking cases, according to local officials in the South and West who point to hospitals near nursing home outbreaks as most immediately at risk of becoming overwhelmed. Other at-risk facilities include those near rural areas without adequate health-care facilities of their own.

The White House has expressed concern about rising cases in North Carolina, where hospitalizations continue to rise and the state reported 1,011 new cases Wednesday. The state reopened restaurants, salons and swimming pools at half capacity on May 22.

“Our metrics have moved in the wrong direction,” Mandy Cohen, the state’s top health official, said Monday.

Jacqueline Dupree contributed to this report.

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