Experts say whether people follow guidelines such as physical distancing and face masks will determine if reopening is successful. Getty Images
  • Nearly 30 states are reporting an increase in confirmed COVID-19 cases in the midst of the reopening of businesses and public facilities.
  • In addition, 16 states are reporting an increase in hospitalization rates.
  • Experts say the behavior of individuals as communities reopen is a major factor in whether COVID-19 cases continue to rise.
  • Experts also say the number of hospitalizations could be a key indicator if reopening is working or not.

It appears to be official.

COVID-19 has come back with a vengeance a month after many states reopened their businesses and public facilities.

On Friday morning, the United States recorded more than 40,000 new confirmed COVID-19 cases during the past 24 hours.

That easily broke the previous single day record set on April 24.

A daily tracking map done by The New York Times reports that 29 states have had a rising number of new confirmed COVID-19 cases over the past 14 days.

Ten states in the South are on the list. The region was the first to reopen businesses and public places.

The map also shows 10 states with decreasing case numbers over the past 2 weeks and 11 states where cases have plateaued.

A weekly graph done earlier this week by Reuters reported that the United States experienced a 25 percent increase in new COVID-19 cases for the week that ended June 21.

The graph showed 25 states with an increase in COVID-19 cases from the previous week. Ten states saw weekly infections rise by more than 50 percent. Twelve states reported new weekly highs in cases.

On Wednesday, another tracking model reported that the seven-day average of new COVID-19 cases was 31,172. That was 34 percent higher than the previous seven days.

In addition, 16 states are reporting increases in hospitalization rates.

The steady increases in cases and hospitalizations prompted officials at the Centers for Disease Control and Prevention (CDC) to predict that COVID-19 deaths in the United States would rise to between 130,000 and 150,000 by July 18.

Earlier this month, another expert predicted that COVID-19 deaths in the United States could hit 200,000 sometime in September.

Those predictions come despite the fact the average number of COVID-19 deaths per day in the United States has decreased to about 600 from the high of about 2,200 in mid-April.

The rising numbers have sparked a debate over how quickly states should reopen.

“Some will say if case numbers are up, why reopen?… But we have to reopen,” Dr. David Rubin, MSCE, director of PolicyLab at Children’s Hospital of Philadelphia, which has been modeling the spread of COVID-19, told Healthline in late May. “The discussion is how well you can contain transmission as you reopen.”

His models accurately predicted a resurgence in several regions during the first half of June.

The most troublesome hot spots

Arizona, California, Florida, Oklahoma, and Texas are the states with the highest concerns right now.

Oklahoma saw the largest weekly increase, rising 111 percent to 2,284 cases. The state now has more than 11,000 cases since the pandemic began.

State officials reported on Wednesday morning that there were 482 new cases, a 4 percent increase from the previous 24 hours. That number had decreased to 395 new cases on Friday morning.

As of Friday morning, there were 308 people hospitalized with COVID-19 in Oklahoma.

Arizona was second on the weekly list.

The Grand Canyon State reported 16,699 new cases, an increase of almost 90 percent.

On Tuesday morning, Arizona reported 3,591 confirmed new COVID-19 cases the previous 24 hours, the highest on record. That state reported 3,428 new cases on Friday morning.

State officials added that 86 percent of inpatient beds and 88 percent of ICU beds were in use in Arizona.

Reuters reported that 20 percent of Arizona’s COVID-19 tests are coming back positive.

The numbers prompted Arizona Governor Doug Ducey to plead with residents to stay home and take other precautions.

Florida is also heating up.

The Reuters graph reported The Sunshine State saw 21,723 new cases in one week, an 86 percent increase.

The state has now joined six other states with more than 100,000 cases since the pandemic began.

Florida reported more than 8,900 new COVID-19 cases on Friday morning after recording more than 10,000 new cases in each of the previous two days.

Reuters reported the state’s positive test percentage has nearly doubled to 11 percent.

On Friday, state officials halted the on-premise consumption of alcohol at bars. The establishments can still sell food at 50 percent capacity.

Four bars in Key West closed their doors this week.

Texas is also battling a coronavirus surge.

The state had the fourth highest weekly increase with new cases jumping 84 percent to 23,747 infections.

On Thursday morning, Texas reported a single day record of 5,996 cases.

The total number of COVID-19 cases has doubled in Texas in the past 31 days.

Reuters reports the percentage of positive test results has risen from 7 percent to 10 percent.

Hospitalizations for COVID-19 have increased by 60 percent the past week and have tripled since Memorial Day. Officials reported that hospitals in Houston are near capacity.

The rising numbers prompted the governor of Texas on Friday to issue an executive order that reinstated restrictions on bars, restaurants, and certain outdoor activities.

Missouri, which started to reopen in early May, saw the fifth highest increase in weekly cases.

The Show-Me State recorded 2,193 new infections, an increase of 74 percent.

On Friday morning, Missouri officials reported 553 new cases over the past 24 hours. That was a new daily high.

However, officials noted that hospitalization rates are decreasing.

Last week, officials reported outbreaks of new cases in seven long-term care facilities in the Kansas City area.

They added that 30 percent of new cases were coming from rural areas.

Officials also reported last week that there are now two confirmed COVID-19 cases among the people who attended a crowded party at the Lake of the Ozarks during the final week of May.

They also noted there are no known cases resulting from two St. Louis hair stylists who tested positive for COVID-19 after showing up for work with coronavirus symptoms and exposing as many as 140 people to the virus.

Last week, Missouri lifted all its statewide restrictions on businesses.

California is also seeing a worrisome trend.

The Reuters graph showed The Golden State had nearly a 25 percent increase in new COVID-19 cases for the week that ended Monday.

However, cases have been on the rise this week. On Wednesday morning, California reported 7,149 new cases, a single day record.

On Friday, they reported 4,890 new infections, pushing California over the 200,000 mark in total COVID-19 cases.

In addition, ICU hospitalizations have increased by 18 percent in the past two weeks.

Some states are doing better

After being the number one hot spot in March and April, New York is also reporting success in its battle against COVID-19.

The Reuters graph reported that new cases in New York decreased almost 14 percent in the past week.

Last week, Governor Andrew Cuomo reported that the state has reached its lowest number of deaths since the pandemic begin.

The state is also seeing a positive test result rate of less than 1 percent.

Other states such as Illinois, Maryland, and Virginia are also recording steadily decreasing cases over the past two weeks.

The goal isn’t to eliminate the virus, Rubin noted. It’s just to maintain an equilibrium that prevents case numbers from rising out of control.

“I see many areas of the country that are teetering on that balance,” he said.

Individual behavior is crucial

People gathered in close proximity at the Grand Canyon in Arizona recently. Getty Images

Reported crowds at Memorial Day events underline a potential complication to even the most conservative reopening plans: Some people will ignore the guidelines.

Before Texas allowed businesses to reopen May 1, for example, a Dallas salon disregarded the shutdown order and opened, sparking a standoff with local authorities.

“If we have replications of what I saw on television about Memorial Day weekend, we will have a resurgence (of the virus) before next fall,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, told Healthline.

A second wave of the virus was expected to come in the fall or winter, as with most influenza-like viruses, but that doesn’t mean another wave can’t hit before then.

We may have flattened the curve at a higher level than we’d like in most places, but we have largely flattened it, said Rubin.

“Now, the question is, can we keep it flat?” he said.

But part of the variables there, he added, is that we can’t control what individuals will do.

Watching hospitalization numbers

The biggest determinant in whether reopening is going well or poorly in a region may be whether there is an increase in people being hospitalized with COVID-19.

This data varies greatly in availability across regions, making comparison difficult. It also varies because more people are being tested for COVID-19 at hospitals now than they were before.

“By now, if you have any respiratory symptoms at all, you’re tested,” said Schaffner. “Unfortunately (hospitalizations) are a lagging indicator. It takes a while for people to become sick enough to be admitted to the hospital.”

He says his home state of Tennessee (restaurants, stores, gyms reopened except in some large cities by May 1) is now seeing an uptick in hospitalization. But it isn’t clear yet if it’s a trend or just a blip.

Florida, Georgia, Virginia, Alabama, Maryland, Mississippi, Wisconsin, Minnesota, Ohio, and Arizona all reported small increases in hospitalizations in late May.

On the other hand, tracking the number of positive cases — or even the percent of tests that come back positive — often doesn’t tell the whole story. Tennessee, Schaffner noted, first tested only people who were symptomatic, then tested everyone, and now is focusing on bringing tests to high-risk populations.

So, watch hospitalizations. 

“As we do open up, all of us (medical experts) expect an increase in hospitalizations,” Schaffner said.

Where a resurgence is likely

Rubin’s model, which was updated in late May, projects the daily number of new COVID-19 cases.

There are some notable trends.

Texas, which allowed all stores, restaurants, malls and movie theaters to open in early May, appears to have some of the worst projections. 

Dallas County is projected to see roughly doubling in daily new cases. El Paso County is projected to see about a 50 percent increase.

Denton County, north of Dallas, is projected to see daily new cases double. Houston’s Galveston County is projected to see daily cases triple.

Elsewhere, Hennepin County, home to Minneapolis, is projected to see an increase in daily new cases of more than a third.

Florence County, South Carolina, is projected to see cases triple.

Tuscaloosa County, Alabama, is projected to see them more than double.

In general, though, reopening hasn’t wreaked havoc — yet.

“I don’t see a clear pattern yet. There hasn’t been a clear explosion across the country,” Schaffner said.

There has been speculation that the virus could behave like the seasonal flu, which generally fades in the summer.

Schaffner acknowledged that was a possibility.

But we don’t know that yet, he said, and it’s unlikely to fully disappear. 

“The virus is not going to take a summer holiday. It’s going to be with us, and will continue to smolder around,” he said.

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