When the LA Surge Hospital closed its doors on June 1 — just nine weeks after it was opened as an emergency facility to treat coronavirus patients — it was a bittersweet moment for Chad Ricks, an associate chief nursing officer who managed the site.
Although he had to say goodbye to his colleagues, the hospital’s closure was a sign that Los Angeles — and the country at large — might be returning to something like normal. “Cases were starting to stabilise and the county was better able to manage its intensive care capacity,” says Mr Ricks, who is currently recovering from the virus after contracting it while working at another facility.
However, he feared California was reopening its economy too quickly and that officials had shut the facility prematurely. “Many of us thought we might need to keep it open a little longer, but no one asked our opinion,” adds Mr Ricks.
He was right to be worried. Coronavirus is now spreading rampantly in Los Angeles and throughout California, as well as in other sunbelt states including Texas, Florida and Arizona. On Thursday, the US reported 71,000 new cases of the virus, setting another daily record, and 977 additional deaths.
Even as countries in Europe and Asia appear to have had some success in taming coronavirus, it is now surging uncontrollably in large swaths of the US. Just over 4 per cent of the world’s population lives in the US, but it accounts for a quarter of confirmed cases globally.
Public health experts blame the latest wave of infections on governors who hastily reopened their states despite the risks, as well as crippling testing delays, and a toxic political backdrop in a polarised country where the use of face masks has become a divisive issue.
“This is the greatest public health catastrophe in the US since the 1918 influenza, and the principle difference is that we knew enough to stop this from happening to this extent,” says Barry Bloom, a professor of public health at Harvard University.
Prof Bloom says the experience of New York and other places that were hit hard earlier in the pandemic should have served as a clarion call to other states. “They had a head start, but the political attitude was that the only thing that counted was keeping the economy going. They paid a big price for that. It is so frustrating because it didn’t have to happen.”
A healthcare worker tends to a patient in the Covid-19 unit at United Memorial Medical Center in Houston, Texas. Several sheriffs in the state have said they will not enforce a statewide mask mandate © Mark Felix/AFP
Opening and closing the economy
When coronavirus first erupted in the US in early March, states in the north of the country such as New York, Michigan and Washington bore the brunt of hospitalisations and deaths. Now the crisis is at its most acute in states such as Texas and Florida, where residents are trapped in a horror movie that will feel familiar to New Yorkers, replete with the constant wail of ambulance sirens, hospitals at breaking point and makeshift morgues.
Although mortality rates are still lower in the sunbelt states than in places like New York, doctors predict the national death toll — which currently stands at more than 138,000 — will climb significantly. “I guarantee it will continue to go up for several weeks as it inevitably spreads to older and more at-risk patients,” says Leora Horwitz, an associate professor of population health at the NYU Langone Health medical centre.
Public health experts say the recent surge in virus cases is a direct result of the reopening in April and May of several states where the coronavirus case count was still climbing, albeit from a relatively low base.
People enter the Downtown Disney District in Anaheim, California, after it reopened following its closure over coronavirus © Mario Tama/Getty
“The reason there is an incredibly gigantic rise in multiple states is because they decided to go back to life as usual before they reduced the number of cases to a low enough level that they could trace people’s contacts,” says Prof Bloom.
Bob Wachter, chair of the department of medicine at the University of California, San Francisco, describes the political leadership in these states as “cavalier”, adding: “There were too many people who thought it was a hoax. [Those places] are doing very badly.”
Most state governors have responded to the latest infections by pausing or reversing their reopening plans. Several school districts, including Los Angeles, have said they will not allow pupils to attend school in person when the term starts again in August. But almost no one is countenancing the kind of full-scale lockdown that proved so effective in suppressing the virus in the spring.
Restaurant workers protest over closures in Miami. Coronavirus is now spreading rampantly throughout the sunbelt states, including Florida © Cristobal Herrera-Ulashkevich/EPA
Some argue that Donald Trump is culpable because he encouraged states to lift coronavirus restrictions quickly in a misguided attempt to boost the US economy ahead of November’s presidential election. “There was a lot of pressure from the White House for a lot of states to reopen,” says Saskia Popescu, an infectious disease specialist at George Mason University, adding that the reopening in May of Arizona, which is experiencing a resurgence of cases, coincided with a high-profile visit from Mr Trump.
“It’s a failure of leadership in the national government,” Prof Bloom says. “Our president effectively said, ‘let’s forget about the epidemic, we have to get the economy back on track so we can win the election’. That is killing a lot of people.”
Exacerbating the problem in some parts of the US are the long delays in processing test results, with many states reporting waiting times of seven days or more. There are more test kits available than there were at the start of the crisis — more than 4m people are being tested a week — but laboratories are struggling to keep up with demand.
“No one expected that the lag time would go from a day or two to seven or, in some cases, 14 days,” says Rajiv Shah, president of the Rockefeller Foundation, which this week published a plan calling for the country to spend $75bn on a mass testing programme.
“With the seven-day lead time you basically aren’t testing at all, it’s the structural equivalent of doing zero tests,” says Dr Shah, explaining that people are at their most contagious during the earlier stages of the disease. If someone finds out they are positive a week or more after being tested, they might have already stopped shedding enough virus to infect someone else, he adds.
A sign at the Covid-19 testing site in Delmar Stadium, Houston, Texas. Public health experts blame the latest wave of infections on governors who hastily reopened their states, as well as crippling testing delays and a toxic political backdrop © Aaron M Sprecher/EPA
Dr Shah says the delays are a product of the private testing laboratory industry in the US, which is dominated by two large players: Quest and LabCorp. “As monopoly companies . . . they don’t have enough capacity in their central processing systems for the volumes that are necessary right now,” he says.
Quest said it was “broadening access” to coronavirus testing by outsourcing samples to independent labs, but warned that “demand for diagnostic testing is growing even faster”. The company said it was able to process 125,000 tests a day and expected to increase this to 150,000 by the end of July. LabCorp said the average time to deliver results was now four-six days as a result of “significant increases in testing demand and constraints in the availability of supplies and equipment”.
The testing delays — which mean the true case count is probably much higher — also threaten to erase hard-won gains in states that have managed to bring the virus under control, such as New York and Massachusetts. This week, City MD, a chain of urgent care clinics in New York City, warned customers it would take a minimum of seven days to return results.
President Donald Trump with Anthony Fauci. Some members of the administration have waged a briefing campaign against the nation’s top infectious diseases doctor and member of the White House coronavirus task force © Drew Angerer/Getty
‘Stream of misinformation’
Others argue that the politicisation of the virus is encouraging some Americans to ignore the risks. Mr Trump has repeatedly claimed his opponents are exaggerating the severity of the crisis in an attempt to discredit his presidency.
Ashish Jha, director of the Harvard Global Health Institute, says a “very strong stream of misinformation” is being spread on social networks such as Facebook, and amplified by Mr Trump.
This week, the president retweeted a post from Chuck Woolery, a retired game show host, which claimed that Democrats, the media and public health officials were telling “outrageous lies” about the virus. “I think it’s all about the election and keeping the economy from coming back, which is about the election,” he wrote. A few days later, Mr Woolery deleted his Twitter account after his son contracted the virus.
Demonstrators protest against a statewide mandate requiring facial coverings to be worn by anyone out in public © Karen Ducey/Getty
Masks in particular have become a divisive issue, with some Trump supporters refusing to wear them to show solidarity with the president. This week, the Republican governor of Georgia, Brian Kemp, suspended state rules that mandate mask-wearing, overturning decisions taken by other elected officials including the mayor of Atlanta. In Texas, several sheriffs have said they will not enforce a statewide mask mandate.
“We’re having absolutely insane debates about whether masks are mind control,” Prof Jha says. “This is not what a serious country does.”
Meanwhile, the White House has been distracted by infighting. This week, some members of the administration waged a briefing campaign against Anthony Fauci, the nation’s top infectious diseases doctor and a member of the White House coronavirus task force. The attempt to discredit Dr Fauci was prompted by an interview in the Financial Times, in which he revealed he had not briefed the president on the virus for two months despite the recent surge in cases.
A long-running battle between two other members of the task force — Robert Redfield, the director of the US Centers for Disease Control and Prevention, and Deborah Birx, the White House coronavirus response co-ordinator, has also burst into the open. On Wednesday, Dr Redfield’s agency was stripped of its role in collecting coronavirus data from hospitals, following a campaign by Dr Birx, who felt the CDC was bungling the task, according to one person briefed on the struggle.
“This administration is literally fighting with each other about who is right and who is wrong in meetings, when they’re supposed to be working as a team to figure out what the hell’s going on,” the person adds.