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Experts say whether people follow guidelines such as physical distancing and face masks will determine if reopening is successful. Getty Images
  • More than 30 states are reporting an increase in confirmed COVID-19 cases in the midst of the reopening of businesses and public facilities.
  • In addition, 12 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 is a key indicator if reopening is working or not.

It appears to be official.

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

A daily tracking map done by The New York Times reports that 35 states have had a rising number of new confirmed COVID-19 cases over the past 14 days.

The map also shows 13 states where cases have plateaued and only two states where case numbers have decreased the past two weeks. They are Maryland and Rhode Island.

The graphic shows new COVID-19 cases had dropped in the United States to about 20,000 per day from mid-May through early June. However, in the past three weeks, the number of cases has steadily risen to the 40,000 per day level.

On Tuesday, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told a Senate committee that if the current trend continues the United States could eventually see 100,000 new COVID-19 cases per day.

A weekly graph released every Tuesday by Reuters reported that the United States experienced a 46 percent increase in new COVID-19 cases for the week that ended June 28.

The graph showed four states in which new COVID-19 cases have doubled in the past week. They are Washington, Idaho, Louisiana, and Florida.

In addition, nine states saw weekly infections rise by more than 50 percent. Eleven states showed a decrease from the previous week.

The report noted that 21 states are now recording positivity rates above the level the World Health Organization (WHO) considers as “concerning.”

It also reported that the percentage of positive test results rose to 7 percent this past week compared to 5 percent the week before.

Arizona’s positivity rate was listed as 24 percent while Florida registered at 16 percent and Texas, South Carolina, and Nevada all had 15 percent rates.

In addition, 12 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.

The Reuters graph shows that the number of COVID-19 deaths hit a high of more than 2,000 per day in mid-April and had declined steadily to about 600 per day in mid-June.

However, the United States recorded 5,605 deaths this past week, a daily average of 800 deaths and 35 percent higher than the previous week.

Much of that increase is attributable to a spike of reported deaths in New Jersey. In all, only 10 states reported increases in deaths the past week.

The rising numbers has intensified the debate over how quickly states should reopen.

As of today, 17 states are either pausing or rolling back their reopening plans due to the spike in COVID-19 cases and hospitalizations.

Experts told Reuters that part of the rise in new COVID-19 cases is due to the 9 percent increase in testing nationwide.

However, they add that states reopening businesses as early as May 1 is another important factor. They said that the trend in most states is people under 35 going to bars, parties, and social events without masks, and then becoming infected and transmitting the virus to others.

Michigan officials, for example, reported on Tuesday that 107 new COVID-19 cases have been traced to one bar in East Lansing.

The New York Times notes that places where people are clustered together such as nursing homes, food processing plants, and prisons have also contributed to the spike in cases.

Fauci said about 50 percent of the new COVID-19 cases nationwide are coming from four states — Florida, Arizona, Texas, and California.

Florida recorded more than 43,000 new COVID-19 cases the past week, a 101 percent increase from the previous week, according to the Reuters graph.

The number of new cases in the Sunshine State have increased fivefold in the past two weeks, reaching a record daily high of 9,585 on Saturday.

That number dropped to slightly more than 6,000 on Tuesday.

The state is also reporting increases in hospitalizations.

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

Four bars in Key West closed their doors last week.

Arizona reported more than 21,000 new cases last week, a 29 percent increase from the surge of infections the week before.

The state set a daily record of more than 3,800 new cases on Sunday. It was the seventh time in 10 days new cases had topped the 3,000 mark.

As of Sunday, 84 percent of Arizona’s hospital inpatient beds were in use and 88 percent of beds in intensive care units (ICUs) were occupied.

On Monday, Arizona’s governor ordered bars, gyms, movie theaters, and water parks to close for at least 30 days due to the spike in cases.

Texas reported more than 37,000 cases the past week, a 56 percent increase from the previous week.

The Lone Star State also reported a daily record of 6,975 new cases on Tuesday morning.

On Monday, the state reported 5,913 people were hospitalized with COVID-19. That was also a new record.

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.

California is also seeing a worrisome trend.

The Golden State reported more than 37,000 new cases this past week, a 50 percent increase from the week before.

California set a daily record on Monday with 8,184 new cases. Many of the new cases are being reported in Los Angeles, Riverside, and Imperial counties.

California’s governor has ordered bars to shut down in seven counties, including Los Angeles and Imperial counties.

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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 Healthcare Website in late May.

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.

Dr. David Rubin, MSCE, director of PolicyLab at Children’s Hospital of Philadelphia, which has been modeling the spread of COVID-19, said in late May that the United States may have flattened the curve at a higher level than we’d like in most places, but the country had largely flattened it then.

“Now, the question is, can we keep it flat?” he told Healthcare Website.

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

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.”

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.

“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.