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A free coronavirus testing site in Tucson, Arizona

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More than a dozen US states have seen a surge in coronavirus cases in recent weeks. Many of them – including Arizona, North Carolina, Oregon and Florida – are experiencing spikes in confirmed cases as they lift stay-at-home orders, so is reopening to blame? Yes, among other factors, experts say.

On 10 June, the US surpassed 2 million confirmed cases of the virus, representing a 141,000 case increase from the previous week. Two months ago, the country saw a weekly increase in confirmed cases of over 210,000, largely due to hotspots such as New York City and Seattle.

Now, however, rates of new cases in each of those cities, along with the percentage of positive tests, have decreased. But places that were not as severely impacted by the first peak are driving the recent increase, including portions of Arkansas, Georgia, and California. And some states are seeing a re-emergence of cases that had been lowered after social distancing measures were put in place.

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In Florida, stay-at-home orders took effect on 3 April. That week, 6820 confirmed cases had been reported. The state has been reopening since 4 May, and 8886 new cases were reported between 4 and 11 June. In response to the surge in cases, the lifting of stay-at-home orders was delayed in parts of Oregon, Utah and Tennessee.

For some states, there hasn’t yet been a peak in cases. In Arizona, one such state, 13.3 per cent of coronavirus tests were positive as of 12 June, according to data from The COVID Tracking Project – almost 3 times higher than the national average.

“We are seeing an increase of cases coinciding with the reopening process,” says Rebecca Fischer at Texas A&M School of Public Health in the US. She adds that it’s tricky to determine the cause, particularly as the US celebrated Memorial Day at the end of May, a holiday usually associated with social gatherings. “It’s really tough to attribute the timing, per se, to an event.”

Texas’ stay-at-home order expired on 30 April. When that occurred, Fischer says, more people re-engaged in the kinds of person-to-person contact that spreads the virus. Interactions following reopening could have increased community transmission and contributed to the spikes that 21 states are now experiencing.

Still, reopening is just one of several factors at play in the surge of cases. A lack of social and health infrastructure, lags in testing and confusion in case reporting, and individual risk-taking behavior have also advanced the spread of the virus.

Bradley Dreifuss at the University of Arizona, an emergency medicine physician and public health specialist, says that efforts to prevent and treat coronavirus infections in Arizona have been stymied by pre-existing barriers to medical care.

For example, the Navajo Nation, a part of which is located in Arizona, is considered a hotspot of the current surge. Its health service allocates $3,943 per person for health care; the average American spent $5,000 on health care in 2019, and Native populations have more underlying – and costly – health conditions than the average American.

Additional setbacks in effective testing and contact tracing means that officials trying to control the virus can only be reactive and not proactive.

Both Fischer and Dreifuss say that people in their region value independence and have not taken kindly to restrictions that come with physical distancing.

It is still possible to re-flatten the curve, though. “The horse has definitely left the barn, but I don’t know if it’s left the farm,” says Dreifuss.

Stemming this rise in cases will require a concerted effort on the part of individuals and policymakers. The US will have to implement large-scale contact tracing and testing at regular intervals for entire workplaces and communities, as well as provide a support system to healthcare workers on the frontline, Dreifuss says.

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