The past month of the American coronavirus crisis looked different.
Shops, restaurants and jobs are reopened. It has become more convenient for people to leave the house. Mass protests over the death of George Floyd at the hands of the Minneapolis police dominated television and social networks, just as fewer people spoke of wearing masks and social distance.
All this time the virus waited patiently.
“People feel that something has fundamentally changed, but nothing has changed fundamentally,” said Dr. Ali Khan, who became dean of the College of Public Health at the University of Nebraska Medical Center after leading the preparedness efforts at the Centers for Disease Control . and prevention.
“Ninety to 95% of Americans are still susceptible. The virus still exists. … The basic biology of the virus has not changed and the basic strategy to combat it has not changed, ”Khan said. “Until we take control of this disease, we must expect continued outbreaks of the disease.”
And this is what happens.
In the United States, the number of new cases has increased from 21,000 per day in the last week of May to almost 23,000 per day this week. Positive tests and, in some places, hospitalizations also increased sharply, prompting many to wonder whether the behavior changes caused an outbreak in states such as California, Arizona, and Florida.
But neither protests, nor more people leaving home explain the surge in new cases of COVID-19, as an analysis of countries TODAY in the USA with at least 100 cases showed. Residents of districts with growth of 25% or more during the previous two weeks left their homes at the same rate as residents of districts without the influx of new infections, according to the location of mobile phones collected by the company Safegraph,
And major protests were as widespread in the districts without outbreaks as in others, although these events could lead to a wide spread of the virus and still could lead to outbreaks.
At the moment, horse racing seems to be the most intense in the counties that escaped the worst outbreaks of coronavirus earlier this year. Areas with recent outbreaks remain generally lower, with an average of 614 confirmed cases of coronavirus per 100,000 people. Those with slower growth have a total of 860 per 100,000.
It seems that not a single reason explains why spikes were observed in some places, but not in others.
“I do not think this is clear. I think that is multifaceted, ”said Ted Ross, director of the Center for Vaccines and Immunology at the University of Georgia.
Rediscovery and protests
Experts suggest that people living in places that were not severely affected by COVID-19 earlier this year may be less diligent in wearing masks and maintaining a safe social distance, making them more likely to spread the virus after it enters into force.
“They are disappointed and tired. And being able to stay alert for a long period of time is difficult, especially when they don’t see the risk right in front of them, ”said Mercedes Carneton, vice president of preventive medicine at the Fainberg University School of Medicine at Northwestern University. “How long can you be afraid of a boogeyman if a boogeyman never knocks on your door?”
Others say months of closed economies and blocking orders have reduced the prevalence of the virus so much that large gatherings may carry the risk of mass spread than in early spring.
This grace period will not last forever. If large crowds of people without masks and without social distance are still gathering in the church, on the beach and in bars, then, according to experts, this is only a matter of time before an infected person provokes a new outbreak.
“Once you get into an ulcer situation, it can explode pretty quickly,” says Dr. Lisa Maragakis, senior director of infection prevention at Johns Hopkins Health System.
Since publicly available data are compiled at the county level, it is not possible to analyze important detailed information about specific social groups and individual risk factors.
For example, the surge caused by people who became ill during the protests may be masked by the fact that the prevalence of coronavirus in their home community has declined due to preventative measures. Or a spike may be associated with one mass event, such as a church service, and not with the general public, who leave their homes more often.
In addition, it may take weeks for the mass distribution of events to cascade so much that they cause a noticeable surge in confirmed cases, especially if the state inadequately isolates the first people who show symptoms and tracks their contacts with others.
Carneton said district-level numbers are a form of “environmental research.” Such an analysis is useful for understanding the general picture of the prevalence of coronavirus in the community, but cannot accurately determine the specific causes of the spread.
“Environmental research is good at giving clues about where association models can be,” she said. “He does not give us data to determine whether a person’s behavior is related to his results.”
Experts believe that sometimes good individual choices are not enough to protect communities.
Minority groups are disproportionately represented among key workers who have been exposed to constant exposure to coronavirus, including in meat processing plants and in nursing homes where they dominate the work force.
USA TODAY previously reported that meat processing plants have become outbreak centers in many communities due to overcrowding in jobs, poor hygiene and policies that prevent sick workers from staying at home. Similarly, many U.S. nursing homes have been cited due to poor infection control that puts both residents and staff at risk, the US said today.
This seems to be a factor in the last major outbreak in Arkansas.
In Washington County, Arkansas, concerns about increasing numbers of Latin American and Asian households far outweigh any influence from protests, said Jennifer Dillaha, an epidemiologist and medical director of immunization and outbreak response at the Arkansas Department of Health.
The Fayetteville region saw the largest increase in coronavirus incidence in the country, adding 792 out of 1970 cases in the last week. Although Fayetteville had great protests, she said that people reporting new cases were not related to them.
Instead, Dillaha said most cases were related to poultry workers who include Hispanics and Asian Americans. Some of the newest cases have also been among children. She said that she did not yet have enough information to find out if the children were infected by the virus from family members at the factory or from some other place in the community.
“We know that the Latin American population is a young population, and they usually have large households,” said Dillaha. “Therefore, we are concerned that it is spreading in homes and social groups outside homes.”
In the face of a skyrocketing number of cases, Fayetteville this week began demanding that people wear fabric facings in public. Dillaha said this was the first such order in the state, but she would not be surprised to see more.
“If we do not deal with cases at the workplace, we will have difficulties opening the University. All this works together, if any one area is not considered, other areas will be affected. ”
Mask of orders
In Larimer County, Colorado, cell phone location data show that from May to June, the percentage of people staying at home decreased by 12%. In late May, big protests broke out when hundreds of people gathered to call for changes in the police.
However, the number of new cases there has been growing at a slower pace – less than five cases per day during the last week – since the first patient was identified in early March.
Katie O’Donnell, a public affairs officer at the Laramie County Department of Health and the Environment, explains the decline in the incidence of real behavior change. The district issued an order for a face mask on May 2, requiring businesses to demand coverage as a condition for reopening.
“We reopened our business because we were ready to receive these orders to close our faces,” O’Donnell said. “People hate that. People are complaining. But for the most part, people realize that if you just put on these masks, we can begin to reopen. “
The decrease in the number of new cases largely coincides with this order. A week before it took effect, the district identified 75 new cases. There were 46 next week. There were only 27 last week.
According to O’Donnell, this is not due to a lack of testing, as testing has become more common. And the protesters, in particular, took advantage of this.
“I get an amazing number of calls from them after they protest,” she said, adding that “our protesters wear masks and try to maintain a social distance.”
For comparison, in Arizona there were no mandatory masks throughout the state, and until recently, local authorities were forbidden to issue their own orders, which is one of the reasons why experts suspect that new cases arise there faster than in most of the country.
“When it all started, many people may not have fully understood all the methods we need to continue,” said Dr. Joshua LaBaire, director of the Biodesign Institute at Arizona State University. “When I go out for the weekend, I see a lot of people walking without masks. “I recently had a football match with groups of parents who chatted without masks, as if there was no pandemic.”
Researchers at the Institute rate transmission increased by 40% in the first two weeks after the state began to open on May 11. On this day, the state reported 261 new positive tests. On Thursday, Arizona reported a record high of nearly 10 times as many: 2,519 new cases.
The districts with the fastest spread of coronavirus in June are not the same as in March.
For example, in the Apache and Navajo districts, which include large sections of the rural Navajo nation and Hopi reservations, one of the highest levels of general morbidity in the country is observed: more than 2500 people are infected for every 100,000 inhabitants. But the pace of distribution there has slowed sharply in recent weeks, as tribal representatives ordered them to be blocked, even when non-tribal residents moved forward in accordance with the plan for opening Arizona.
Everyone with COVID-19 in Apache County is now infecting 1.02 other people, compared to 1.7 in early April. In Navajo County, this figure fell from 1.5 to 1.1. If the indicator drops below 1, it means that the flash is localized and disappears.
In a recent address, President Donald Trump urged governors to describe a nationwide increase in positive tests as a result of increased testing, saying there should be no cause for alarm.
Last week, Arizona Governor Doug Ducey, a Republican, described a surge in cases as a result of increased testing. A few days later his tone changed. On Wednesday, he called on Arizonans to wear masks and commissioners of cities and counties to establish local mandates, recognizing that cases of coronavirus are growing.
LaBaer supported other experts who said that easier access to testing does not fully explain the increase.
“You can tell by the number of hospitalizations, by the number of visits to the Republic of Poland,” he said. “There are more cases of COVID-19 and more transmission.”
A five-day average of tests in Arizona shows that 17% were positive, well above the 10% threshold, which is considered a sign of adequate testing by the World Health Organization. It is also above the peak at the end of April at 14% and a minimum of 7% when the state announced that it would reopen.
Pointing to a graph showing the number of new cases announced each day, LaBaer pulled the pointer up and to the right.
“This is the foot on the accelerator,” he said. “This means that day after day there are more cases and the virus is actively spreading in the community.”
Assistance: Mike Stuck and Dan Kimahill
This article originally appeared in the USA TODAY: So far, George Floyd’s protests are not behind the bursts of coronavirus