More than 80,000 people have died from coronavirus-related illness in the US, but nearly every state is rolling out plans for phased reopenings, under immense pressure from lawmakers and businesses desperate to reboot the nation’s economy while millions out-of-work Americans struggle for benefits.
Health officials say it could be months or more than a year before a vaccine is developed and treatment options are widely available, but scientists stress that expanded testing and tracking the contacts of people who had the virus are crucial to map the safety of “reopening”.
Some states have seen a plateau in new cases. Others have seen a decrease. But experts say that neither can determine the scope of the virus without adequate testing capacity.
Though states may see a low death rate, they also are experiencing relatively little testing, despite Donald Trump‘s assurances that “anyone” can access a test, let alone a network of contact tracing to determine the scale of the virus in each state.
The president’s guidelines for “Opening Up America Again” — a three-phase set of non-binding rules for states to meet certain criteria before businesses can reopen — say that states and local governments must have a “downward trajectory” of flu-like illnesses and Covid-19 symptoms or documented coronavirus cases within a two-week period before they can move from the first phase and into the next.
Most states’ current daily testing numbers are far below their recommended targets, according to analysis from the Harvard Global Health Institute.
Among the more than a dozen states that have lifted or have imminent plans to lift their stay-at-home orders, several have seen a bump in new cases, without any clear rubric for rolling back openings if they fall short of the criteria within 14 days of their reopenings.
Epidemiologists warn that it could take weeks to see the number of cases reflected in the data on which states rely to move to move into their next phase, if states are even equipped to test and trace those cases.
The rates of new positive cases continue to grow throughout the US, when cases from New York, New Jersey and Connecticut are removed from the data.
Former Food and Drug Administration commissioner Scott Gottlieb told CNBC that reopening states that have yet to report an uptick likely will in coming days.
“The bottom line is a lot of states are now reopening activity against a backdrop that doesn’t meet the criteria that the White House set out in terms of when it would be safe to reopen,” he said. “We’re going to see cases go up now that we’re reopening.”
White House officials have also warned states about the dangers of reopening too early without meeting the phase-by-phase criteria.
Dr Anthony Fauci, who leads the National Institute of Allergy and Infectious Diseases, told a Senate committee on Tuesday that if local governments “jump over those various checkpoints” without accompanying healthcare capacity, those areas could see spikes “that might turn into outbreaks” that “you may not be able to control”.
Outbreaks will not only lead to “some suffering and death that could be avoided” but will set back any efforts towards economic stability.
Governors in more than a dozen states have lifted their stay-at-home orders, while Arkansas, Iowa, Nebraska, North Dakota and South Dakota never had a stay-at-home order on the state or local levels.
This week, several other states have imminent plans to lift their stay-at-home orders or begin easing some restrictions, including Arizona, Louisiana, Nevada, Washington DC, New Mexico and Wyoming, allowing residents to visit bars and restaurants and other retailers.
But several cities and states are extending their orders through the end of May, or June, or indefinitely.
Here’s a look at 13 states that lifted their stay-at-home mandates:
Population: 4.9 million
Cases by 12 May: 10,260
Deaths by 12 May: 428
When the state’s order expired on 30 April, it was replaced with a “safer-at-home” measure that allowed restaurants, bars, beaches, gyms, beaches, hair salons and other retailers to reopen in limited capacity. Nightclubs, theatres, bowling alleys and casinos remain closed under the order.
Within the first two weeks of the stay-at-home order being lifted, the state saw a spike of more than 3,000 cases, including more than 400 deaths. Health officials say another 3,000 people have recovered.
Cases by 12 May: 383
Deaths by 12 May: 10
Alaska entered the second phase of its reopening on 8 May, allowing statewide reopenings of bars, gyms, movie theatres and other retailers that have been closed since March following statewide orders to close nonessential business. Businesses can also expand their capacity from 25 per cent to 50 per cent.
Anchorage Mayor Ethan Berkowitz said the largely rural, expansive state is able to reopen based on “epidemiology, based on our health care capacity and based on our public health capacity.”
“We are green-lit in all of those areas, with the exception of personal protective equipment, and that’s mostly due to uncertainty about what supply lines look like,” he said.
The rate of new cases appears to be slowing. State health officials said more than 300 residents have recovered from the virus, which has led to the deaths of 10 others.
Population: 21.5 million
Cases by 12 May: 41,923
Deaths by 12 May: 1,779
Under a plan from Republican Governor Ron DeSantis, most counties except for hard-hit areas in South Florida, were allowed to reopen in limited capacity. The state’s stay-at-home order expired on 30 April.
As Florida entered the second week of its reopening, with nearly 42,000 cases identified in the state, health officials confirmed more than a dozen new deaths, with a statewide death toll reaching nearly 1,800 people.
One day after reopening some counties at the beginning of the month, the state reported a one-day death record high with 113 Covid-19-related deaths.
But the figures reported from the state’s Department of Health don’t match the toll from the state Medical Examiners Commission — the health department’s count is higher, as controversy builds over allegations of underreporting in a bid to pressure the state to meet certain guidelines.
Population: 10.6 million
Cases by 12 May: 34,737
Deaths by 12 May: 1,465
Georgia Governor Brian Kemp, among one of the first governors to announce a reopening plan, allowed some businesses to begin reopening as early as 24 April, including barbers, nail salons and bowling alleys, with some capacity restrictions, though critics warn that the decision was not informed by any epidemiological data.
Just days earlier, on 20 April, the state reported 922 new infections, the most recorded in a single day, falling well outside the bounds of the president’s 14-day guidelines.
Movie theatres and restaurants were allowed to reopen on 27 April with some restrictions. A statewide stay-at-home order expired on 30 April.
Population: 6.7 million
Cases by 12 May: 25,127
Deaths by 12 May: 1,444
Indiana’s stay-at-home order expired on 1 May, and Governor Eric Holcomb’s five-stage plan for reopening parts of the state entered its second phase, allowing easing capacity restrictions in restaurants and malls, with appointment-only visits to barbers and salons.
The rate of new cases has remained largely the same, meaning growth has stalled or a lack of widespread testing hasn’t captured the scale.
Population: 2.9 million
Cases by 12 May: 7,116
Deaths by 12 May: 158
Governor Laura Kelly’s stay-at-home order expired on 4 May. Restaurants, libraries, child care services, campgrounds, drive-in movie theatres can open with physical distancing requirements, and gyms, malls and other retailers can open at 50 per cent capacity.
The rate of new cases in the state has also remained largely the same, but an overnight jump in more than 200 new cases on 9 May was the 10th highest spike since the state began reporting cases in March.
Population: 2.9 million
Cases by 12 May: 9,908
Deaths by 12 May: 457
Republican Governor Tate Reeves’s stay-at-home order expired on 11 May, allowing restaurants to reopen at 50 per cent capacity, followed by barbers, nail salons and other retailers in the poorest state in the US with one of the worst health outcomes.
But on 5 May, three days before the new guidance was issued, the state recorded the highest daily cases and deaths, spiking by more than 300 cases and 32 deaths.
Population: 6.2 million
Cases by 12 May: 10,006
Deaths by 12 May: 524
Governor Mike Parson’s stay-at-home order expired on 3 May, allowing some businesses to reopen, with physical distancing restrictions in place at 25 per cent capacity.
But the state has struggled to receive adequate testing and has sought assistance from the federal government to boost its capacity, despite White House guidelines urging states to have testing at hand while entering the first phase of reopening plans.
St Louis, however, will continue its stay-at-home order indefinitely, as new cases have yet to trend downward.
But new cases in the rest of the state have to significantly plunge — in the first half of April, the state saw an average of 235 daily cases. The following weeks have seen an average of 200 daily cases.
Population: 1.1 million
Cases by 12 May: 461
Deaths by 12 May: 16
The largely rural and spread-out state began a phased reopening on 27 April, with bars and restaurants allowed to reopen on 4 May. With a less-dense population, the state is also able to test more people per day than health guidelines suggest.
Governor Steve Bullock has also allowed schools to begin reopening this month, though most school districts have turned down the offer. Some schools in less populous parts of the state are opening in limited capacity.
Population: 5.2 million
Cases by 12 May: 7,927
Deaths by 12 May: 355
Governor Henry McMaster allowed some retailers to reopen on 20 April, among one of the earliest states to begin lifting restrictions. A “work-from-home” order also expired this month, and restaurants are allowed to reopen in limited capacity, along with barbers, gyms and public pools.
But the state has not seen a decrease in cases in that time, and state health officials suggest thousands of residents have likely contracted the virus without being tested.
The department plans to double its testing capacity by the end of May, though less than 2 per cent of the state’s population has been tested thus far. Health officials also are ramping up contact tracing, boosting staff from 20 to 400 with 1,400 contact tracers from private companies added to the ranks.
Population: 6.8 million
Cases by 12 May: 16,110
Deaths by 12 May: 264
The state’s stay-at-home order expired on 30 April. On 1 May, the state reported more than 1,200 cases, its highest-ever single-day count of new cases.
Daily counts have since dropped, though two counties in the state have some of the highest infection rates in the US, largely due to prison populations.
The state is also testing more than 8,000 people a day, well above recommended targets for reopening.
Population: 29 million
Cases by 12 May: 41,408
Deaths by 12 May: 1,133
Governor Greg Abbott lifted a stay-at-home order that lasted barely a month. His controversial reopening plan allowed many businesses to reopen on 1 May, with some restrictions, as cases plateaued at more than 1,000 new daily cases.
He also was caught on a phone call with state lawmakers admitting that reopening would most definitely lead to an increase in cases — not just from expanding testing but from spreading of the disease among groups.
Population: 3.2 million
Cases as of 12 May: 6,432
Deaths as of 12 May: 73
Utah is among only a handful of states that have met testing guidelines to “safely” reopen this month, with more than 3,000 tests performed daily. Governor Gary Herbert said that the state isn’t “returning to business as usual yet” though it can “now cautiously relax some requirements, and allow businesses that were closed to operate with safety measures in place” for bars, restaurants, gyms and other retailers on 1 May.
But as the state prepared to reopen, the Utah Department of Health reported the highest average daily increase in new cases since the outbreak was first identified in the state.
Since 26 April, the state’s average of new daily cases reached roughly 154. The health department also reported the largest one-day jump in positive tests in more than a month, bringing the total number of cases in the state past 5,000.
Five states that never instituted stay-at-home orders on state or local levels:
Population: 3 million
Cases by 12 May: 4,164
Deaths by 12 May: 95
Population: 3.1 million
Cases by 12 May: 12,912
Deaths by 12 May: 289
Population: 1.9 million
Cases by 12 May: 8,572
Deaths by 12 May: 100
Cases by 12 May: 1,571
Deaths by 12 May: 38
Cases by 12 May: 3,663
Deaths by 12 May: 39