The new wave of COVID-19 may be more difficult to contain

A record number of new cases of COVID-19 were reported Thursday in the United States, fueled by spikes in the southern and western states. The waves are steep and terrifying, and can be even more difficult to overcome than the first ascending phase.

The same problems that plagued New York City in March and April (limited access to evidence, long response times for results, and mixed messages from officials) are emerging in states like Arizona. Now they are canceling elective medical procedures and asking people to stay home. It is a familiar pattern, one that developed in Italy and on the coasts of the United States.

Those lessons were not assimilated. Cases are increasing in communities that, until now, had the virus under control. That made it harder for people to internalize all the risks of an outbreak, which are now emerging in those areas. Orders to stay home, phased closings, and encouraging wearing masks in public eventually helped places like New York cut their cases. This time, officials at new hot spots may not be able to implement the same strategies.

Visible failures, invisible successes.

In March and April, the virus hit New York City, Seattle, and San Francisco hardest. New York City, in particular, was incapacitated by the pandemic: hospitals were overrun with patients, bodies piled in trailers outside funeral homes, and people lived with the almost constant sounds of ambulance sirens.

Seeing the devastation, states with relatively low numbers of confirmed cases also banned large gatherings, closed businesses, and ordered hospitals to free up bed space. Those measures were successful: They helped keep those numbers of cases and hospitalizations low, and states like Texas initially avoided the same fate as New York. “We really crushed the curve,” said Umair Shah, executive director of the Harris County Health Department, which includes Houston, The daily beast.

Photo by Jeffrey Basinger / Newsday RM via Getty Images

However, control was tenuous. Because those measures kept COVID-19 out of sight, it was harder for people to see why they were needed in the first place, says Emily Toth Martin, an epidemiologist at the University of Michigan School of Public Health. “It is the characteristic Catch-22 of public health. What you did worked if people say you exaggerated, ”she says. “You stopped the critical situation, but it’s very difficult to communicate that and for people to internalize it.”

Some critics seemed to deliberately misinterpret how and why preventing a problem is a better option than responding to one: New York Times Columnist Bret Stephens, for example, wrote in April that New York City’s strict blockade rules should not apply to the rest of the country. “The rest of the United States needs to come back to life,” Stephens wrote. The spikes over the past week clearly showed that “coming back to life” too soon meant waves of infection.

The vast majority of people across the country supported the closings. But the economic challenges were real for millions, and without clear messages about why continued prevention is important, it may have been easy for people to equate flattening the curve with ending the threat. “You are making those sacrifices for the benefit of a crisis that you do not see in front of you. I can see it’s a very emotional challenge, “says Martin.

Message (not) received

Not seeing a direct impact in your area may also have made some people less concerned with the virus, overall, and less likely to take action, avoiding meetings, wearing masks, which protect against the disease, Martin says. It is understandable: it is difficult to make sacrifices when there seems to be nothing wrong to justify them.

“Your understanding of the severity of a problem and the likelihood of something affecting it will affect the likelihood that you will step in to prevent it,” says Martin.

She notes that Detroit, which was hit hard by COVID-19, has seen a steady and disciplined decline in the number of cases. However, rural Michigan is experiencing waves. Michigan had an order to stay home statewide, but only the Detroit area experienced exponential case growth during that time.

“Within our own state, you have entire communities that don’t have that experience of seeing a field hospital being built on your street,” says Martin. “I think that has a big impact on people’s ability to be ready to receive the message.”

People who live in the first critical points are more concerned about the virus than people who live in places where case counts began to rise later, according to a YouGov analysis published in early June. That follows familiar patterns from before in the pandemic. Despite the fact that people in New York saw Italy teetering on the brink of collapse, the message was not heard until it reached his door.

Concerns may increase in those communities as the number of cases increases, as they did in New York, which can inspire people to follow public health guidelines. However, this time it will be more difficult to sell. Those same guidelines that helped Detroit and New York recover have been heavily politicized, making it difficult for public health officials to implement. President Trump pressured states to lift orders to stay home, and the policy of governors in states like Florida won the president’s favor. Right-wing politicians rejected the masks, and support for the use of masks now breaks on party lines.

“We see this with vaccination in certain communities. When something like this connects with a sense of identity, we lose it as a public health tool, “says Martin.

Photo by EVA MARIE UZCATEGUI / AFP via Getty Images

Policy failures

The challenges that make this virus increasingly difficult to contain were preventable. New York City had an opportunity to avoid the crush of cases, but the governor and mayor struggled to implement policies to stem the tide. The rest of the country had the opportunity to learn from New York. And for a time, many states had things under control.

However, instead of clinging to those successes, local and national leaders let them slip away. They looked at the constant numbers of cases across the country through May and decided the problem was over, despite region-specific trackers showing that certain areas of the country were ready to exploit. Many states opened bars and restaurants before it was safe to do so, and before testing and contact tracing were done to check for any further spread.

Now, they are left with the task of fighting new peaks without so much acceptance from the communities around the strategies that could help. State leaders seem reluctant to re-close what they have already opened. Policy decisions and flaws in messaging made people less likely to stick to the recommendations, and they were unprepared for the reality of a pandemic. Messaging emphasized the critical importance of flattening the curve, but did not emphasize that sustained effort is required to keep that curve flat. Claiming victory too soon, but assured a rebound.

If the officials’ message At the start of the pandemic, he had emphasized that adjustments to daily life were going to be a marathon, not a sprint, it could have made a difference in how communities processed the risk of COVID-19, Martin says. “She has never had that long-term vision that really allowed people to mentally prepare that this is something that they will have to deal with for a long time,” she says. “So I think it’s understandable that the American public has grown tired of it.”