Mass protests against police brutality across the US have public health officials worried about the accelerating spread of the coronavirus. But even before the protests began on May 26, sparkle since the death of George Floyd on May 25 in Minneapolis, several states have seen large jumps in the number of COVID-19 cases.
The head of the Centers for Disease Control and Prevention, Dr. Robert Redfield, expressed concern in congressional hearing Thursday. He shook his head as a congresswoman showed him photos crowds people at Lake of the Ozarks in Missouri over Memorial Day weekend and crowds in Florida who had gathered to watch on May 30 launch of the SpaceX Dragon crew capsule.
“We are very concerned that our public health message is not resonating,” Redfield said. “We're still trying to figure out how to get the message across with different groups. The photos the president showed me are great examples of serious problems.”
The US still sees around 20,000 new cases one day. The toll varies widely by state, from an average of one case a day last week in Hawaii to 2,614 new cases a day in California. Certain areas in the Golden State have become hot spots, along with certain counties every southern state.
The northeastern states of New York, New Jersey and Massachusetts — which accounted for a quarter of all US COVID-19 deaths — are seeing a significant slowdown in new cases.
A closer look at these hard-hit areas highlights some of the common and unique challenges states face as they manage the protests and begin efforts to reopen the economy amid risks of more illness and death.
Officials try to publicize the cause when infections increase
In the South, the timing of new cases appears to be tied to the reopening of restaurants, barbershops and gyms, which began in most states more than a month ago. Data tracked by NPR show that the number of cases in North Carolina and South Carolina this week is up about 60 percent from two weeks ago. In Tennessee, that increase is 75%.
Georgia and Louisiana seem more stable, but experienced some of that highest case counts and deaths in the region in recent weeks, at the height of the pandemic.
In southern states that reopened earlier than others, officials sometimes felt the need to explain large spikes in case counts on certain days. In Georgia, for example, a state health official said a large one-day increase could be attributed to a backlog of cases from a commercial laboratory. In Tennessee this week, a daily jump of 800 cases was partly to blame a constant prison outbreak which yielded 350 new positive test results.
Populous Los Angeles County counts cases in California
In California, counties continue to allow businesses to reopen even as newly confirmed coronavirus cases increase. The state saw a 40 percent jump in cases last week. Large metro areas such as Los Angeles and San Francisco have gradually lifted restrictions, and Californians have responded by traveling to beaches and neighboring areas, blurring the effectiveness of varying degrees of restrictions between neighboring counties.
Los Angeles County, home to more than 10 million people, has the highest number of cases in the state. Numbers tracked by NPR show that, on average, health officials are reporting about 1,300 new cases every day. The county blamed the slow lab results on the backlog, while acknowledging that community transmission has accelerated, especially among communities of color.
In the Northeast, where New York became the US epicenter of the pandemic for weeks, there are still thousands of new cases daily, although the rate of increase has slowed. It fell 41% in New Jersey over the past two weeks, 33% in New York and 13% in Massachusetts. However, health officials caution that this does not mean the coronavirus is under control in these three states. New York is still seeing more than 1,000 new cases a day. Last week, Massachusetts averaged just over 500 a day and New Jersey nearly 800.
Ethnic disparities persist throughout the country
In Los Angeles, the elderly, especially them who live in nursing homes have been disproportionately affected. Nearly half of the people who died of COVID-19 in the county were nursing home residents. County health officials have been slow to test nursing homes for the virus, and recent figures reported by the health department show that two-thirds of Los Angeles County workers who died from the virus worked in nursing homes.
People of color have been disproportionately affected in California, as elsewhere: Latinos make up more than half of the COVID-19 cases in California, where it is 40% of the state's population. In Los Angeles County, the highest death rates from COVID were among Native Hawaiians, Pacific Islanders, and black residents. Minorities have an increased risk of developing underlying conditions such as high blood pressure and diabetes, making them more likely to develop more serious illness if infected with the virus.
In Tennessee, which has one of the fastest-growing numbers of cases in the country, neighborhoods with large immigrant populations have emerged as persistent hot spots for contamination. In partnership with advocacy organizations, Nashville's public health department has employee community workers with special skills or unique access to migrant communities to conduct contact tracing and connect families with coronavirus tests.
“We knew we had to do something different, and that's what we're doing now,” said Leslie Waller, a city epidemiologist overseeing the project.
Waller acknowledges that many of the people at risk work in jobs that have been deemed essential or have businesses that cannot be operated remotely. Public health officials are also concerned that co-workers in tight-knit immigrant communities are often recruited into the same jobs, and some work sites have experienced large foci.
But in southern states, the rise in the number of cases has not slowed momentum for further lifting of restrictions. On Thursday, Tennessee announced a additional relaxation restrictions on community events, allowing fairs, exhibitions and parades. Instead of limiting the number of people who can gather, the focus has shifted to making sure everyone can maintain social distancing.
“Thanks to the continued hard work of Tennesseans and responsible business owners, we are able to further open up our state's economy,” Tennessee Gov. Bill Lee said in a written statement. “These new guidelines provide useful information so we can enjoy the events that connect us with our neighbors and our communities.”
There has been virtually no public discussion of restoring business restrictions as long as hospitals can cope with any increase in illness.
Northeastern states are taking a slower approach to reopening
You still can't sit down in a restaurant in New York or anywhere in Massachusetts and New Jersey. This may be allowed in the coming weeks, but only outdoors. Those states are still in the early stages of reopening after residents were told to stay home for nearly two months and all but the most essential businesses closed.
While most states do not have broad requirements for face coverings, rules requiring them are more common in the Northeast. In Massachusetts, some type of face covering is required indoors and outdoors if you cannot stay at least 6 feet away from other people. In New York and New Jersey, masks are required in public and when riding buses or trains.
In some states, the rules vary by county, which can be confusing. In Los Angeles County, health officials have made cloth face coverings mandatory at all times when you are outside your home, while San Diego County only requires masks when you are within 6 feet of another person.
Residents everywhere are challenging the rules, but states hardest hit are experiencing wider acceptance of social distancing rules. ONE voting last week found that twice as many New Yorkers were worried it would open too soon, compared to the number of New Yorkers who worried it would happen too slowly. Polls in New Jersey and Massachusetts they have also shown better-than-majority support for gradual, gradual openings.
This story is part of a collaboration that includes WBUR, Nashville Public Radio, KPCC and NPR.