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America is not ready to reopen

Is America’s coronavirus crisis getting better? It depends on where you live.

People walk by the New York Stock Exchange along Wall Street in New York City
People walk by the New York Stock Exchange along Wall Street on May 7, 2020.
Spencer Platt/Getty Images

Some of America’s leaders and parts of the public seem to believe that the US has turned the corner on the coronavirus pandemic. The White House has talked about winding down its Covid-19 task force. Most states are pushing to relax social distancing measures, with President Donald Trump’s encouragement. Americans are growing weary of staying at home — and they’re going out more than before.

But it’s worth emphasizing: This pandemic is not over. The coronavirus is still circulating nationwide, the country is not yet hitting the benchmarks that experts have called for, and there’s a real risk that rushing to reopen will lead to an explosion in Covid-19 cases and deaths, since the majority of the population still lacks immunity.

On a national level, the past few weeks of trends have been positive. Although daily reports of new Covid-19 cases have hovered between 20,000 and 30,000 since March, there has been a sustained decline — so far — since late April and early May.

But this national trend masks the state-by-state variation. Most notably, the New York City area suffered a big Covid-19 outbreak earlier than much of the US, and its epidemic is now receding. It’s possible that a plateau or drop in nationwide cases could be caused by the New York City area getting better even as the rest of the country gets worse or, at the very least, doesn’t improve.

Indeed, the data supports that possibility. Daily new coronavirus cases in the three states in the tri-state area, which encompasses Connecticut, New Jersey, and New York, have been falling over the past few weeks. But in the rest of the US, the best anyone can say is that confirmed cases have fallen in recent days, though they’re still up from two weeks prior, based on data compiled by the New York Times.

A chart showing America’s diverging coronavirus epidemics. German Lopez/Vox

Some of the upward trend in Covid-19 cases outside Connecticut, New Jersey, and New York in recent weeks is likely due to increased testing. With more tests, officials are likely to find more cases, all else being equal.

Still, the numbers suggest it’s too early to declare victory. Experts generally recommend two weeks of sustained decreases in Covid-19 cases before social distancing measures can be relaxed. At the very best, states outside the New York City area have started to see a decline only recently — in the last few days, not over two full weeks.

Experts also caution that more work is necessary before social distancing measures can safely end — starting with even more aggressive testing and tracing measures across the country. Without that, moves to relax social distancing risk further outbreaks that could kill up to hundreds of thousands, if not millions, of Americans.

Most states aren’t quite there yet with Covid-19 cases and testing

The White House’s guidelines and experts’ proposals lay out standards that states have to meet to safely reopen their economies. Typically, they recommend decreases in new cases for at least 14 days, and enough coronavirus testing to diagnose the sick and their contacts.

Most states don’t meet both criteria. Based on data compiled by the New York Times, only 14 states as of May 11 have seen daily new Covid-19 cases decrease recently, much less fall for at least two weeks. Nine states have seen their daily new cases actually increase, while cases have held steady in the remaining 27.

Again, an increase in cases could be partly attributed to more testing. But even if states are testing more than in weeks prior, there’s evidence they’re still not testing enough to safely reopen.

Testing is crucial to controlling the coronavirus pandemic. When paired with contact tracing, testing lets officials track the scale of an outbreak, isolate the sick, quarantine those with whom the sick came in contact, and deploy community-wide efforts as necessary. Aggressive testing and tracing is how other countries, including South Korea and Germany, got their outbreaks under control, allowing them to start reopening in the past couple of weeks (though even they have scaled back their reopenings after new spikes in Covid-19 cases).

“The whole point of this social distancing is to buy us time to build up capacity to do the types of public health interventions we know work,” Natalie Dean, a biostatistics professor at the University of Florida, told me. “If we’re not using this time to scale up testing to the level that we need it to be … we don’t have an exit strategy. And then when we lift things, we’re no better equipped than we were before.”

There’s no widely accepted standard for this, but experts generally agree that the US needs to be doing much more testing. Some have called for conducting as little as 500,000 tests a day, while others have called for up to tens of millions.

Nationwide, the US is not hitting the proposed minimum. Based on data from the Covid Tracking Project, America averaged roughly 276,000 tests a day during the week of May 3. That’s up from an average of 150,000 a day in the first half of April, but only a little more than half of the bare minimum experts recommend.

A chart showing the number of coronavirus tests in the US each day. German Lopez/Vox

At the state level, the Times estimated that the daily minimum of 500,000 tests amounts to about 152 tests per 100,000 people. Only two states, Rhode Island and North Dakota, met this standard as of May 7. Again, this is the proposed minimum; some experts argue the US needs multiple times that number of tests.

Still, there are some signs of things getting a bit better. Not only has the number of daily new tests nationwide increased in recent weeks, but states have also seen an improvement in another important metric: the positive rate.

This standard measures what percent of people test positive for the coronavirus among all tests done. If the positive rate is high, it’s likely not enough people are being tested, since it suggests that only people with a high chance of infection are getting tested, potentially missing a lot of people without significant symptoms. Experts recommend a positive rate no higher than 10 percent — and preferably much lower.

In recent weeks, the nationwide positive rate has fallen below 10 percent — hitting 9 percent the week of May 3, based on Covid Tracking Project data. Most states have seen their positive rates fall below that threshold, too. It’s a sign that states are now getting enough testing capacity to match their outbreaks.

As promising as that might be, experts caution that improvements in the positive rate have to be matched with adequate numbers of tests and sustained decreases in Covid-19 cases to safely reopen. Testing also has to be paired with contact tracing — which might require hiring 100,000-plus “disease detectives” — to truly control outbreaks.

When taking all of those fronts into account, America just isn’t there yet — making it clear that the coronavirus pandemic is still very much with us, and the country shouldn’t rush to reopen.

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