A14 EZ RE THE WASHINGTON POST.SUNDAY, AUGUST 2 , 2020
day that there was no reason for a
mask order when deaths in the
county have been few and far be-
tween.
“It hasn’t hit us here yet, that’s
what I’m scared of,” Branson Al-
derman Bill Skains said before
voting with a majority in favor of
the mandate. “It is coming, and it’s
coming like a freight train.”
Democratic mayors in Mis-
souri’s two biggest cities, Kansas
City and St. Louis, said that with
so many people needing jobs, they
are reluctant to follow Birx’s rec-
ommendation to close bars.
“The whole-blanket approach
to shut everybody down feels a
little harsh for the people who are
doing it right,” said Jacob Long,
spokesman for St. Louis Mayor
Lyda Krewson. “We’re trying to
take care of some bad actors
first.”
Minneapolis Mayor Jacob Frey
also got a warning from Birx. On
Wednesday, he said all bar drink-
ing must move outside.
“We don’t want to be heading in
the direction of everybody else,”
said Kristen Ehresmann, director
of the infectious-disease epidemi-
ology division at the Minnesota
Department of Health. She ac-
knowledged that some options
“are really pretty draconian.”
The problem is that less-painful
measures have proven insuffi-
cient.
“The disease transmission
we’re seeing is more than what
would have been expected if peo-
ple were following the guidance as
it is laid out. It’s a reflection of the
fact that they’re not,” she said.‘A tremendous
disappointment’
Wisconsin Gov. Tony Evers (D)
tried to implement broad state-
wide measures early in the pan-
demic, only to have his “Safer at
Home” order struck down by the
state’s Supreme Court.
With cases in his state rising
anew, he tried again Thursday,
declaring a public health emer-
gency and issuing a statewide
mask mandate.
“While our local health depart-
ments have been doing a heck of a
job responding to this pandemic
in our communities, the fact of the
matter is, this virus doesn’t care
about any town, city or county
boundary, and we need a state-
wide approach to get Wisconsin
back on track,” Evers said.
Ryan Westergaard, Wisconsin’s
chief medical officer, said he is
dismayed by the failures of the
national pandemic response.
“I really thought we had a
chance to keep this suppressed,”
Westergaard said. “The model is a
good one: testing, tracing, isola-
tion, supportive quarantine.
Those things work. We saw this
coming. We knew we had to build
robust, flexible systems to do this
in all of our communities. It feels
like a tremendous disappoint-
ment that we weren’t able to build
a system in time that could handle
this.”
There is one benefit to the way
the virus has spread so broadly, he
noted: “We no longer have to keep
track of people traveling to a hot
spot if hot spots are everywhere.”
[email protected]
[email protected]
[email protected]Jacqueline Dupree and Lena H. Sun
contributed to this report.the coronavirus pandemic
sity.
Another report from the Asso-
ciation of American Medical Col-
leges offered a similarly blunt
message: “If the nation does not
change its course — and soon —
deaths in the United States could
be well into the multiple hun-
dreds of thousands.”
The country is exhausted, but
the virus is not. It has shown a
consistent pattern: It spreads op-
portunistically wherever people
let down their guard and return to
more familiar patterns of mobility
and socializing. When communi-
ties tighten up, by closing bars or
requiring masks in public, trans-
mission drops.
That has happened in some Sun
Belt states, including Arizona,
Florida and Texas, which are still
dealing with a surge of hospital-
izations and deaths but are finally
turning around the rate of new
infections.
There are signs, however, that
the virus is spreading freely in
much of the country. Experts are
focused on upticks in the percent-
age of positive coronavirus tests in
the upper South and Midwest. It is
a sign that the virus could soon
surge anew in the heartland. In-
fectious-disease experts also see
warning signs in East Coast cities
hammered in the spring.
“There are fewer and fewer
places where anybody can assume
the virus is not there,” Gov. Mike
DeWine (R) of Ohio said Wednes-
day. “It’s in our most rural coun-
ties. It’s in our smallest communi-
ties. And we just have to assume
the monster is everywhere. It’s
everywhere.”
Dire data
An internal Trump administra-
tion briefing document prepared
by the Federal Emergency Man-
agement Agency and obtained
Friday by The Washington Post
counted 453,659 new infections in
the past week.
Alaska is in trouble. And Ha-
waii, Missouri, Montana and
Oklahoma. Those are the five
states, as of Friday, with the high-
est percentage increase in the sev-
en-day average of new cases, ac-
cording to a Post analysis of na-
tionwide health data.
“The dominoes are falling now,”
said David Rubin, director of the
PolicyLab at Children’s Hospital
of Philadelphia, which has pro-
duced a model showing where the
virus is likely to spread over the
next four weeks.
His team sees ominous trends
in big cities, including Baltimore,
Chicago, Detroit, Indianapolis,
Kansas City, Louisville, Philadel-
phia, St. Louis and Washington,
with Boston and New York not far
behind. And Rubin warns that the
expected influx of students into
college towns at the end of this
month will be another epidemio-
logical shock.
“I suspect we’re going to see big
outbreaks in college towns,” he
said.
Young people are less likely to
have a severe outcome from the
coronavirus, but they are adept at
propelling the virus through the
broader population, including
among people at elevated risk.
Numbers of coronavirus-related
hospitalizations in the United
States went from 36,158 on July 1
to 52,767 on July 31, according to
The Post’s data. FEMA reports a
sharp increase in the number of
patients on ventilators.
The crisis has highlighted the
deep disparities in health out-
comes among racial and ethnic
groups, and data from the Centers
for Disease Control and Preven-
tion last week showed that hospi-
talization rates due to the corona-
virus are roughly five times higher
among Black, Hispanic and Na-
tive Americans than Whites.
Thirty-seven states and Puerto
Rico will probably see rising daily
death tolls during the next two
weeks compared with the previ-
ous two weeks, according to the
latest ensemble forecast from the
University of Massachusetts at
Amherst that combines more
than 30 coronavirus models.
There are glimmers of progress.
The FEMA report showed 237 U.S.
counties with at least two weeks of
steady declines in numbers of new
coronavirus cases.
But there are more than 3,
counties in America.
“This is not a natural disaster
that happens to one or two or
three communities and then you
rebuild,” said Beth Cameron, vice
president for global biological pol-
icy and programs at the Nuclear
Threat Initiative and a former
VIRUS FROM A
Experts say
virus needs
coordinated
response
interview Wednesday.
Without a vaccine, the primary
tools for combating the spread of
the virus remain the common-
sense “non-pharmaceutical inter-
ventions,” including mask-wear-
ing, hand-washing, staying out of
bars and other confined spaces,
maintaining social distancing of
at least six feet and avoiding
crowds, Fauci said.
“Seemingly simple maneuvers
have been very effective in pre-
venting or even turning around
the kind of surges we’ve seen,” he
said.
Thirty-three U.S. states have
positivity rates above 5 percent.
The World Health Organization
has cited that percentage as a
crucial benchmark for govern-
ments deciding whether to re-
open their economy. Above 5 per-
cent, stay closed. Below, open with
caution.
Of states with positivity rates
below 5 percent, nine have seen
those rates rise during the last two
weeks.
“You may not fully realize that
when you think things are okay,
you actually are seeing a subtle,
insidious increase that is usually
reflected in the percent of your
tests that are positive,” Fauci said.The shutdown blues
Some governors immediately
took the White House warnings to
heart. On Monday, Kentucky Gov.
Andy Beshear (D) said at a news
conference that he had met with
Birx the previous day and was told
he was getting the same warning
Texas and Florida received “weeks
before the worst of the worst hap-
pened.”
To prevent that outcome in his
state, Beshear said, he was closing
bars for two weeks and cutting
seating in restaurants.
But as Beshear pleaded that
“we all need to be singing from the
same sheet of music,” discord and
confusion prevailed.
Iowa Gov. Kim Reynolds (R)
said Thursday that she wasn’t con-
vinced a mask mandate is effec-
tive: “No one knows particularly
the best strategy.”
Earlier in the week, Tennessee
Gov. Bill Lee (R) demurred on
masks and bar closures even as he
stood next to Birx and spoke to
reporters.
“That’s not a plan for us now,”
he said. He added emphatically,
“We are not going to close the
economy back down.”
The virus is spreading through-
out his state, and not just in the big
cities. Vacationers took the virus
home from the honky-tonks of
Nashville and blues clubs of Mem-
phis to where they live in more
rural areas, said John Graves, a
professor at Vanderbilt University
studying the pandemic.
“The geographical footprint of
the virus has reached all corners
of the state at this point,” Graves
said.
In Missouri, Gov. Michael L.
Parson (R) was dismissive of New
York’s imposition of a quarantine
on residents from his state as a
sign of a worsening pandemic.
“I’m not going to put much stock
in what New York says — they’re a
disaster,” he said at a news confer-
ence Monday.
Missouri has no mask mandate,
leaving it to local officials to act —
often in the face of hostility and
threats. In the town of Branson,
angry opponents testified Tues-period is typically about six days,
according to the CDC. When
symptoms flare, they can be am-
biguous. A person may not seek a
test right away. Then, the test
results may not come back for
days, a week, even longer.
That delay makes contact trac-
ing nearly futile. It also means
government data on virus trans-
mission is invariably out of date to
some degree — it’s a snapshot of
what was happening a week or
two weeks before. And different
jurisdictions use different metrics
to track the virus, further fogging
the picture.
The top doctors on the White
House coronavirus task force,
Deborah Birx and Anthony S. Fau-
ci, are newly focused on the early
warning signs of a virus outbreak.
Last week, they warned that the
kind of runaway outbreaks seen in
the Sun Belt could potentially
happen elsewhere. Among the
states of greatest concern: Indi-
ana, Kentucky, Ohio and Tennes-
see.
Fauci and Birx have pointed to a
critical metric: the percentage of
positive test results. When that
figure starts to tick upward, it is a
sign of increasing community
spread of the virus.
“That is kind of the predictor
that if you don’t do something —
namely, do something different —
if you’re opening up at a certain
pace, slow down, maybe even
backtrack a little,” Fauci said in ansupport and simultaneously limit
sickness and death from the virus.
Many Americans may simply
feel discouraged and overtaxed,
unable to maintain precautions
such as social distancing and
mask-wearing. Others remain re-
sistant, for cultural or ideological
reasons, to public health guidance
and buy into conspiracy theories
and pseudoscience.
DeWine is struggling to get
Ohio citizens to take seriously the
need to wear masks. A sheriff in
rural western Ohio told the gover-
nor Wednesday that people didn’t
think the virus was a big problem.
DeWine informed the sheriff that
the numbers in his county were
higher per capita than in Toledo.
“The way I’ve explained to peo-
ple, if we want to have Friday night
football in the fall, if we want our
kids back in school, what we do in
the next two weeks will determine
if that happens,” DeWine said.The crucial metric
The coronavirus has always
been several steps ahead of the
U.S. government, the scientific
community, the news media and
the general public. By the time a
community notices a surge in pa-
tients to hospital emergency
rooms, the virus has seeded itself
widely.
The virus officially known as
SARS-CoV-2 can be transmitted
by people who are infectious but
not symptomatic. The incubationWhite House National Security
Council staffer focused on pan-
demics. “This is a spreading disas-
ter that moves from one place to
another, and until it’s suppressed
and until we ultimately have a safe
and effective and distributed vac-
cine, every community is at risk.”
A national strategy, whether
advanced by the federal govern-
ment or by the states working in
tandem, will more effectively con-
trol viral spread than the current
patchwork of state and local pol-
icies, according to a study from
researchers at the Massachusetts
Institute of Technology published
Thursday in the Proceedings of
the National Academy of Sciences.
The coordination is necessary
because one state’s policies affect
other states. Sometimes that in-
fluence is at a distance, because
states that are geographically far
apart can have cultural and social
ties, as is the case with the “peer
states” of New York and Florida,
the report found.
“The cost of our uncoordinated
national response to covid-19, it’s
dramatic,” said MIT economist Si-
nan Aral, senior author of the
paper.
Some experts argue for a full
six- to eight-week national shut-
down, something even more
sweeping than what was institut-
ed in the spring. There appears to
be no political support for such a
move.
Neil Bradley, executive vice
president of the U.S. Chamber of
Commerce, said fresh federal in-
tervention is necessary in this sec-
ond wave of closures. Enhanced
federal unemployment benefits
expired at the end of July, with no
agreement on a new stimulus
package in sight.
“Congress, on a bipartisan ba-
sis, was trying to create a bridge to
help individuals and businesses
navigate the period of a shut-
down,” Bradley said. “Absent an
extension of that bridge, in light of
a second shutdown, that bridge
becomes a pier. And then that’s a
real problem.”
With the economy in shambles,
hospitals filling up and the public
frustrated, anxious and angry, the
challenge for national leadership
is finding a plausible sea-to-sea
strategy that can win widespreadLUKE SHARRETT FOR THE WASHINGTON POST
Pedestrians exercise on the Big Four walking bridge over the Ohio River in Louisville on Wednesday. Kentucky Gov. Andy Beshear announced last week that he was closing
bars for two weeks and reducing seating in restaurants after federal officials warned him of the prospect of a dangerous surge in coronavirus cases in the state.ANDREW SPEAR FOR THE WASHINGTON POST
Christopher Bolls, center, waits with other socially distanced clients inside an Ohio Bureau of Motor
Vehicles location on Thursday. Some rural residents of the state have balked at wearing masks.WISCONSIN DEPARTMENT OF HEALTH SERVICES/ASSOCIATED PRESS
Wisconsin Gov. Tony Evers (D) issued a statewide mask mandate
and declared a public health emergency Thursday as cases rise.