Hospitals rapidly approached capacity across the Sun Belt, and the Miami area moved to close restaurants and gyms again because of the surging coronavirus Monday as the U.S. emerged from a Fourth of July weekend of picnics, pool parties and beach outings that health officials fear could fuel the outbreak.
The seesaw effect -- restrictions lifted, then reimposed -- has been seen around the country in recent weeks and is expected to continue after a holiday that saw crowds of people celebrating, many without masks.
"We were concerned before the weekend and remain concerned post-holiday, as anecdotal stories and observed behavior indicate that many continue to disregard important protective guidance," said Heather Woolwine, a spokeswoman for the Medical University of South Carolina.
[Video not showing up above? Click here to watch » https://www.youtube.com/watch?v=XB1ZugqhS_4]
The White House again rejected calls for a nationwide order to wear face coverings, with Chief of Staff Mark Meadows saying on Fox News that it is a matter for governors and mayors to decide. He said that "certainly a national mandate is not in order."
Confirmed cases are on the rise in 41 states plus the District of Columbia, and the percentage of tests coming back positive for the virus is increasing in 39 states.
Florida, which recorded a high of 11,400 new cases Saturday and has seen its positive test rate top 18%, has been hit especially hard, along with other Sun Belt states such as Arizona, California and Texas.
[CORONAVIRUS: Click here for our complete coverage » arkansasonline.com/coronavirus]
A virus outbreak in the California Legislature indefinitely delayed the state Assembly's return to work from a summer recess. Hospitalizations in California have increased 56% in the past two weeks while the number of confirmed cases has jumped 53%.
IN FLORIDA
In Miami-Dade County, population 2.7 million, Mayor Carlos Gimenez ordered authorities to reverse course on a reopening plan, issuing an emergency order that shuts down gyms, party venues and restaurants. The order takes effect Wednesday.
Beaches will reopen today after being closed over the weekend. "But if we see crowding and people not following the public health rules, I will be forced to close the beaches again," the mayor warned.
"We want to ensure that our hospitals continue to have the staffing necessary to save lives," said Gimenez, a Republican.
He said the spike has been driven by infections among 18- to 34-year-olds who have been gathering in congested places -- indoors and out -- without wearing masks and maintaining proper distancing.
"Contributing to the positives in that age group, the doctors have told me, were graduation parties, gatherings at restaurants that turned into packed parties in violation of the rules, and street protests where people could not maintain social distancing and where not everyone was wearing facial coverings," Gimenez said.
Florida has seen its caseload soar past 200,000 overall.
Hospitalizations across the state have been ticking up, with nearly 1,700 patients admitted in the past seven days compared with 1,200 the previous week. Five hospitals in the St. Petersburg area were out of intensive care unit beds, officials said. Miami's Baptist Hospital had only four of its 88 ICU beds available.
"If we continue to increase at the pace we have been, we won't have enough ventilators, enough rooms," said Dr. David De La Zerda, ICU medical director and pulmonologist at Miami's Jackson Memorial Hospital.
IN LOUISIANA
The federal government is setting up five new drive-thru testing sites in Louisiana's capital city region, which is seeing spikes in confirmed cases.
Baton Rouge Mayor Sharon Weston Broome said most of the sites will open today and operate seven days a week from 8 a.m. to 4 p.m., with a goal of testing as many as 5,000 people a day through July 18. The sites will use self-administered nasal swabs.
"I implore our residents to take advantage of these testing sites if they have symptoms or were exposed," Broome said.
[Gallery not loading above? Click here for more photos » arkansasonline.com/77covid/]
She enacted a mask requirement last week for anyone entering businesses around the city. The region has seen sizable increases in cases and hospitalizations, including an outbreak traced to a cluster of bars near the Louisiana State University campus.
New Orleans' health director worried about what she said were strains on testing capacity.
Dr. Jennifer Avegno said tests are being done at a rate of about 850 per day -- well above the 500 per day needed to meet federal standards for a community the size of New Orleans.
But she said there have been issues getting trays and chemicals needed for the large machines used to run the tests, and the problems have led to some people being turned away.
IN TENNESSEE
A group of critical care physicians called on Tennessee Gov. Bill Lee to do more to stop the spread of the virus.
Dr. Aaron Milstone suggested the governor needs to do three things to bring the state's surging case numbers back down. First, he said, Lee needs to require people to wear masks in public.
"If people ignore speed limits, they're fined because they are endangering others," said Milstone, a pulmonary and critical care physician. "During this health crisis, not wearing a mask, not social distancing, is endangering others."
The doctors also want Lee to make the Tennessee Pledge enforceable. The pledge outlines how businesses can protect workers and customers with social distancing, masks and other measures. And the doctors want Lee to give cities more authority to make rules that protect their residents.
Tennessee saw coronavirus cases jump by 121% in June as it reopened businesses.
On Friday, Lee issued an order granting 89 counties the authority to issue local mask requirements if cases spike.
Dr. Jigme Sethi said the virus is unlike anything he has ever seen.
"This is the first time in my 35 years as a physician that I've felt helpless in the ICU," he said. "The grief and sorrow of these needless deaths is devastating. They are dying alone, with no family present and no one holding their hands."
IN WEST VIRGINIA
Republican Gov. Jim Justice reversed course and ordered the wearing of masks indoors, joining other state leaders around the country.
"I'm telling you, West Virginia, if we don't do that and do this now, we're going to be in a world of hurt," he said, adding: "It's not much of an inconvenience."
West Virginia hit a peak of 130 new cases Sunday, putting its total at 3,356.
"If you go to work in a building, I expect you to wear a mask as you enter work, and if you're working in an area that is completely socially distanced, take your mask off," Justice said. "If you go to a drinking fountain, put your mask on. If you go into a retail business, then I expect you to wear a mask."
Local ABC affiliate WCHS reported that Justice said he had put off mandating masks but eventually decided "it is the very thing I want to do the most because I know in my heart if we don't, we are going to have funeral after funeral."
OTHER STATES
Officials in Texas reported that hospitals are in danger of being overwhelmed. Hospitalizations statewide surged past 8,000 for the first time over the weekend, a more than fourfold increase in the past month. Houston officials said intensive care units there have exceeded capacity.
Along the border with Mexico, two severely ill patients were flown hundreds of miles north to Dallas and San Antonio because hospitals in the Rio Grande Valley were full.
In Arizona, the number of people hospitalized topped 3,200, a new high, and hospitals statewide were at 89% capacity. Confirmed cases surpassed 100,000, and more than half of those infected are younger than 44, state health officials said.
As cases surge across the state, Katie Cameron said it appears some of her neighbors in Phoenix are in denial. The mother of two said she's seen people tearing down caution tape meant to keep them off playground equipment in parks; large groups gathering to socialize; and -- most concerning -- very few masks.
"I feel like people don't care or don't think its real," Cameron said. "It's kind of like 'out of sight, out of mind,' or they are just lying to themselves because they don't want to believe it."
Health officials in South Carolina reported more than 1,500 new cases Monday. If the numbers keep rising at their current rates, then hospitals will probably have to adopt an emergency plan to add 3,000 more beds in places such as hotels and gyms, authorities said.
Alabama has been averaging about 1,000 new cases a day, two or three times what it was seeing in late April, when its stay-at-home order was lifted.
"We set a record for highs over the holiday weekend and, of course, given the number of people who were out and about over the weekend celebrating, we are certainly concerned about what the next couple of weeks are going to look like as well," said Scott Harris, Alabama's health officer.
New Jersey's Democratic Gov. Phil Murphy has said he'd like to see a national strategy, including a mask requirement. He said his state is seeing "small spikes in reinfection" from residents returning from Florida, South Carolina and other hot spots, and that the U.S. is "as strong as our weakest link right now."
In New York, once the most hard-hit spot in the country, Gov. Andrew Cuomo said he was concerned about reports of large gatherings over the holiday weekend in New York City, on Fire Island and in other places.
"I understand people are fatigued," he said. "We've been doing this for 128 days. I get it. But it doesn't change the facts, and we have to stay smart."
DEATHS IN U.S.
The coronavirus is blamed for 537,000 deaths worldwide, including more than 130,000 in the U.S., according to the tally kept by Johns Hopkins University. The number of confirmed infections nationwide stood at 2.9 million, though the real number is believed to be much higher.
New cases per day nationwide have hit record levels of well over 50,000.
Average deaths per day have fallen over the past two weeks from around 600 to about 510, in what experts say reflects advances in treatment and prevention as well as the large share of cases among young adults, who are more likely than older ones to survive covid-19.
But deaths are considered a lagging indicator -- that is, it takes time for people to get sick and die. And experts are worried that the downward trend could reverse itself.
Meanwhile, three of the top U.S. medical organizations issued an open letter urging Americans to wear masks, socially distance and wash hands often to help stop "the worst public health crisis in generations."
The American Medical Association, American Nurses Association and American Hospital Association issued the plea in the absence of a mask-wearing order from Washington. The groups said steps taken early on that helped slow the virus "were too quickly abandoned."
S.D. GOVERNOR
Shortly after fireworks above Mount Rushmore disappeared into the night sky Friday, South Dakota Gov. Kristi Noem accompanied President Donald Trump aboard Air Force One despite having had close contact with Trump's son's girlfriend, who had tested positive for the coronavirus.
Noem had interacted closely at a campaign fundraiser with Donald Trump Jr.'s girlfriend, Kimberly Guilfoyle, who turned out to be infected. Noem didn't wear a mask on the plane and chatted with the president as the flight returned to Washington, said her spokesperson, Maggie Seidel.
Noem had tested negative shortly before welcoming Trump to South Dakota on Friday, a day after she had interacted with Guilfoyle. A picture on social media showed Noem and Guilfoyle, who is also a Trump campaign staff member, hugging. The Trump campaign announced that Guilfoyle had tested positive Friday.
Guilfoyle's infection prompted some Republicans, such as Rep. Greg Gianforte of Montana, to take precautions. He suspended in-person campaigning for his gubernatorial bid after his wife and his running mate both attended a fundraiser with Guilfoyle earlier in the week.
Noem doesn't plan anything similar or to get tested again, Seidel said. She cast Noem's decision to fly on Air Force One as a demonstration of how to live with the virus. Seidel pointed to comments from the World Health Organization that the spread of the virus is "rare" from asymptomatic people. But that runs counter to guidance from public health experts, including the Centers for Disease Control and Prevention, that advises people to wear masks when interacting with people outside their households.
The CDC says that people with active infections can still test negative, especially if it is early in the infection. The agency recommends that even people who test negative take precautions like avoiding close contact and wearing masks around others.
"The president is tested constantly, has tested negative, and those around him are tested as well," White House press secretary Kayleigh McEnany said.
When asked why Noem was allowed to travel on Air Force One, McEnany referred the question to the Secret Service but added: "They take the president's health very seriously. They would never put him in a situation that would put him in harm's way."
Information for this article was contributed by Adriana Gomez Licon, Lisa Marie Pane, Melinda Deslatte, Kevin McGill, Travis Loller, Stephen Groves and staff members of The Associated Press; and by Joshua Partlow, Nick Miroff, Laurie McGinley, Felicia Sonmez, Hannah Denham, Lateshia Beachum, Nick Anderson and Yasmeen Abutaleb of The Washington Post.
