BALTIMORE, June 11 (WNM/Johns Hopkins Center for Health Security) – Several weeks after US states began to relax social distancing measures and “stay at home” orders as well as celebrations over the Memorial Day holiday weekend, a number of states are reporting increasing COVID-19 incidence. Analysis published by NPR (https://www.npr.org/sections/health-shots/2020/03/16/816707182/map-tracking-the-spread-of-the-coronavirus-in-the-u-s) identifies 23 US states and Puerto Rico with increasing COVID-19 incidence over the past 2 weeks, including 5 states with more than double the daily incidence compared to 2 weeks ago. Additionally, analysis published by The Washington Post (https://www.washingtonpost.com/health/2020/06/08/14-states-puerto-rico-hit-their-highest-seven-day-average-new-covid-19-infections-since-june/) found that 13 states and Puerto Rico recently reported their highest 14-day average incidence. Reported incidence does not necessarily represent the full impact, and other analysis indicates that the number of COVID-19 hospitalizations is increasing as well (https://www.washingtonpost.com/health/2020/06/09/coronavirus-hospitalizations-rising/). Increased hospitalizations suggest that growing case counts in many states is not entirely a result of more testing. Much like trends on the international scale, areas hit the hardest early in the US epidemic are largely exhibiting decreasing COVID-19 incidence, whereas areas not previously affected are experiencing increasing community transmission.

Arizona has reported significant increases in daily incidence over the past 2 weeks (https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php), and now state health officials are directing health systems to anticipate a surge in COVID-19 patients (https://eu.azcentral.com/story/news/local/arizona-health/2020/06/08/arizona-hospitals-have-been-told-fully-activate-emergency-plans/5321075002/). On June 6, the Director of Arizona’s Department of Health Services, Dr. Cara Christ, reportedly distributed a letter to hospitals across the state that urged them to “fully activate” their emergency response plans. This would likely include activating hospital incident command systems, preparing to implement crisis standards of care, suspending elective medical procedures, and expanding intensive care unit (ICU) bed capacity. The number of hospital, emergency department (ED), and ICU beds (https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php) in use statewide has increased steadily since mid-April, and the number of mechanical ventilators in use has increased since at least late March. Dr. Christ (https://ein.az.gov/emergency-information/emergency-bulletin/arizona-department-health-services-provides-updates-covid) emphasized that “COVID-19 is widespread and still circulating” in Arizona, even though the state is relaxing social distancing and resuming normal activities.

Texas reported record numbers for COVID-19 hospitalizations this week (https://www.npr.org/sections/coronavirus-live-updates/2020/06/08/872660425/texas-reports-record-breaking-covid-19-hospitalizations-as-state-reopens), as efforts continue to relax social distancing. In addition to elevated daily incidence (https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83), Texas reported 5 of its 6 highest daily totals for COVID-19 hospitalizations (https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/0d8bdf9be927459d9cb11b9eaef6101f) over the past 5 days, including its first day with more than 2,000 hospitalized COVID-19 patients. Texas’ test positivity is also increasing, up from a low of 4.27% on May 26 to 7.55% on June 6 (currently 6.66%). On June 3, Texas Governor Greg Abbott announced (https://gov.texas.gov/news/post/governor-abbott-announces-phase-iii-to-open-texas) that the state would move into Phase 3 of its recovery plan, which allows businesses to increase to 50% of their normal capacity. In the announcement, Governor Abbott stated that the increased transmission was a “result of isolated hot spots in nursing homes, jails, and meat packing plants” rather than broader increases in community transmission. Governor Abbott also stated that 1,457 COVID-19 patients were hospitalized at that time, but this comment is inconsistent with data reported by the Texas Department of State Health Services, which indicates nearly 1,800 hospitalizations on that date.