States move to reopen again as case counts rise

PHOENIX — Four months after a race to reopen state economies led to a summer onslaught of coronavirus infections, several of those same states are moving again to reduce restrictions and return to some semblance of normalcy.

The decisions to end restrictions come as the number of new cases confirmed every day begins to rise once again after a mid-September plateau. Public health experts worry that growing case counts, coupled with the coming influenza season, will contribute to a new spike that will once again threaten to overwhelm hospitals.

Arizona’s Department of Health Services said Thursday that the state’s 15 counties have all met benchmarks needed to reopen gyms, bars that serve food, and movie theaters. Gov. Doug Ducey (R) said last week that he has no plans to reimplement restrictions even though he anticipates case counts will rise.

Florida Gov. Ron DeSantis (R) last week lifted all restrictions on businesses including bars and restaurants. The executive order DeSantis signed also prohibits local municipalities from fining people who violate mask-wearing mandates.

In Nebraska, Gov. Pete Ricketts (R) rolled back virtually all restrictions on social gatherings and distancing. Iowa Gov. Kim Reynolds (R) allowed bars to reopen in four counties where she had ordered them shuttered just three weeks before. Reynolds has also tried to force public schools to open, setting up a clash with the Des Moines public school district.

Tennessee Gov. Bill Lee (R) ended restrictions on businesses and public gatherings in 89 of 95 counties. Mississippi Gov. Tate Reeves (R) became the first governor in the nation to rescind a statewide mask mandate, one he had ordered in August.

“The numbers just simply don’t justify the heavy hand of government telling us that we have to wear a mask,” Reeves told The Hill in an interview Friday. “I will tell you that I continue to strongly suggest to my fellow Mississippians, particularly those that are in the more vulnerable categories, to please continue to wear a mask in public.”

“What you’ll see is that we’ll continue to have great participation by Mississippians and we’ll continue to slow the spread and flatten the curve,” he said.

Political leaders in those states cited positive trends in hospitalizations, even as overall case counts continue to rise.

“We know from some of the models that the public health experts are hypothesizing that there will be increased spread in colder climates,” Daniel Ruiz, Arizona’s chief operating officer, told The Hill. “We are very intentional about what reopening looks like.”

But public health experts warn that some states are putting themselves back on the path to a significant new outbreak, like those that erupted in June, July and August.

“We all want to get back to our normal lives as they were before the pandemic began, but one thing is absolutely clear: that the path to sustained economic recovery and the resumption of public activities is the path laid out by public health,” said Rich Besser, a former director of the Centers for Disease Control and Prevention (CDC) who now heads the Robert Wood Johnson Foundation.

“Every time a state has moved forward without that roadmap, what we’ve seen is increases in cases, increases in hospitalizations and increases in deaths,” he added. 

In some of those states beginning to reopen, the outbreak is far less widespread than it was over the summer. Arizona recorded 3,227 new infections last week, or about 45 per every 100,000 residents. That per capita figure is about one-eighth as bad as the state was suffering in early July, at the peak of its outbreak. Mississippi’s per capita infection rate is about a third of what it was in late July.

“By all accounts, we have made tremendous progress in our state,” Reeves said. “We’re about 60 percent below the peak. Our hospitalization usage has come down considerably.”

But other states have not seen case curves bend downward as successfully. In Iowa, just under 200 people per 100,000 residents tested positive last week; in both North and South Dakota, the per capita infection rate is north of 300. Nebraska’s rate of weekly new infections, 169 per 100,000 residents, is the highest it has ever been, according to The Hill’s analysis of current case data.

Across the country, new infections are rising. An average of 42,000 people tested positive over the last week, substantially higher than the 35,000 cases averaged over the middle weeks of September.

Some public health experts say the states racing to reopen are repeating the same mistakes of May and June, premature decisions that led to a spike in cases over the summer. This time, those experts worry that another factor other than public health is driving decisions: November’s looming election.

“Instead of following CDC or other scientific guidelines, we’re kind of following the electoral map,” said Christine Petersen, an epidemiologist at the University of Iowa. “We’re Sweden.”

State health officials say their understanding of the spread and treatment of the coronavirus and the disease it causes, COVID-19, has improved markedly since the summer. And some states, especially in the Northeast, have kept new case counts low as they slowly reopen, with the assistance of aggressive testing and tracing programs.

“What you find when you’re reopening is that you have to pay meticulous attention to data, to recognize when a slight increase in cases might represent either a change in behavior or a new outbreak,” Besser said. “And when you see that, you have to jump on it to ensure a small cluster of cases doesn’t lead to an overwhelmed health care system and increasing rates of death.”

In Arizona, case counts rose quickly in two counties that are home to major public colleges. Both of those schools — the University of Arizona in Pima County and Northern Arizona University in Coconino County — significantly increased their testing ability. Both counties bulked up contact tracing capabilities, and case counts have subsequently fallen.

“We can watch in real time every week with this information coming in whether we’re seeing an increase in cases coming in,” Ruiz said. “We want to avoid another spike.”