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Washington, Jun 9: When epidemiologists talked about "flattening the curve," they probably didn't mean it this way: the US hit its peak coronavirus caseload in April, but since that time the graph has been on a seemingly unending plateau.

That's unlike several other hard-hit countries which have successfully pushed down their numbers of new cases, including Spain and Italy, which now have bell-shaped curves.

Experts say the prolonged nature of the US epidemic is the result of the cumulative impact of regional outbreaks, as the virus that started out primarily on the coasts and in major cities moves inward.

Layered on top of that are the effects of lifting lockdowns in parts of the country that are experiencing rising cases, as well as a lapse in compliance with social distancing guidelines because of economic hardship, and in some cases a belief that the threat is overstated.

"The US is a large country both in geography and population, and the virus is at very different stages in different parts of the country," Tom Frieden, a former director of the Centers for Disease Control and Prevention told AFP.

The US saw more than 35,000 new cases for several days in April. While that figure has declined, it has still been exceeding 20,000 regularly in recent days.

By contrast, Italy was regularly hitting more than 5,000 cases per day in March but is currently experiencing figures in the low hundreds.

"We did not act quickly and robustly enough to stop the virus spreading initially, and data indicate that it travelled from initial hotspots along major transport routes into other urban and rural areas," added Frieden, now CEO of the non-profit Resolve to Save Lives.

To wit: the East Coast states of New York, New Jersey and Massachusetts accounted for about 50 percent of all cases until about a month or so ago -- but now the geographic footprint of the US epidemic has shifted to the Midwest and southeast, including Florida.

Another key problem, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins, is that the United States is still not doing enough testing, contact tracing and isolation.

After coming late to the testing party -- for reasons ranging from technical issues to regulatory hurdles -- the US has now conducted more COVID-19 tests than any other country.

It even has one of the highest per capita rates per country of 62 per 1,000 people, according to the website ourworldindata.org -- better than Germany (52 per 1,000) and South Korea (20 per 1,000).

But according to Nuzzo, these numbers are misleading, because "the amount of testing that a country should do should be scaled to the size of its epidemic.

"The United States has the largest epidemic in the world so obviously we need to do a lot more testing than any other country."

For Johns Hopkins, the more important metric is the positivity rate -- that is, out of all tests conducted, how many came back positive for COVID-19.

As of June 7, the United States had an average daily positivity rate of 14 percent, well above the World Health Organization guideline of 5 percent over two weeks before social distancing guidelines should be relaxed.

By contrast, Germany, which has tested far fewer people in relation to its population, has a positivity rate of 5 percent.

Even if testing were scaled up, carrying out tests in of itself does very little good without the next steps -- finding out who was exposed and then asking them to isolate.

Here also, too many US states are lagging woefully behind.

Texas, which is experiencing a surge in cases after relaxing its lockdown, is a case in point. The state targeted hiring a modest 4,000 tracers by June, but according to local reports is still more than a thousand shy of even that goal.

Opt-in app based efforts have also been slow to get off the ground.

Then there is the fact that some people are growing tired of lockdowns, while others don't have the economic luxury of being able to stay home for prolonged periods.

The government sent some 160 million Americans a single stimulus check of up to $1,200 back in April but it's not clear whether more will be forthcoming.

Still others, particularly in so-called red states under Republican leadership, have chafed under restrictions and mask-wearing guidelines that they see as an affront to their personal freedom.

"The US is kind of on the extreme of the individual liberty side," Sten Vermund, dean of the Yale School of Public Health, told AFP.

Part of this has to do with mixed messaging from Republican leaders, including President Donald Trump, said Nuzzo.

"We have had at the highest political level an assertion that this is a situation that's been overblown, and that maybe certain protective behaviors are not necessary," she said.

More recently, tens of thousands of people across the country have taken to the streets to protest the killing on an unarmed black man by police, risking coronavirus infection to demonstrate against the public health threat of racialized state violence.

Jun 1: The new coronavirus is losing its potency and has become much less lethal, a senior Italian doctor said on Sunday.

"In reality, the virus clinically no longer exists in Italy," said Alberto Zangrillo, the head of the San Raffaele Hospital in Milan in the northern region of Lombardy, which has borne the brunt of Italy's coronavirus contagion.

"The swabs that were performed over the last 10 days showed a viral load in quantitative terms that was absolutely infinitesimal compared to the ones carried out a month or two months ago," he told RAI television.

Italy has the third-highest death toll in the world from COVID-19, with 33,415 people dying since the outbreak came to light on Feb. 21. It has the sixth-highest global tally of cases at 233,019.

However new infections and fatalities have fallen steadily in May and the country is unwinding some of the most rigid lockdown restrictions introduced anywhere on the continent.

Zangrillo said some experts were too alarmist about the prospect of a second wave of infections and politicians needed to take into account the new reality.

"We've got to get back to being a normal country," he said. "Someone has to take responsibility for terrorizing the country."

The government urged caution, saying it was far too soon to claim victory.

"Pending scientific evidence to support the thesis that the virus has disappeared ... I would invite those who say they are sure of it not to confuse Italians," Sandra Zampa, an undersecretary at the health ministry, said in a statement.

"We should instead invite Italians to maintain the maximum caution, maintain physical distancing, avoid large groups, to frequently wash their hands and to wear masks."

A second doctor from northern Italy told the national ANSA news agency that he was also seeing the coronavirus weaken. "The strength the virus had two months ago is not the same strength it has today," said Matteo Bassetti, head of the infectious diseases clinic at the San Martino hospital in the city of Genoa.

"It is clear that today the COVID-19 disease is different."

New York, May 8: An Indian-American father and daughter, both doctors in New Jersey, have died due to the COVID-19, with Governor Phil Murphy describing their demise as “particularly tough" and hailed them for dedicating their lives for others.

Satyender Dev Khanna, 78, was a surgeon who served both on staff and as the head of the surgical departments for multiple hospitals across New Jersey for decades.

Priya Khanna, 43, was a double board-certified in both internal medicine and nephrology. She was Chief of Residents at Union Hospital, now part of RWJ Barnabas Health.

"Dr Satyender Dev Khanna and Dr Priya Khanna were father and daughter. They both dedicated their lives to helping others. This is a family dedicated to health and medicine. Our words cannot amply express our condolences," New Jersey Governor Murphy tweeted on Thursday.

“Both dedicated their lives to helping others and we lost both of them to COVID-19,” Murphy said during a press conference on Thursday, saying their demise is a "particularly tough one.”

Satyender passed away at the Clara Maass Medical Center where he had worked for more than 35 years.

Murphy described him as a "pioneering doctor” who was one of the first surgeons to perform laparoscopic surgery in the state. He is being remembered by colleagues as a “gentle and caring physician."

“And for a doctor, I'm not one, but I would bet, I don't think there could be a more fitting way to be remembered, or a nurse or a healthcare worker of any kind,” Murphy said, adding that the doctor had a passion for bicycling, and he often found peace from the hustle of the hospital in biking along the Jersey Shore.

Priya did all of her medical training in New Jersey and then did her fellowship in nephrology in South Jersey with the Cooper Health System. Like her father, she too worked at Clara Maass, where she died.

She was also Medical Director at two dialysis centres in Essex County and “took pride” in teaching the next generation of doctors, Murphy said, adding that the ICU physician who cared for Priya Khanna was trained and taught by her as well.

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“Priya will be remembered as a caring and selfless person who put others first. And even while in the hospital, fighting her own battle, she continued to check up on her mom and dad and her family,” Murphy said.

“This is a family, by the way, dedicated to health and medicine,” he said.

The governor spoke with Satyender's wife Komlish Khanna, who is a paediatrician. The couple has two more daughters - Sugandha Khanna, an emergency medicine physician and Anisha Khanna, a paediatrician.

“Unbelievable. Our words cannot amply express our condolences nor, I am sure, can they express the pain that the Khanna family is feeling. But I hope that the fact that our entire state mourns with them is some small comfort. And we mourn everyone we have lost. We commit in their memory to saving as many lives as we can,” Murphy said.