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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.

As the deadly coronavirus has spread worldwide, it has carried with it xenophobia -- and Asian communities around the world are finding themselves subject to suspicion and fear.

When a patient on Australia's Gold Coast refused to shake the hand of her surgeon Rhea Liang, citing the virus that has killed hundreds, the medic's first response was shock.

But after tweeting about the incident and receiving a flood of responses, the respected doctor learned her experience was all too common.

There has been a spike in reports of anti-Chinese rhetoric directed at people of Asian origin, regardless of whether they have ever visited the centre of the epidemic or been in contact with the virus.

Chinese tourists have reportedly been spat at in the Italian city of Venice, a family in Turin was accused of carrying the disease, and mothers in Milan have used social media to call for children to be kept away from Chinese classmates.

In Canada, a white man was filmed telling a Chinese-Canadian woman "you dropped your coronavirus" in the parking lot of a local mall.

In Malaysia, a petition to "bar Chinese people from entering our beloved country" received almost 500,000 signatures in one week.

The incidents are part of what the Australasian College for Emergency Medicine has described as "misinformation" which it says is fuelling "racial profiling" where "deeply distressing assumptions are being made about 'Chinese' or 'Asian-looking' people." Disease has long been accompanied by suspicions of foreigners -- from Irish immigrants being targeted in the Typhoid Mary panic of 1900s America to Nepali peacekeepers being accused of bringing cholera to earthquake-struck Haiti in the last decade.

"It's a common phenomenon," said Rob Grenfell, director of health and biosecurity for Australia's science and research agency CSIRO.

"With outbreaks and epidemics along human history, we've always tried to vilify certain subsets of the population," he said, comparing the behaviour to 1300s plague-ridden medieval Europe, where foreigners and religious groups were often blamed.

"Sure it emerged in China," he said of the coronavirus, "but that's no reason to actually vilify Chinese people." In a commentary for the British Medical Journal, doctor Abraar Karan warned this behaviour could discourage people with symptoms from coming forward.

Claire Hooker, a health lecturer at the University of Sydney, said the responses from governments may have compounded prejudice.

The World Health Organisation has warned against "measures that unnecessarily interfere with international travel and trade", but this has not stopped scores of countries from introducing travel bans.

The tiny Pacific nation of Micronesia has banned its citizens from visiting mainland China altogether.

"Travel bans respond largely to people's fears," said Hooker, and while sometimes warranted, they often "have the effect of cementing an association between Chinese people and scary viruses".

Abbey Shi, a Shanghai-born student in Sydney, said the attitude shown by some of her peers has "become almost an attack on students who are Chinese".

While Australia's conservative government has banished its citizens returning from Wuhan -- the central Chinese city at the epicentre of the virus -- to a remote island for quarantine, thousands of students still stuck in China risk their studies being torpedoed.

"Right now it looks like they have to miss the semester's start and potentially the whole year, because of the way the courses are set up," Shi said.

According to Hooker, studies in Toronto on the impact of Severe Acute Respiratory Syndrome, or SARS -- another global coronavirus outbreak in 2002 -- showed the impact of xenophobic sentiment often lasted much longer than the public health scare.

"While there may be a cessation of direct forms of racism as news about the disease dies down, it takes quite a bit of time for economic recovery and people continue to feel unsafe," she said.

People may not rush back to Chinese businesses or restaurants, and may even heed some of the more outlandish viral social media disinformation -- such as one popular post imploring people to avoid eating noodles for their own safety.

"In one sense you might think the effects lasted from the last coronavirus to this one because the representation as China being a place where diseases come from has been persistent," Hooker said.

Feb 17: Chinese authorities on Monday reported a slight upturn in new virus cases and 105 more deaths for a total of 1,770 since the outbreak began two months ago.

The 2,048 new cases followed three days of declines but was up by just 39 cases from the previous day’s figure. Another 10,844 people have recovered from COVID-19, a disease caused by the new coronavirus, and have been discharged from hospitals, according to Monday’s figures.

The update followed the publication late Saturday in China’s official media of a recent speech by President Xi Jinping in which he indicated for the first time that he had led the response to the outbreak from early in the crisis. While the reports were an apparent attempt to demonstrate the Communist Party leadership acted decisively from the start, it also opened Xi up to criticism over why the public was not alerted sooner.

In his speech, Xi said he gave instructions on fighting the virus on Jan. 7 and ordered the shutdown of the most-affected cities that began on Jan. 23.

The disclosure of his speech indicates top leaders knew about the outbreak’s potential severity at least two weeks before such dangers were made known to the public. It was not until late January that officials said the virus can spread between humans and public alarm began to rise.

New cases in other countries are raising growing concerns about containment of the virus.

Taiwan on Sunday reported its first death from COVID-19, the fifth fatality outside of mainland China. Taiwan’s Central News Agency, citing health minister Chen Shih-chung, said the man who died was in his 60s and had not traveled overseas recently and had no known contact with virus patients.

Japanese Prime Minister Shinzo Abe convened an experts meeting to discuss containment measures in his country, where more than a dozen cases have emerged in the past few days without any obvious link to China.

“The situation surrounding this virus is changing by the minute,” Abe said.

Japanese Health Minister Katsunobu Kato said the country is “entering into a phase that is different from before,” requiring new steps to stop the spread of the virus.

Japan now has 413 confirmed cases, including 355 from a quarantined cruise ship, and one death from the virus. Its total is the highest number of cases among about two dozen countries outside of China where the illness has spread.

Hundreds of Americans from the cruise ship took charter flights home, as Japan announced another 70 infections had been confirmed on the Diamond Princess. Canada, Hong Kong and Italy were planning similar flights.

The 300 or so Americans flying on U.S.-government chartered aircraft back to the U.S. will face another 14-day quarantine at Travis Air Force Base in California and Lackland Air Force Base in Texas. The U.S. Embassy said the departure was offered because people on the ship were at a high risk of exposure to the virus. People with symptoms were banned from the flights.

About 255 Canadians and 330 Hong Kong residents are on board the ship or undergoing treatment in Japanese hospitals. There are also 35 Italians, of which 25 are crew members, including the captain.

In China’s Hubei province, where the outbreak began in December, all vehicle traffic will be banned in another containment measure. It expands a vehicle ban in the provincial capital, Wuhan, where public transportation, trains and planes have been halted for weeks.

Exceptions were being made for vehicles involved in epidemic prevention and transporting daily necessities.

Hubei has built new hospitals with thousands of patient beds and China has sent thousands of military medical personnel to staff the new facilities and help the overburdened health care system.

Last Thursday, Hubei changed how it recognized COVID-19 cases, accepting a doctor’s diagnosis rather than waiting for confirmed laboratory test results, in order to treat patients faster. The tally spiked by more than 15,000 cases under the new method.