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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.

Jan 30: The death toll rose to 170 in the new virus outbreak in China on Thursday as foreign evacuees from the worst-hit region begin returning home under close observation and world health officials expressed “great concern” that the disease is starting to spread between people outside of China.

Thursday’s figures cover the previous 24 hours and represent an increase of 38 deaths and 1,737 cases for a total of 7,711. Of the new deaths, 37 were in the epicenter of the outbreak in Hubei province and one in the southwestern province of Sichuan.

The news comes as the 195 Americans evacuated from Wuhan, the Hubei province city of 11 million where the outbreak originated, are undergoing three days of testing and monitoring at a Southern California military base to make sure they do not show signs of the virus.

A group of 210 Japanese evacuees from Wuhan landed Thursday at Tokyo’s Haneda airport on a second government chartered flight, according to the foreign ministry. Reports said nine of those aboard the flight showed signs of cough and fever. Three of the 206 Japanese who returned on Wednesday tested positive for the new coronavirus, Prime Minister Shinzo Abe said during a parliamentary session. Two of them showed no symptoms of the disease.

France, New Zealand, Australia and other countries are also pulling out their citizens or making plans to do so.

The World Health Organization emergencies chief said the few cases of human-to-human spread of the virus outside China — in Japan, Germany, Canada and Vietnam — were of “great concern” and were part of the reason the U.N. health agency’s director-general was reconvening a committee of experts on Thursday to assess whether the outbreak should be declared a global emergency.

The new virus has now infected more people in China than were sickened there during the 2002-2003 SARS outbreak.

Dr. Michael Ryan spoke at a news conference in Geneva on Wednesday after returning from a trip to Beijing to meet with Chinese President Xi Jinping and other senior government leaders. He said China was taking “extraordinary measures in the face of an extraordinary challenge” posed by the outbreak.

To date, about 99% of the cases are in China. Ryan estimated the death rate of the new virus at 2%, but said the figure was very preliminary. With fluctuating numbers of cases and deaths, scientists are only able to produce a rough estimate of the fatality rate and it’s likely many milder cases of the virus are being missed.

In comparison, the SARS virus killed about 10% of people who caught it. The new virus is from the coronavirus family, which includes those that can cause the common cold as well as more serious illnesses such as SARS and MERS.

Scientists say there are many questions to be answered about the new virus, including just how easily it spreads and how severe it is.

In a report published Wednesday, Chinese researchers suggested that person-to-person spread among close contacts occurred as early as mid-December.

“Considerable efforts” will be needed to control the spread if this ratio holds up elsewhere, researchers wrote in the report, published in the New England Journal of Medicine.

More than half of the cases in which symptoms began before Jan. 1 were tied to a seafood market, but only 8% of cases after that have been, researchers found. They reported the average incubation period was five days.

Scientists predict the world may have a COVID-19 vaccine within one year or even a few months earlier, said the Director-General of the World Health Organisation even as he underlined the importance of global cooperation to develop, manufacture and distribute vaccines.

However, making the vaccine available and distributing it to all will be a challenge and requires political will, Tedros Adhanom Ghebreyesus said on Thursday during a meeting with the European Parliament's Committee for Environment, Public Health and Food Safety.

One option would be to give the vaccine only to those that are most vulnerable to the virus.

There are currently over 100 COVID-19 vaccine candidates in various stages of development.

Adhanom Ghebreyesus said the pandemic has highlighted the importance of global solidarity and that health should not be seen as a cost but an investment.

He added that all countries in the world must strengthen primary health care and crisis preparedness and stressed the need for EU leadership globally.

While the Director-General said the situation in the EU has improved significantly, he underlined that COVID-19 is very much still circulating globally, with more than four million new cases in the last month.

Many Members of European Parliament said that the global community must cooperate including in developing, manufacturing and distributing vaccines against COVID-19 and asked when a safe vaccine could be available.

Several Members of European Parliament underlined the importance of the WHO but also said it has made mistakes in its response to the pandemic.

The Director-General admitted everyone makes mistakes and informed the members that an independent panel will evaluate the WHO response to the pandemic to learn from any mistakes made.

It will start its work soon, he said.