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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.

Shanghai, Jan 27: The death toll from a coronavirus outbreak in China rose to 81 on Monday, as the government extended the Lunar New Year holiday and more big businesses shut down or told staff to work from home in an effort to curb the spread.

Chinese Premier Li Keqiang visited the central city of Wuhan, the epicenter of the outbreak, as the government sought to signal it was responding seriously to the crisis.

The total number of confirmed cases in China rose about 30% to 2,744, about half of them in Hubei province, whose capital is Wuhan.

As worries grew around the world, Chinese-ruled Hong Kong, which has had eight confirmed cases, banned entry to people who had visited Hubei in the past 14 days. The ban did not cover Hong Kong residents.

The number of deaths from the flu-like virus in Hubei climbed to 76 from 56, health officials said, with five deaths elsewhere in China, including the southern island province of Hainan, which reported its first fatality on Monday.

While a small number of cases have been confirmed in more than 10 countries, linked to people who traveled from Wuhan, no deaths have been reported elsewhere.

Li is the most senior leader to visit Wuhan since the outbreak began. Clad in a blue protective suit and mask, he inspected efforts to contain the epidemic and spoke to patients and medical staff, the government said.

The government is extending the week-long Lunar New Year holiday by three days to February 2, in a bid to slow the spread of the virus. The Lunar New Year is usually a time for millions of people to travel, but many have had to cancel their plans because of travel curbs over the virus.

Incubation

Wuhan is already in virtual lockdown and severe limits on movement are in place in several other Chinese cities.

The city of 11 million clamped down further on Monday, announcing the suspension of visa and passport services until January 30.

Despite the curbs, the mayor of Wuhan said on Sunday that five million people had left the city for holidays and other reasons.

Images from Wuhan showing hospital corridors packed with people seeking treatment have circulated on social media, along with complaints of soaring prices for essentials such as vegetables.

Chinese leaders have urged transparency in the crisis, after public trust was eroded by the cover-up of the spread of Severe Acute Respiratory Syndrome (SARS), a coronavirus that originated in China and killed nearly 800 people globally in 2002 and 2003.

Much is not known about the newly identified coronavirus, including how easily it spreads and just how dangerous it is. It can cause pneumonia, which has been deadly in some cases.

National Health Commission minister Ma Xiaowei said on Sunday the incubation period could range from one to 14 days, and the virus was infectious during incubation, unlike SARS.

That compares with a World Health Organization (WHO) estimate of two to 10 days for the incubation period.

“Understanding the time when infected patients may transmit the virus to others is critical for control efforts,” the WHO said.

The virus is believed to have originated late last year in a Wuhan market illegally selling wildlife. It has spread to other cities, including Beijing and Shanghai, as well as more than 10 countries including France, Japan and the United States.

‘Overwhelmed’

Australia confirmed its fifth case on Monday involving a woman on the last flight out of Wuhan to Sydney before China’s travel ban.

Health minister Greg Hunt told the Australian Broadcasting Corporation (ABC) authorities aimed to get about 100 Australian children and young people out of Wuhan.

One father of two, Nathan Wang, told the ABC his wife was stuck in Wuhan with the children. “We absolutely want the children to come back, because hospitals in Wuhan are overwhelmed,” he said.

Airports around the world have stepped up screening of passengers from China, although some health experts have questioned its effectiveness.

Last week the WHO stopped short of calling the outbreak a global health emergency, but some health experts question whether China can contain the epidemic.

WHO Director-General Tedros Adhanom Ghebreyesus is due to travel to Beijing to meet officials and health experts.

Australia, France, Italy, Japan and the United States have all said they are working to evacuate citizens from Wuhan.

Some of China’s biggest companies have been affected, with hotpot restaurant chain Haidilao International Holding shutting branches nationwide from Sunday until Friday.

Gaming giant Tencent Holdings Ltd advised staff to work from home until February 7, and e-commerce firm Alibaba removed vendors’ offers of overpriced face masks from its online Taobao marketplace as prices surged.

Seoul, Jun 6: South Korea on Saturday reported 51 new cases of COVID-19, mostly in the densely populated capital region, as authorities scramble to stem transmissions among low-income workers who can't afford to stay home.

The figures announced by South Korea's Centers for Disease Control and Prevention brought national totals to 11,719 workers and 273 deaths.

At least 34 of the new coronavirus cases were linked to door-to-door sellers hired by Richway, a Seoul-based health product provider.

Vice Health Minister Kim Gang-lip said the spread of the virus among Richway sellers was particularly alarming as most of them are in their 60s and 70s. He called for officials to strengthen their efforts to find and examine workplaces vulnerable to infections.

More than 120 infections have also been linked to a massive warehouse operated by Coupang, a local e-commerce giant, which has been accused of failing to properly implement preventive measures and having employees work even when sick.

South Korea was reporting around 500 new cases per day in early March due to a massive outbreak surrounding the southern city of Daegu, before officials managed to stabilize the situation with aggressive tracking and testing.

But the recent resurgence of COVID-19 in the greater capital area, where about half of South Korea's 51 million people live, is now threatening to erase some of the country's hard-won gains. It has also led to second-guessing whether officials were too quick to ease social distancing and reopen schools.

Health authorities and hospital officials on Friday participated in a table-top exercise for sharing hospital capacities between Seoul and nearby cities and ensure swift transports of patients so that a spike of cases in one area doesn't overwhelm its hospital system.