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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.

May 20: The novel coronavirus is behaving differently in patients in northeast China who have contracted it recently compared with early cases, indicating it is changing as it spreads, a prominent doctor said.

China, which has largely brought the virus under control, has found new clusters of infections in the northeastern border provinces of Jilin and Heilongjiang in recent weeks, raising concern about a second wave.

Qiu Haibo, an expert in critical care medicine who is part of a National Health Commission expert group, said the incubation period of the virus in patients in the northeast was longer than that of patients in Wuhan, the central city, where the virus emerged late last year.

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"This causes a problem, as they don't have any symptoms. So when they gather with their families they don't care about this issue and we see family cluster infections," Qiu told state broadcaster CCTV in a programme broadcast late on Tuesday.

Patients in the northeastern clusters were also carrying the virus for longer than earlier cases in Wuhan, and they were taking longer to recover, as defined by a negative nucleic acid test, he said.

Patients in the northeast also rarely exhibited fever and tended to suffer damage to the lungs rather than across multiple organs, he said.

He said the virus found in the northeastern clusters was probably imported from abroad, which could account for the differences.

He did not say where he though they might have come from but both Jilin and Heilongjiang border Russia.

China reported five new coronavirus cases on Wednesday, down from six a day earlier.

Four of the new cases were local transmissions and one was imported by a traveller coming from abroad, the commission said in a statement, compared with three imported cases reported the previous day.

China's total number of coronavirus infections stands at 82,965, while the death toll 4,634. 

Islamabad, May 25: Pakistan’s coronavirus cases on Monday reached 56,349 with 1,748 new patients while the death toll climbed to 1,167, the health ministry said.

The Ministry of National Health Services reported that 22,491 cases were diagnosed in Sindh, 20,077 in Punjab, 7,905 in Khyber-Pakhtunkhwa, 3,407 in Balochistan, 1,641 in Islamabad, 619 in Gilgit-Baltistan and 209 in Pakistan-occupied Kashmir.

So far 1,167 people have died of the COVID-19 including 34 who lost their lives in the last 24 hours. A total of 17,482 patients have recovered from the deadly contagion.

The authorities have conducted 483,656 tests in the country, including 10,049 on Sunday. The trajectory showed that the number was steadily going up with authorities fearing a rise in cases in the wake of the easing of lockdown before Eid which was observed in the country on Sunday.